Global Overview of Measles 10th Annual Measles Initiative Meeting American Red Cross National Headquarters Washington DC September 13-14, 2011 Peter Strebel (WHO/EPI) and Edward Hoekstra (UNICEF/Program Division)

Tenth Anniversary of the Measles Initiative Joint Declaration, 31 January 2001 Work together in partnership to further reduce measles mortality according to each partner organization's strengths To advocate for human and financial resources Support strategies outlined in the WHO/UNICEF Strategic Plan, including use of rubella vaccine Support the GAVI goal of saving lives

Overview Progress Challenges Opportunities Measles global annual reported cases and MCV coverage, 1980 to 2010 Progress Challenges Opportunities Campaigns

Burden of measles in 2000 40 million cases Complications: 8% pneumonia 1:1,000 encephalitis 1:10,000 blindness 500,000 deaths

Global Goals Millennium development goal #4: By 2005 By 2010 By 2015 Reduce child deaths among children by 2/3 by 2015 (vs. 1990) Measles immunization coverage indicator of access to care By 2005 50% reduction in measles deaths (achieved on time) By 2010 90% reduction in measles deaths (achieved in 5/6 WHO Regions) By 2015 Vaccination coverage: 90% national level and 80% in every district Reported incidence: <5 cases of measles per million Mortality reduction: 95% (vs 2000)

Measles and Rubella Elimination Goals by WHO Region, August 2011 World Health Organization Measles and Rubella Elimination Goals by WHO Region, August 2011 27 May, 2018 Americas, Europe, E. Mediterranean, W. Pacific, Africa have measles elimination goals Americas and Europe have rubella elimination goals 2015 2015 2000 2010 2015 2012 2020 SEARO RC in Sept 2009 endorsed a resolution to mobilize support towards eliminate measles, 2010 RC meeting adopted the global 2015 measles targets (95% mortality reduction). Note: EURO changed target to 2015, EMRO is in process of changing target to 2015 SEAR: 95% Measles Mortality Reduction by 2015 6

Feasibility of Measles Eradication July 2010 – Global Consultation Measles can and should be eradicated In the context of strengthening immunization and primary health care systems Opportunity to accelerate rubella control and the prevention of congenital rubella syndrome Target date of 2020 feasible if measurable progress

SAGE, November 2010 Measles can and should be eradicated Measurable progress towards 2015 global targets and existing regional elimination goals is required before establishing a target date Requested frequent updates on progress Executive Board (Jan 2011) endorsed SAGE approach

Progress towards 2015 global targets

Since 2001, 1st dose coverage up by 12% 2015 Target Source: WHO/UNICEF coverage estimates, 2011 revision. Date of slide: 29 July 2011

Scaling-up 2nd Dose Strategies Number of doses of measles vaccine administered, by delivery strategy, 2000-2010 Measles Initiative 1 billion vaccinated as of July 2011 1st routine dose: WHO/UNICEF coverage estimates, The World Population Prospects New York, 2011. 2nd routine dose: WHO/UNICEF Joint reporting form, (not all countries report 2nd dose). SIA dose;: WHO SIA database, July 2011 (Provisional data)

Reported measles cases down by two-thirds Reported number of measles cases by WHO Region, 2000-2010 Source: Cases from annual Joint Reporting Form 193 WHO Member States, Data as of August 2011

Estimated Global Measles Deaths have decreased by three-quarters, 2000-2010 76% 2015 Target PROVISIONAL ESTIMATES Source: 2010 WHO/IVB measles model, Sept 2011 Shading indicates uncertainty bounds

Reduction in Estimated Measles Deaths by WHO Region 2000 to 2010 26% 87% 85% 79% 78% 76% 85% Notes: SEAR* excludes India. Majority of remaining estimated mortality in WPR is in Philippines, Laos, and Cambodia, which have implemented or will implement measles SIAs by the end of 2011 95% 2015 reduction goal * SEAR excluding India Source: 2010 measles burden model, WHO/IVB, September 2011

Major causes of mortality among children <5 years, 1990 vs 2008 Measles accounts for ~23% of overall decrease in child mortality 1990: 12.1 mil 2008: 8.8 mil Van den Ent et al (2011) J. Infect Diseases 2011;204:S18-S23 15 15

Measles Deaths Averted, 2000-2010 5.0 million deaths averted (32%) 10.8 million deaths averted (68%) *Provisional estimates Based on method of Wolfson et al, Lancet 2007

Challenges

#1: India 134 million children need vaccination High quality Coverage >90% Immunization safety including needle disposal

#2: Resurgence in Africa 4-fold increase since 2008 Large outbreaks in Burkina Faso (2009), S. Africa (2010), and DRC (2011) Outbreaks in drought affected Horn of Africa High case-fatality Weekly Epidemiological Record (2011) 86:129-136

#3: Weak Immunization Systems Measles 1st dose coverage among infants, 2010 1st dose: 67 Countries have MCV1 coverage <90% 2nd dose (routine): 54 countries do not have routine 2nd dose Campaigns: Variable quality Delayed 80-89% (24 countries or 12 %) 50-79% (41 countries or 21%) >=90% (126 countries or 66%) <50% (2 countries or 1%)

#4: Financing is late and unpredictable Lack of multi-year funding Countries not committing 50% of the operational costs of SIAs Outbreak response not budgeted for Measles Initiative Annual Donations, 2001-2011* *Excluding country contributions

The Next Decade

Surveillance Network of 673 laboratories Outbreak and virus tracking Diagnosis in the field

Innovation New vaccine delivery methods Needle-free injection Aerosol vaccination Skin patch vaccination?

Synergies Measles Polio eradication Rubella/CRS prevention Routine immunization New vaccines JE, Men A

Summary Achievements Challenges Enhance program performance 1st dose coverage up to 85% 1 billion doses delivered in campaigns 2/3 reduction in cases 3/4 reduction in deaths Challenges Cases and deaths unchanged in past 3 years Enhance program performance Surveillance, innovation, synergies

Remarks by William H. Gates Sr. Lions Club, July 7, 2011 One of the challenges of the fight against measles, and of immunization in general, is that you’ve got to keep at it. You’ve got to be relentless, tireless. Because children who need to be protected … are born every day. You don’t vaccinate once. You do it year, after year, after year.

Anne Ray Charitable Trust