Edward J. Hoekstra, MD, MSc Edward J. Hoekstra, MD, MSc Senior Health Advisor Senior Health Advisor UNICEF HQ, New York UNICEF HQ, New York Peter Strebel, MBChB, MPH Peter Strebel, MBChB, MPH WHO HQ, Geneva WHO HQ, Geneva Jeff Mcfarland, MD Jeff Mcfarland, MD UNICEF HQ, New York UNICEF HQ, New York Global Overview of Measles Global Overview of Measles Partners for Measles Advocacy 7th Annual Meeting Washington D.C., 27 – 28 February 2007

2005 Mortality Reduction Goal Achieved !!

Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 1999 No second opportunity 2005 ( 47 ) 94 % of all measles deaths 94 % of all measles deaths

Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 2005 Nation - wide second opportunity 2005 ( 34 ) Partial implementation of second opportunity 2005 ( 11 ) No second opportunity 2005 ( 2 )

1 st Dose Measles Coverage in 47 Measles Priority Countries Source: WHO / UNICEF coverage estimates, as of August 2006 Percent 54 % 65 % 77 % 71 % Global Coverage 1 st dose

Estimated Global Measles Deaths % reduction 2005 Goal Source: Lancet 2007, L Wolfson, P Strebel, M Gacic-Dobo, E Hoekstra, J McFarland, B Hersh High-low lines indicate uncertainty bounds

Percent reduction in estimated measles deaths by WHO region between 1999 and % 81 % 75 % 62 %

2005 Mortality Reduction Goal Achieved !!  > 360 million vaccinated in SIAs  2.3 million additional deaths prevented  Phone - in press conference  > 220 media reports

How was this possible ? Caring … Parents Commitment … Countries and Governments Cash …. Partnership Measles control benefited from other investments –Strengthening routine immunization systems ( GAVI ) –Polio eradication infrastructure and field staff Photo: Aung

Progress in 2006

Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 2005 Nation - wide second opportunity 2005 ( 34 ) Partial implementation of second opportunity 2005 ( 11 ) No second opportunity 2005 ( 2 )

Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 2006 Nation - wide second opportunity 2006 ( 42 ) Partial implementation of second opportunity 2006 ( 3 ) No second opportunity 2006 ( 2 )

Measles Vaccines Shipped by UNICEF Doses Millions

A - D Syringes Shipped by UNICEF Safe Injection Practices Number A-D Syringes in millions 0.5 ml Auto Disable Syringes

$ Millions Expenditures Measles Mortality Reduction UNICEF HQ and WHO HQ,

m & m integration

Measles & Malaria Foto: Mark Grabowsky

LLINs delivered during integrated campaigns, Rapid ITN scale - up In 2006, most LLINs are being delivered during integrated measles campaigns Pre Source: Global Fund

Measles Control Goals by WHO Region Africa and SE Asia have mortality reduction goals Americas, Europe, E. Mediterranean, W. Pacific have elimination goals GIVS Goal: 90% reduction in deaths by 2010 (vs. 2000)

Strategies Mortality Mortality Reduction Reduction Elimination Elimination 1 st dose coverage> 90%> 95% 2 nd OpportunityAll children SurveillanceAggregate or case - based Case - based Case ManagementVitamin A Supportive Rx

Reported Measles Incidence by WHO region, Source: Joint Reporting Form, WHO/IVB database, August 2006 Elimination

Americas: Measles Eliminated since 2002 Importations cause limited outbreaks No persistent genotype D6 transmission ends D9 transmission ends Genotype D4 D5 D6 D8 D9 B3 H1 Unknown / other 2004 Sources: PAHO, Country reports, Global Measles Laboratory

What will it take to achieve the goal ? 90% Source: WHO/IVR projections, February 2007

What will it take to achieve the goal ? Source: WHO/IVR projections, February %

What will it take to achieve the goal ? Source: WHO/IVR projections, February %

What will it take to achieve the goal ? Source: WHO/IVR projections, February %

Planned measles campaigns January – December 2007 WHO/IVB SIA database, as of 31 January 2007 Measles activities only MR MMR Other interventions: Vitamin A – 19 De-worming – 10 Bed nets – 9 OPV - 4

Challenges Complete catch-up Sustain the gains Stronger routine Quality follow – up Low incidence  declining support Government financing of follow - up SIAs Integrate with other child health programmes … going down hill is also going forward..

Source: Orenstein WA. Pediatr Infect Dis J 2006; 25: Funding

Measles Good spots, bad spots “ … But the fight against disease is like any battle. It is unwise to let your guard drop when you are on top … " … The Economist, 20 Jan 2007

Funding for Measles Mortality Reduction ( in million USD ) Estimated Total Funds needed = 479 million USD ( Measles Investment Case II ) Excludes country contributions

Summary Most ambitious measles goals ever –Less than 4 years to go Comprehensive strategy required downupInverse relationship: funding down, measles up –Some 2.3 m lives are saved; But don't fail now

… We are going to ASIA … Myanmar January 2007 … Next step

So … Where in the world is Peter Strebel ?? Thanks