Tracey Koehlmoos: Measles eradication – lofty goal or major distraction?

Tracey KoehlmoosImmunization really is the bread and butter work of global public health, so that many of us engaged in global health trace our roots to vaccination campaigns for polio or, for the most venerable, smallpox. My first job was as an international monitor and observer on the measles campaigns in Nepal. I still have projects around Bangladesh looking at better ways to improve immunization uptake and delivery in hard-to-reach areas.

Thus, when asked by a team at the London School of Hygiene and Tropical Medicine in the spring of 2009 if I wanted to participate in a set of studies undertaken to provide input into decisions around measles eradication, I did so without hesitation. Our work was to be the health systems part of a three part look at measles eradication sponsored by the World Health Organization (WHO). The two other studies were on the economics of eradication.

Before our first meeting with representatives from the expanded immunization program, Ministry of Health and Family Welfare, and officials from WHO and non-governmental organizations in Bangladesh on this topic, I wondered if they would pan the idea of moving toward eradication, in light of the failure to eradicate polio globally and the big push to meet the millennium development goals. Would there be an appetite to look at another major undertaking. Should measles be next on the list for global eradication?

What we know is that seroprevalence studies suggest that vaccination coverage of 90-95% is needed to eliminate measles from a setting. In Bangladesh, routine measles vaccination coverage rates have only recently reached 80-85%.

At our first meeting and throughout the course of the research, we found an overwhelmingly enthusiastic response to measles campaigns, measles eradication, and the positive role that the vaccination program is viewed as having on health outcomes and on health systems strengthening.

Our results were combined with findings from similar country level work conducted in Brazil, Ethiopia, and Vietnam among others. I know that the results were not universally as favorable as the results from Bangladesh. The results of this work were presented at the 1st Global Symposium for Health Systems Strengthening in November 2011 but will also be featured in a soon-to-be released supplement of the Journal of Infectious Diseases.

In January 2011, the WHO’s strategic advisory group of experts recommended that measles can and should be eradicated. However, rather than moving immediately toward setting a date for global eradication, the group recommends that nations and regions should move toward their own elimination goals through the strengthening of routine immunization systems.
With my roots in vaccine work, I am left with the sense of having been on the ground at the start of something massive. However, with the need to introduce new vaccines, such as Haemophilus influenzae type B (Hib) and rotavirus, and to determine the best ways to reach children in remote corners of the nation, living on islands or hidden among the urban homeless, the demands of today call me back from the prospect of a measles-free world.

Tracey Koehlmoos is programme head for health and family planning systems at ICDDR,B and adjunct professor at the James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.

  • Richard Smith

    Your blog reminds me of an article that Fiona Godlee, now editor of the BMJ, wrote in 1995 suggesting that WHO's obsession with eradication–“eradicationitis”–could be counterproductive. I think that she might have been right.

  • Tracey

    Thank you for sharing Dr. Godlee's article, Richard. I think that the sort of visionary, aspiration goals of eradication are very much in line with the ideals of the World Health Organization. Eradicating measles does seem to be within our grasp in ways that other endeavors (like even polio) may not be.
    Of course, operationalizing that vision is the challenge–the resources: financial, human, temporal, geographic needed are tremendous. Also, I know that in Bangladesh we have perhaps the greatest enthusiasm for vaccine related programmes and measles elimination is a distinct and forthcoming possibility.
    I will read about Eradicationitis and think about how it might apply and what others might not be doing if they are hunting down the last pocket of something. Thank you again!