Fact Sheet Expert Opinion First Person Photo Essay


Reducing measles mortality

next Dr. Edward Hoekstra, Senior Health Advisor, UNICEF Health Section

Q: Why is UNICEF working on reducing measles mortality?

Hoekstra: Of the children that die from vaccine-preventable diseases, 45 percent die from measles. It is unacceptable that nearly 345,000 children die every year from a fully preventable disease. All these deaths can be prevented with an injection of the measles vaccine. The vaccine is highly effective and safe.


Q: Why is measles a top killer of children?

Hoekstra: Measles is one of the most contagious diseases in the world. If you are in a room with someone who has measles and you are not protected against measles, you get measles too. In developing countries, measles can be deadly for children because it lowers their resistance to other diseases. Many children develop complications – they get a lung infection or intestinal infection with diarrhoea. As many of these children live in remote areas and have no access to health care, they can die of these complications.


Measles is definitely a top priority in developing countries where governments support efforts to reduce measles mortality. In most, we just have to mention that we have some funds, and they go ahead with the immunization campaign. In Africa, where measles takes a large toll, it is very easy for us to give the vaccine. In some African countries, mothers won’t give their children real names until they have survived measles.


Q: How has measles mortality been reduced in half between 2000 and 2005?

Hoekstra: UNICEF developed a strategy with the World Health Organization (WHO) to increase routine measles vaccination coverage and conduct supplemental campaigns providing  second opportunity for immunizing children. Failure to immunize children against measles at least once is the primary reason for the high number of cases in problem countries. In contrast, we have seen major progress in countries that have offered a second opportunity for measles immunization. The second dose allows us to immunize children we may have missed the first time and it enables us to administer a second dose to other children, thereby guaranteeing that they will be immune to the disease. In 52 countries that give children only one opportunity to get the measles vaccine, the death rates are much higher than in all other countries worldwide.


Q: What are some of the specific ways UNICEF is working to achieve this goal?

Hoekstra: Between September and December of 2001, we were involved with one of the largest measles campaigns ever in Africa as part of the African Measles Initiative. We vaccinated over 21 million children in eight countries: Benin, Burkina Faso, Cameroon, Ghana, Mali, Tanzania, Togo and Uganda. WHO is a major partner in the campaign, along with several others: The United Nations Foundation, the American Red Cross, and the US Centers for Disease Control and Prevention (CDC). 


This campaign had a major impact: we were able to avert 140,000 child deaths. In most of the countries, we were able to reach over 95 per cent of children under 14 and in others, 95 per cent of those under age five. The impact will be felt far into the future because now these countries have a good basis from which to conduct future measles immunization. In the next five years, we hope to go to all of the countries in Africa.


Q: What are the challenges going forward?
Hoekstra: The major area of concern for us is getting sufficient funding. We have a lot of technical people and partners on the ground that are very experienced at setting up good, sustainable measles programmes. To achieve the goal of reducing measles deaths by another 40 percent over the next four years, we will need $688 million.


Conflict and wars are other barriers to our immunization efforts. In Afghanistan we vaccinated over ten million children against measles. Usually we carry out a program within one or two weeks and we vaccinate five or six million children in that week. Afghanistan is so difficult that we did it over a half-year period, where we went from village to village. But, ultimately, we averted 35,000 child deaths.