Immunization highlights: 2012
Reaching more people with existing vaccines
Global partners launch new plan to control and eliminate measles and rubella
In April 2012, the Measles and Rubella Initiative (formerly the Measles Initiative) announced a new global strategy aimed at reducing measles deaths and congenital rubella syndrome to zero. The launch of the Global Measles and Rubella Strategic Plan 2012-2020 coincided with the publication of new data using a state-of-the-art methodology which showed that accelerated efforts to reduce measles deaths have resulted in a 74% reduction in global measles mortality, from an estimated 535 300 deaths in 2000 to 139 300 in 2010.
"A three-quarters drop in measles deaths worldwide shows just how effective well-run vaccination programmes can be. Now we need to take the next logical step and vaccinate children against rubella, too."
Dr Margaret Chan, Director-General, World Health Organization
Vaccination has been key to this progress. Through increased routine immunization coverage and large-scale immunization campaigns, sub-Saharan Africa made the most progress with an 85% drop in measles deaths between 2000 and 2010.
The new data showed that progress in reducing measles deaths was especially strong from 2001 to 2008. However, when investment and political commitment to measles control faltered in 2008 and 2009, many children were not immunized. Measles came roaring back and caused large outbreaks in Africa, Asia, Eastern Mediterranean and Europe.
These outbreaks combined with a delayed start in intensifying measles control in India, meant that the goal of 90% reduction in measles mortality by end 2010 compared with 2000 levels was not met. India accounted for about 47% of global measles deaths in 2010. In addition, target dates for measles elimination goals in the WHO Eastern Mediterranean and European regions had to be revised.
The new Strategic Plan presents a five-pronged strategy to cut global measles deaths by at least 95% by 2015 compared with 2000 levels and to achieve measles and rubella elimination in at least five WHO regions by 2020. The strategies include:
- high vaccination coverage;
- monitoring spread of disease using laboratory-backed surveillance;
- outbreak preparedness and response and measles case management;
- communication and community engagement; and
- research and development.
Let every child have a name: The road to a world without measles
At the 2012 Measles & Rubella Initiative annual meeting held in September, the Initiative partners unveiled a new exhibit inspired by illustrator Sophie Blackall’s journey to the Democratic Republic of the Congo where she learned firsthand about measles and its devastating consequences.
The exhibit Let Every Child Have a Name: The Road to a World Without Measles is a series of evocative illustrations colored in Ms Blackall’s charming, insightful style. Viewers can join a pirogue as it travels to a remote village up the Congo river; watch health workers as they carefully map their communities for a measles campaign; and join children as they queue with their families. To see the exhibit, visit:
- Global Measles and Rubella Strategic Plan 2012-2020
- WHO measles fact sheet
- WHO rubella fact sheet
- Assessment of the 2010 global measles mortality reduction goal: results from a model of surveillance data
Progress towards eliminating maternal and neonatal tetanus
Maternal and neonatal tetanus kills tens of thousands of newborns each year, most of them in developing countries. Yet, tetanus is preventable through hygienic birth practices and immunization of women of childbearing age with tetanus toxoid vaccine.
In 2012, six additional countries ―Burkina Faso, Cameroon, China, Guinea-Bissau, Tanzania and Timor-Leste ― were validated as having eliminated maternal and neonatal tetanus. This brings the number of countries that have eliminated the disease to 29 out of 59 countries where maternal and neonatal tetanus persist as public health problems.
From 1999 to 2012, more than 108 million women of reproductive age living in high-risk areas have been reached with more than two doses of Tetanus Toxoid vaccine.
The maternal and neonatal tetanus elimination initiative ― a partnership launched in 1999 by UNICEF, UNFPA and WHO ― continues to gain momentum with funding from BD (Becton, Dickinson and Company) , U.S. Centers for Disease Control and Prevention; Procter & Gamble (Pampers); Kiwanis International, GAVI Alliance , UNICEF National Committees and others.
With only two years remaining before the 2015 elimination deadline, there are still 30 countries where maternal and neonatal tetanus persist as public health problems.
Progress towards a polio-free world: looking back on 2012
The year ended with the fewest children paralyzed by polio, in the fewest places, in history. Just over 220 cases have been reported so far for 2012 – a greater than 60% reduction from 2011. Over the year, through the tireless dedication of the on-the-ground heroes of polio eradication, more than two billion doses of vaccine were distributed to 429 million children around the world. And too many of these heroes gave their lives to reach some of the most vulnerable children in the world with vaccine.
2012 was the year that India was removed from the list of polio-endemic countries. Angola and the Democratic Republic of the Congo both put a stop to re-established polio transmission. In May, the 194 Member States of the World Health Assembly, declared the completion of polio eradication a “programmatic emergency for global public health”. This declaration announced that the global community was committed to ending this disease, and granted countries greater powers to prevent its spread.
A key factor in the progress in 2012 has been enhanced country ownership. All three remaining endemic countries – Nigeria, Pakistan and Afghanistan – implemented their own emergency action plans and introduced oversight mechanisms at the highest levels of government (such as the Presidential Task Force in Nigeria).
Technical and programmatic innovation played a lead role in 2012, with GPS technology making a difference in ensuring that vaccination teams reach every child. The introduction of a direct disbursement mechanism in Pakistan ensured that health workers were paid directly and on time. Delegations from India to the remaining endemic countries helped transfer vital knowledge about micro-planning, accountability, strategies for special populations and data collection. All this paid off in more children being reached in the sanctuaries of the poliovirus. Nigeria was the only country which saw an increase in cases – and even there, more children were being reached with vaccine in the latter half of 2012 than in the first half.
Tremendous sacrifices are being made to reach these children. In Pakistan, an unacceptable and horrifying series of attacks on health workers brought the year to a tragic close. Parts of all three endemic countries remain off-limits at the end of the year, but through the ongoing negotiations of partners we continue to reach more and more children, including around 30 000 children living in the Tirah Valley of Pakistan who were vaccinated in 2012 for the first time in three years.