Measles elimination – Malaria lessons

Measles still kills nearly 800,000 children annually, but some regions of the World, according to de Quadros (2004) have made major strides in eliminating the disease. What does this process teach us about eliminating and eventually eradicating both diseases? de Quadros explains that –

The 24th Pan American Sanitary Conference in 1994 established a goal of eradicating measles from the Americas. Progress to date has been remarkable and the disease is no longer endemic in the Americas, with most countries having documented interruption of transmission. As of November 2003, 12 months had elapsed since the last indigenous case was detected in Venezuela. This experience shows that measles transmission can be interrupted, and that this can be sustained over a long period of time.

measles-immu-cote-divoire-who2.jpgShort campaigns can interrupt transmission temporarily, but what is needed to sustain the interruption of transmission long enough to result in elimination – the total and continual lack of cases in a country/region – and ultimately in eradication – the total elimination of cases/transmission world-wide? The strategy in the Americas has included –

  • a one-time catch-up campaign, implemented during the low season for measles virus, targeting all children aged 1–14 years, to attempt to interrupt all chains of measles transmission.
  • maintain continued routine high vaccination coverage of the susceptible population at all times to keep up with new birth cohorts
  • a follow-up campaign should to be undertaken every five years among all children aged 1–4 years regardless of previous vaccination status
  • effective surveillance to detect measles transmission and respond accordingly

WHO points out that “The first country to adopt this strategy in the Americas was Cuba, which successfully interrupted measles transmission in the late 1980s.”  We are beginning to see malaria progress in other island situations such as Zanzibar and Bioku.

Unlike measles, malaria control has several tools at its disposal, but unlike measles, malaria has a vector, and hence the need for additional tools and their coordinated use.  No one is claiming that the immunization tool for measles is perfectly effective, but the consistent application of the strategy offered above has worked.

Likewise no one is claiming that any of the current malaria interventions is perfect, and no one expects the first vaccines to be 100% effective. What is the important lesson from the experiences in the Americas is the willingness to maintain both campaign and routine intervention over a period of time long enough to interrupt transmission and sustain that interruption. Do we have the same political and financial will to eliminate malaria?

de Quadros concludes that, “A world free of measles by 2015 is not a dream.” What date is in our dreams for eliminating malaria?

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