With routine coverage against measles at 88 per cent in 2003, the Middle East/North Africa region is well on course to achieve the goal of 90 per cent coverage. Maintaining its average annual rate of improvement since 1990 would be more than enough to see it through. Nevertheless, as is often the case, the broad-brush regional average conceals the fact that there are some countries in the region that will not reach the target without a substantial improvement over the next few years.
Of the 20 countries and territories in the region, 16 have already achieved the 90 per cent coverage goal for measles immunization. Almost all of these finance their immunization campaigns entirely from their own budgets, which indicates both the commitment of governments to this aspect of child health and the likely sustainability of their efforts.
Among the successful, the most notable are arguably those recovering from or still subject to conflict. Kuwait and Lebanon recovered swiftly during the 1990s from major wars and now have near-universal coverage of most key vaccines. The Occupied Palestinian Territory has managed to achieve very high coverage since 1995 and now has 99 per cent immunization against measles. Iraq's recovery from 13 years of sanctions and two wars is more problematic, but the cold-chain system that had been destroyed has been reinstalled; coverage in 2003 was at 90 per cent against measles.
Algeria, Djibouti, Sudan and Yemen will all require major improvements if their children are to be adequately protected against disease. Algeria has better coverage for other vaccines than for measles, at 84 per cent. Djibouti had substantially lower measles immunization coverage in 2003 than it did in 1990, although the last few years have actually shown significant rises following a catastrophic drop to little better than 20 per cent in 1998-1999 due to a breakdown in the cold chain.
Yemen also suffered a marked drop in the mid-1990s because of a fall in donor support and a period of civil unrest; it is still not maintaining a consistent upward trend, having improved in the early 2000s, dropped again and recovered in 2004. The country now finances campaigns entirely from its own resources. Sudan has never reached immunization coverage above two thirds (in 2001) for the measles vaccine, but even that has now suffered a decline, made worse in 2004 by further conflict and lack of access in Darfur.