As the world eagerly waits for positive news about a vaccine to prevent Covid-19 infections, other vaccine-preventable illnesses are raging. Last year, there were close to 900,000 cases worldwide of measles. Over 200,000 of these patients died. The 2019 global measles outbreak led to a rise in measles-related deaths by over 50%, and over 30,000 cases of measles were reported in the United States alone.
Preventable measles outbreaks are not new to the U.S. In 2015, a measles outbreak stemming from cases at Disneyland spread to several states and Mexico within a few weeks. This came as no surprise at the time, as vaccination rates in parts of California and other states had plummeted to single digit percents, mainly due to parental concerns regarding risks of vaccines being associated with the rise autism spectrum disorders, as well as increasing mistrust of both the pharmaceutical industry as well as physicians.
In pre-vaccination days, measles was considered to be a rite of passage in childhood. Millions of children would develop the infection, leaving many with permanent deficits such as hearing loss, brain damage, or lung disease. Thousands of children would die each year. The advent of the measles vaccine in 1963, now given in combination with the mumps and rubella and occasionally varicella immunization (MMR or MMRV, measles, mumps, rubella, varicella), first at age 12-15 months and a booster at age 4-5 years, provides over 97% percent protection from the measles virus. Lauding 90% efficacy from Pfizer’s coronavirus vaccine is great, but measles vaccine efficacy has always been better, especially when compared to many vaccines such as the influenza vaccine, clocking in at 40-60% efficacy each year.
Measles is preventable. Once more for the people in the back: the measles vaccine is over 97% effective in prevention of measles infections. The vaccine is so effective, that in 2000, measles was declared eliminated in the United States, due to nearly four decades of widespread vaccination efforts. In the decades following the new millenium, the anti-vaccination movement changed that. In order for the measles vaccine’s efficacy to get to that coveted 97%, two things need to happen: 1) Two doses must be given to each person; 2) At least 95% of the population needs to receive those two doses. Herd immunity for vaccines such as measles works, given the combination of high efficacy and high percents of the population being immunized. The current issue and controversy over herd immunity when it comes to Covid-19 not being feasible at this time is because herd immunity from SARS-Cov2 as a result of infections would mean that literally billions would need to be infected, with resultant increased deaths on the order of hundreds of millions.
Perhaps some positive news in the early months of 2020 was that we saw a decline in measles cases. But as soon as the Covid-19 pandemic surged worldwide, close to 100 million children were precipitously put at risk for missing their measles vaccinations, as vaccination campaigns around the world were halted. In early November 2020, the CDC, the WHO, UNICEF, the American Red Cross, and the United Nations Foundation partnered to ensure improved provision of worldwide measles vaccinations to those who need vaccine provision and delivery, especially in countries where outbreaks are continuing.
The sharp drop in childhood immunization rates has not been limited to developing countries with poor access to medical care. In the U.S., by early summer 2020, childhood immunization schedules were set back by several months, as families chose to delay routine pediatric care. Despite pediatricians and the American Academy of Pediatrics strongly recommending that infants and children stay on schedule for vaccinations, including MMR or MMRV, many states reported anywhere from 50-60% reduction in childhood immunization rates comparing April 2019 to April 2020.
Elizabeth Cousens, president and CEO of the United Nations Foundation, spoke with Infectious Disease Special Edition this week: “The fact that measles outbreaks are occurring at the highest levels we’ve seen in a generation is unthinkable when we have a safe, cost-effective and proven vaccine. No child should die from a vaccine-preventable disease. We are proud to chart a bold way forward with partners to close gaps in access to immunization and rapidly respond to outbreaks so everyone, everywhere can live healthy lives.”
In these dismal days of the coronavirus pandemic raging on, with the fainest ray of light barely visible, whereby a vaccine may exist at the end of this long trecherous tunnel, public health efforts to prevent diseases that are, indeed, preventable need to remain at the forefront of healthcare advocacy.