1. Global Overview of Measles
10th Annual Measles Initiative Meeting
American Red Cross National Headquarters
Washington DC
September 13-14, 2011
Peter Strebel (WHO/EPI) and
Edward Hoekstra (UNICEF/Program Division)

2. Tenth Anniversary of the Measles Initiative
Joint Declaration, 31 January 2001
Work together in partnership to further reduce measles mortality according to each partner organization's strengths
To advocate for human and financial resources
Support strategies outlined in the WHO/UNICEF Strategic Plan, including use of rubella vaccine
Support the GAVI goal of saving lives

3. Overview Progress Challenges Opportunities
Measles global annual reported cases
and MCV coverage, 1980 to 2010
Progress
Challenges
Opportunities
Campaigns

4. Burden of measles in 2000 40 million cases Complications:
8% pneumonia
1:1,000 encephalitis
1:10,000 blindness
500,000 deaths

5. Global Goals Millennium development goal #4: By 2005 By 2010 By 2015
Reduce child deaths among children by 2/3 by 2015 (vs. 1990)
Measles immunization coverage indicator of access to care
By 2005
50% reduction in measles deaths (achieved on time)
By 2010
90% reduction in measles deaths (achieved in 5/6 WHO Regions)
By 2015
Vaccination coverage: 90% national level and 80% in every district
Reported incidence: <5 cases of measles per million
Mortality reduction: % (vs 2000)

6. Measles and Rubella Elimination Goals by WHO Region, August 2011
World Health Organization
Measles and Rubella Elimination Goals by WHO Region, August 2011
27 May, 2018
Americas, Europe, E. Mediterranean, W. Pacific, Africa have measles elimination goals
Americas and Europe have rubella elimination goals
2015
2012
2020
SEARO RC in Sept 2009 endorsed a resolution to mobilize support towards eliminate measles, 2010 RC meeting adopted the global 2015 measles targets (95% mortality reduction).
Note: EURO changed target to 2015, EMRO is in process of changing target to 2015
SEAR: 95% Measles Mortality Reduction by 2015 6

7. Feasibility of Measles Eradication
July 2010 – Global Consultation
Measles can and should be eradicated
In the context of strengthening immunization and primary health care systems
Opportunity to accelerate rubella control and the prevention of congenital rubella syndrome
Target date of 2020 feasible if measurable progress

8. SAGE, November 2010 Measles can and should be eradicated
Measurable progress towards 2015 global targets and existing regional elimination goals is required before establishing a target date
Requested frequent updates on progress
Executive Board (Jan 2011) endorsed SAGE approach

9. Progress towards 2015 global targets

10. Since 2001, 1st dose coverage up by 12%
2015 Target
Source: WHO/UNICEF coverage estimates, 2011 revision. Date of slide: 29 July 2011

11. Scaling-up 2nd Dose Strategies
Number of doses of measles vaccine administered, by delivery strategy,
Measles Initiative
1 billion vaccinated
as of July 2011
1st routine dose: WHO/UNICEF coverage estimates, The World Population Prospects New York, nd routine dose: WHO/UNICEF Joint reporting form, (not all countries report 2nd dose). SIA dose;: WHO SIA database, July 2011 (Provisional data)

12. Reported measles cases down by two-thirds
Reported number of measles cases by WHO Region,
Source: Cases from annual Joint Reporting Form
193 WHO Member States, Data as of August 2011

13. Estimated Global Measles Deaths have decreased by three-quarters, 2000-2010
76%
2015 Target
PROVISIONAL ESTIMATES
Source: 2010 WHO/IVB measles model, Sept 2011
Shading indicates uncertainty bounds

14. Reduction in Estimated Measles Deaths by WHO Region 2000 to 2010
26%
87%
85%
79%
78%
76%
85%
Notes: SEAR* excludes India. Majority of remaining estimated mortality in WPR is in Philippines, Laos, and Cambodia, which have implemented or will implement measles SIAs by the end of 2011
95% 2015 reduction goal
* SEAR excluding India
Source: 2010 measles burden model,
WHO/IVB, September 2011

15. Major causes of mortality among children <5 years, 1990 vs 2008
Measles accounts for ~23% of overall decrease in child mortality
1990: 12.1 mil
2008: 8.8 mil
Van den Ent et al (2011) J. Infect Diseases 2011;204:S18-S23 15 15

16. Measles Deaths Averted, 2000-2010
5.0 million deaths averted (32%)
10.8 million deaths averted (68%)
*Provisional estimates
Based on method of Wolfson et al, Lancet 2007

17. Challenges

18. #1: India 134 million children need vaccination High quality
Coverage >90%
Immunization safety including needle disposal

19. #2: Resurgence in Africa
4-fold increase since 2008
Large outbreaks in Burkina Faso (2009), S. Africa (2010), and DRC (2011)
Outbreaks in drought affected Horn of Africa
High case-fatality
Weekly Epidemiological Record
(2011) 86:

20. #3: Weak Immunization Systems
Measles 1st dose coverage among infants, 2010
1st dose:
67 Countries have MCV1 coverage <90%
2nd dose (routine):
54 countries do not have routine 2nd dose
Campaigns:
Variable quality
Delayed
80-89% (24 countries or 12 %)
50-79% (41 countries or 21%)
>=90% (126 countries or 66%)
<50% (2 countries or 1%)

21. #4: Financing is late and unpredictable
Lack of multi-year funding
Countries not committing 50% of the operational costs of SIAs
Outbreak response not budgeted for
Measles Initiative Annual Donations, *
*Excluding country contributions

22. The Next Decade

23. Surveillance Network of 673 laboratories Outbreak and virus tracking
Diagnosis in the field

24. Innovation New vaccine delivery methods Needle-free injection
Aerosol vaccination
Skin patch vaccination?

25. Synergies Measles Polio eradication Rubella/CRS prevention
Routine immunization
New vaccines
JE, Men A

26. Summary Achievements Challenges Enhance program performance
1st dose coverage up to 85%
1 billion doses delivered in campaigns
2/3 reduction in cases
3/4 reduction in deaths
Challenges
Cases and deaths unchanged in past 3 years
Enhance program performance
Surveillance, innovation, synergies

27. Remarks by William H. Gates Sr. Lions Club, July 7, 2011
One of the challenges of the fight against measles, and of immunization in general, is that you’ve got to keep at it. You’ve got to be relentless, tireless. Because children who need to be protected … are born every day. You don’t vaccinate once. You do it year, after year, after year.

28. Anne Ray Charitable Trust