After 20 years of significant decline the incidence of measles in Africa is on the rise again. The effectiveness of preventive measures is in doubt, despite vaccination having reduced the number of lives claimed worldwide by this respiratory disease from 2.5 million in 1980 to 164,000 in 2008.
According to Florence Fermon of Médecins Sans Frontières (MSF), the World Health Organisation's target of eradicating the disease by 2015 has been regarded as a "misplaced slogan" for the past two years. Interim data suggests that more than 64,000 cases and 1,188 deaths were registered between the end of 2009 and the beginning of 2010 in some 30 African countries.
What surprises MSF is the epidemics are not only occurring in war zones but also in stable countries such as Malawi, Burkina Faso and South Africa.
The assumption is that the fragile improvement achieved through 20 years' vaccination has pushed measles down health minister's and funding agencies' lists of priorities.
Rich countries see this extremely contagious infantile disease as being relatively harmless, but it can prove fatal for 5 to 20% of patients in areas with limited access to medical care. There is no treatment, but vaccination offers effective and low-cost protection.
The head of operations at MSF, Thierry Durand, advocates better coordination between agencies and ministries. He said the expanded WHO vaccination programme initiated in 1974 is over-standardised and inflexible. Routine measles vaccinations are only carried out between nine and 11 months. As a result "many children [aged] over one are not vaccinated and the vaccine can only be administered if they are at great risk," he said.
Durand added that technical discussions in the field on "strategy, age groups and [vaccination] zones" can seriously delay work. In Zimbabwe MSF had to wait for eight months for the health ministry to authorisation. There is also an increasing shortage of funding to combat epidemics with donors reluctant topay a second time, after backing prevention campaigns that proved inadequate. As a direct result immunisation coverage in certain countries is dropping.
