WHO announces new milestones in battle against measles and rubella

BRISBANE, Australia — Health programs targeting measles and rubella in the Western Pacific have demonstrated major milestones, with New Zealand and the Republic of Korea becoming the first countries in the region certified to have eliminated both measles and rubella.

The announcement was made at the 68th session of the World Health Organization Regional Committee for the Western Pacific, held in Brisbane from October 9 to 13. The countries join Australia, Brunei Darussalam, Cambodia, and Japan, as well as Hong Kong and Macau, which have all previously been declared measles — but not rubella — free.

“A strong immunization program can eliminate measles and rubella,” Dr. Shin Young-soo, WHO regional director for the Western Pacific, told reporters on Monday. “And New Zealand and the Republic of Korea have just become the first two countries in our region to be certified as having eliminated both diseases.”

Measles and rubella are combined for targeted elimination due to a combined measles and rubella vaccination. But a region is only verified as having eliminated measles and rubella if they have been able to document the interruption of the endemic measles and rubella viral transmission for a period of at least 36 months, have the presence of verification standard surveillance, and can use genetic evidence to supports the interruption of endemic measles virus transmission.

The announcement was met with discussion of a measles and rubella elimination action plan, providing a regional strategy for the Western Pacific region.

Despite achievements, there’s more work to be done

At the sessions discussing the action plan on Tuesday, representatives of member countries endorsed the proposed plan, but warned there will still be many gaps in the region, with Papua New Guinea actively suffering an outbreak in one of its regions.

“We are one of the countries in the region that is yet to eliminate measles and rubella,” the representative for Papua New Guinea told the session. “Maybe we are one of the nations that could be categorized as not on track. That is pretty serious. Our immunization coverage has not been improved for decades. We have had immunization coverage at around 60 percent for a decade.”

External consultants were not providing the help needed, said the representative, and while the country strongly supports a program targeting immunization and measles, it needs to take a step back and understand the problem before working further with partners.

There are still many immunization gaps in the region, primarily in remote and poor communities that need to be better targeted. The Laos Ministry for Health has developed a 2016-2020 plan for vaccination to target vulnerable populations and urged improved technical support for subdistrict level mobilization of routine vaccination in high-risk areas, early detection of outbreaks, and quality data to support decision-making.

But immunization gaps are no longer limited to the poorest. In Malaysia, there is growing anti-vaccination movement among well-educated and urban populations, which has seen parents refuse vaccinations, despite having 95 percent vaccination coverage in the country. This has led to a resurgence of measles, and 50 percent of those impacted were younger than 15 years old and had not been vaccinated.

Malaysia’s representative urged the WHO to take charge on better education processes to target the growing anti-vaccination movement.

Verification does not mean the disease is gone

Mark Jacobs, WHO’s director for the division of communicable diseases, explained to Devex that the verification of the elimination of a disease does not mean it has gone forever.

“What we mean by elimination is not that there is no disease, just that it stops circulation,” he said. “When the United States eliminated measles, they explained it as: ‘measles doesn’t live here anymore, but it does visit.’”

Until measles and rubella are eliminated from the world entirely, responding to measles and rubella shifts to responding to an emerging — or re-emerging — disease. Disease surveillance needs to quickly identify and respond to imported cases of the disease to prevent it from circulating among the population. And vaccinations are still required to ensure there are no gaps in coverage, allowing the disease to re-establish.

“Ultimately we would like measles eradicated from the world, like smallpox,” Jacobs said. “When it comes to immunization, the aim is to leave no one behind.” But he explained for countries in the Western Pacific region, there are a diversity of challenges to achieving this. “For countries such as China, the size of the country creates a problem of universal vaccination coverage. For a smaller country like PNG, it is an issue of geography, resourcing the health systems, making sure vaccination can reach population at the right temperature and surveillance systems can identify outbreaks.”

But despite the continued challenges, the Western Pacific countries considered the successes important to celebrate and they reignited determinations to improve vaccination coverage to protect the 1.9 billion people in the region.

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