Lower-Income Countries Push To Reach More Than 85 Million Children With Measles Vaccine

Following the impact of the COVID-19 pandemic on critical routine health activities and secondary impacts on malnutrition leading to alarming rise in measles cases and outbreaks globally, Gavi, the Vaccine Alliance (Gavi) is working with governments, communities and other partners in a concerted effort to rollout measles vaccines to vulnerable children across Lower Income Countries.

From 2022 through the first half of 2023, Gavi plans to support 22 lower-income countries to undertake measles follow-up campaigns aiming to reach more than 85 million children. These countries represent applications approved to-date, with Alliance partners continuing to work with other priority and at-risk countries. In parallel, Gavi has stepped up support for outbreak response, dedicating an additional US$ 10 million and supporting nine countries with response activities so far this year.

“Measles vaccination not only prevents outbreaks and deaths, but it also serves as an entry point for routine immunisation. Given the high rates of coverage needed, these campaigns can help identify un- and under-immunized children, bringing them more consistently into the health system,” said Thabani Maphosa, Managing Director of Country Programs at Gavi. “This is critical for the sustainability of the measles response, reducing outbreaks in the long-term, and can also help save lives from other vaccine preventable diseases.”

Thanks to the widespread introduction of measles vaccine, global measles deaths have fallen dramatically – in 2000, more than a million children died from measles, by 2020 this number was at a little over 60,000 deaths. Even with that impressive decline, however, progress has stalled in recent years. The pandemic further impacted this: recent data from the 57 lower-income countries supported by Gavi shows that coverage of a first dose of measles vaccine (MCV1) fell by a total 4% during the pandemic. The pandemic also impacted countries’ abilities to undertake surveillance and report cases, making more outbreaks inevitable.

But now lower-income country governments, with support from Gavi and partners, are pushing back. Between January and October 2022, follow-up campaigns were launched in Burundi, Guinea, Madagascar, Syria (Damascus) and recently Gambia. In Zimbabwe, a planned campaign was fast-tracked in response to an outbreak in September. In total, urgent efforts across multiple countries will aim to reach millions of children through the first half of 2023.

Alongside introductions, catch-up and follow-up campaigns, Gavi is supporting governments with dedicated outbreak response activities, helping 9 countries combat outbreaks so far this year. Working through the Measles and Rubella Initiative’s (M&RI) Outbreak Response Fund (ORF), Gavi is the main funder of measles outbreak response activities in lower-income countries – providing a total of US$ 85 million to cover the more than 60 country applications for outbreak response support the ORF has received since 2013. M&RI is a partnership of American Red Cross, U.S. Centers for Disease Control and Prevention, UNICEF (United Nations International Children’s Emergency Fund), United Nations Foundation, and World Health Organization.

In its current strategic period (2021-2025), with a mission to ‘leave no one behind with immunization’, Gavi is also deepening its investments in health and immunization systems strengthening. In particular, the Alliance is focused on providing targeted support to reach “zero-dose children” and missed communities through routine programs, dedicating US$ 500 million through a special Equity Accelerator Fund (EAF) to be accessed by Gavi eligible countries to ‘identify’ reach the zero dose children through innovative approaches and partnerships to overcome systemic challenges.

Up to US$100 million of this has been set aside for the Zero-Dose Immunization Program (ZIP), a collaboration between Gavi and non-government organizations with humanitarian expertise, with the aim to reach zero-dose children amongst refugees and displaced populations across fragile and conflict-affected countries in the Sahel and Horn of Africa.

A unique challenge and opportunity

One of the top vaccine-preventable killers of children, measles is both highly contagious and requires close to 95% vaccine coverage through routine vaccination and highly effective supplemental campaigns to stop from spreading. This presents a significant challenge to countries, particularly for low-income countries, where the vast majority of measles deaths occur. These more vulnerable health systems need to consistently and effectively reach large parts of their population, including “zero-dose children” who are systemically left behind. With the rising birth cohort in Africa, countries need to reach more children every year just to maintain coverage. Following the pandemic, countries are also dealing with several other competing health priorities, making planning and implementing effective campaigns extremely challenging.

At the same time, measles vaccination represents an important opportunity to improve the overall strength of a health system. If a zero-dose child can be identified through a measles campaign, this is a critical entry point for both routine immunization and other essential services. This can help save more lives and build trust while also increasing countries’ abilities to detect and respond to outbreaks.

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