INSIGHT-COVID has disrupted measles vaccinations in Africa and now cases are rising

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The COVID pandemic has disrupted measles vaccination campaigns

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As a result, cases in children are now increasing, particularly in Africa

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A lack of funding is delaying catch-up vaccinations across the continent

By Edward McAllister and Jennifer Rigby

BUNDUNG, Gambia/LONDON, Oct 24 (Reuters) – Carrying an umbrella, medical records and her two-year-old daughter, Kani Fall cleared brown puddles that lapped at the hospital gate, the final hurdle in a two-hour downpour. soaked journey to their next vaccination clinic in West Gambia.

Autumn waited with dozens of mothers and babies in the flooded courtyard of Bundung Hospital. Then a doctor showed up with bad news. The hospital had run out of measles vaccines and it wasn’t clear when they would get new ones.

“They told me there was no vaccine. But I’ll be back,” said Fall, 27, who closed her catering business for the day to make the trip. “It’s for my daughter, it’s for her health,” she added, fighting back tears of frustration.

The COVID-19 pandemic disrupted measles vaccination campaigns worldwide in 2020 and 2021, leaving millions of children vulnerable to one of the world’s most infectious diseases, whose complications include blindness, pneumonia and death.

After what health experts are calling the biggest relapse in a generation, there have been 26 large or disruptive measles outbreaks worldwide, according to the World Health Organization. A devastating outbreak in Zimbabwe this year has killed more than 700 children, mostly among religious sects who don’t believe in vaccination.

Now, African health systems are particularly vulnerable due to a lack of funds and manpower, especially in countries where conflict and malnutrition make children more vulnerable to deadly infections, according to Reuters interviews with more than a dozen disease experts, doctors and global health officials.

“We have never seen so many unimmunized children as now,” said Dr. Deblina Datta, director of global measles elimination efforts at the US Centers for Disease Control and Prevention.

“I’ve stood at the bedside of children who have died from measles and it’s shocking to see it. And that is a preventable event.”

More than 45,000 cases were reported in Africa this year, killing more than 2,300 people. That’s double the number of cases from this time last year, when some ongoing social distancing measures may have slowed infections.

The WHO and UNICEF launched an awareness and fundraiser campaign in 2020 to fill vaccine gaps caused by the pandemic, particularly in middle-income countries, but have raised almost no money, the agencies told Reuters.

Estimated global measles deficit: at least $255 million. COVID, war in Ukraine, food shortages and inflation have squeezed donations from wealthier nations, the agencies said.

“Our current resources will not suffice as countries step up their requests for the funding needed to respond to increasing numbers of measles outbreaks,” said WHO spokesperson Margaret Harris.

In a recent document shared with governments and health organizations and reviewed by Reuters, WHO outlined 15 vaccination campaigns to begin in Africa in 2022 and 2023. However, an October update revealed that only three of those campaigns had specific launch dates. The rest were marked with either 2022 or 2023, then “??” in the monthly and daily sections, by the WHO team.

Health officials at Bundung Hospital in The Gambia said the measles vaccine shortage was temporary, the result of a surge in demand for routine vaccinations after a health workers’ strike ended in July.

But it shows how precariously underfunded health systems can be in countries already overwhelmed by COVID. Dozens of measles cases have emerged in The Gambia this year, an increase from previous years. The country last had a national “catch-up” campaign in 2015 to reach families in more remote areas who are unlikely to take their children for routine vaccinations.

Another was due for 2020, but this year resources were allocated for COVID, said Shahid Mahbub Awan, child survival and development manager at UNICEF The Gambia. Routine immunization coverage for pediatric vaccines across the board fell from 93% in 2018 to 66% in 2020, Awan said.

“It was like a point. One day everything happened and the next day it didn’t,” he said.

The measles campaign was pushed back to 2021, but in July of that year polio was found in a water sample. Without the resources for parallel campaigns, public health officials prioritized polio. A national measles catch-up campaign was scheduled for October.

OLD MURDERER

Measles typically causes a high fever, cough, and a telltale rash. In pregnant women, it increases the risk of miscarriage and premature birth. The virus killed around 2 million children each year before a vaccine was introduced in the 1960s.

In poor countries, where children often have weakened immune systems due to malnutrition or other untreated infections, it can kill up to 10% of those infected and is extremely transmissible. A single measles patient can transmit the disease to 12 to 18 other people.

Over the years, the measles vaccine’s success has blunted many of those risks, health experts say. A growing number of communities in countries that have long since eradicated measles, including the United States and Europe, are now choosing not to vaccinate their children. Measles cases had been declining worldwide by 2016, when increasing vaccine hesitancy due to misinformation and a growing loss of trust in government health officials began to reverse.

In 2019, global cases rose to a 23-year high, killing 200,000 people, including in countries where the disease had previously been eradicated. The Democratic Republic of the Congo was one of the hardest-hit countries, with more than 6,000 deaths.

At that time, according to WHO estimates, 86% of children worldwide had received at least the first dose of measles vaccine. By 2021, when 25 million children worldwide missed their first dose, only 81% had been reached, the lowest figure since 2008. In Africa it is only 68%.

MEDIUM REJECTED

The US CDC has identified 12 African countries that do not have clear plans or secured resources for their next measles vaccination campaign. Chad, Mali and Liberia are particularly at risk, where vaccination rates are between 55 and 70 percent.

Some of the world’s poorest countries have had to turn to international partners for help, most notably Gavi, the Vaccine Alliance. Gavi sent back requests for funding from eight countries between September 2021 and March 2022, seeking details he felt were needed to ensure the campaigns were effective, his vaccine director, Jalaa ‘Abdelwahab, told Reuters.

In particular, Gavi is looking for details on how countries will reach so-called “zero dose children” – those who have never received a vaccine – along with full budgets and follow-up details, he added.

In Cameroon, delays in funding have delayed a measles preventive campaign by eight months, despite the launch of several targeted vaccination campaigns in response to outbreaks, Gavi said. Cameroon’s Health Ministry did not respond to requests for comment.

In Liberia, where the number of cases has risen 10-fold from a year earlier, health officials have been seeking funding for a measles and rubella campaign. Gavi returned the application because of gaps in the epidemiological data, said the West African country’s vaccination chief, Adolphus Clarke. Liberia will not have the information ready until next year, he said.

“I NEVER KNEW ABOUT MEASLES”

Gavi said they understand the urgency and are trying to expedite applications for campaigns that can take over a year to plan and approve.

This has already happened in Afghanistan, where cases are skyrocketing, Abdelwahab said. A follow-up campaign in Zimbabwe has also been accelerated, and a number of campaigns in other African countries have been approved in recent months, Gavi said. Campaigns in 23 countries are to be supported by mid-2023.

Vaccination campaigns also play a key role in educating communities about the dangers of diseases like measles. Health workers are coming to schools, mosques and markets reminding people of the importance of vaccination.

That would have helped Adama Komma, a 27-year-old mother of five who lives with six other families on a property in the crowded town of Bundung, about 10 miles west of Gambia’s capital Banjul.

Two of their children – Aisha, 7, and Hassan, 5 – fell ill in January.

“Her eyes were red… she was scratching her body,” she said, sitting on the porch of her home while Aisha and Hassan clung to her side.

The symptoms got worse. They got sores on their mouths that were so painful they could not eat. She took them to a clinic, where they were admitted and given medication.

They gradually recovered, but Comma hates thinking about what could have been.

“I never knew about measles, it was the first time I saw it,” she said. Her voice faltered and her eyes filled with tears. “I hadn’t heard of measles vaccinations.” (Reporting by Edward McAllister and Jennifer Rigby; Editing by Michele Gershberg and Nick Macfie)

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