Measles

"Of the density-dependent diseases, measles requires a population of about half a million to become endemic, and the others probably less; in other words, while no city in Greece could support smallpox, it could certainly have become established in Rome."

", my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything. “Are you feeling all right?” I asked her. “I feel all sleepy, ” she said. In an hour, she was unconscious. In twelve hours she was dead. The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was twenty-four years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her... ...I dedicated two of my books to Olivia, the first was James and the Giant Peach. That was when she was still alive. The second was The BFG, dedicated to her... after she had died... You will see her name at the beginning of each of these books. And I know how happy she would be if only she could know that her death had helped to save a good deal of illness and death among other children."

"“Pretty much name any country and you will find measles there,” says Robb Linkins, a measles specialist in the global immunization division at the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, and chair of the Measles & Rubella Initiative, a partnership of five organizations."

"Steve Cochi, a paediatrician and senior adviser to the CDC’s global-immunization division, is especially frustrated by measles’s global toll, because from a biological and technical standpoint, he says, the disease could be eradicated. Unlike Ebola, yellow fever or (probably) the new coronavirus, it has no animal host, and a cheap and effective vaccine exists."

"In 2010, the WHO’s key Strategic Advisory Group of Experts on Immunization (SAGE) declared that measles can and should be eradicated, but it stopped short of recommending a target date. Since then, advocates have been lobbying the WHO to launch a global measles-eradication campaign and set a date for completion, as it did for smallpox and polio. At a meeting last October, however, SAGE recommended a different tack: instead of setting eradication deadlines that would be difficult to meet, the group advised waiting until success is actually in sight — say, 5 years away — before pushing full-bore to wipe out the disease. Doing so would require boosting rates of routine immunization with two doses of measles vaccine to a level never achieved before. The DRC is one of about 20 countries that have yet to add the second dose to its regime. And even that wouldn’t be enough. Eradication would also depend on improving the quality of mass campaigns and bringing in an easier-to-use vaccine. Those goals are very far away, measles experts say."

"Measles is a density-dependent disease that requires a population of about 300,000 to maintain itself and was unknown in many rural areas of the world until they were “invaded” by town dwellers."

"The delivery of measles vaccine in endemic areas must contend with a biological catch-22. From birth to about nine months of age, most infants have maternal antibodies that protect them from measles infection. But these antibodies also prevent the measles vaccine from conferring lifelong immunity. Those children whose maternal immunity wears off early are at risk of infection at an age when measles infection can be most severe. Thus, health systems in endemic regions, like the DRC, employ a first dose at a relatively early age (nine months) to immunise these vulnerable children. Later they provide a second dose to catch those for whom the first dose didn’t provide protection."

"It is a race against time to deliver the vaccine before it overheats in the equatorial sun. Nine hours later, and shortly after sundown, the team arrives with their precious cargo in Boso Manzi, the nearest town to Macau. The fleet of motorcycle drivers wearily unload cool-boxes into MSF’s temporary warehouse – a white tent lined with refrigerators powered by a series of generators. After checking the 2,900 vials are intact, the temperate log for each cool-box is plugged into a computer. Seconds later, a graph appears, showing every change in temperature since leaving the manufacturer’s warehouse in India. This is just the first phase of a herculean effort. Over the next 10 days, the vials will be loaded back onto the motorbikes and transported to villages such as Macau, and deeper into the forest, to reach children missed in previous vaccination efforts. After overcoming logistical challenges in reaching remote communities in the DRC, the cost per vaccine increases five-fold, according to Sodjinou."

"Two doses of the measles vaccine are recommended and roughly 95 per cent of the population needs to be vaccinated to ensure immunity and prevent outbreaks, according to the World Health Organization. In DRC, measles immunization coverage was only 57 per cent in 2018."