Global Overview of Measles 10 th Annual Measles

Global Overview of Measles 10 th Annual Measles Initiative Meeting American Red Cross National Headquarters Washington DC September 13 -14, 2011 Peter Strebel (WHO/EPI) and Edward Hoekstra (UNICEF/Program Division)

Tenth Anniversary of the Measles Initiative l Joint Declaration, 31 January 2001 l Work together in partnership to further reduce measles mortality according to each partner organization's strengths l To advocate for human and financial resources l Support strategies outlined in the WHO/UNICEF Strategic Plan, including use of rubella vaccine l Support the GAVI goal of saving lives 2|

Overview Measles global annual reported cases and MCV coverage, 1980 to 2010 Campaigns l Progress l Challenges l Opportunities 3|

Burden of measles in 2000 l 40 million cases l Complications: – 8% pneumonia – 1: 1, 000 encephalitis – 1: 10, 000 blindness l 500, 000 deaths 4|

Global Goals l Millennium development goal #4: – Reduce child deaths among children by 2/3 by 2015 (vs. 1990) – Measles immunization coverage indicator of access to care l By 2005 – 50% reduction in measles deaths (achieved on time) l By 2010 – 90% reduction in measles deaths (achieved in 5/6 WHO Regions) l By 2015 – Vaccination coverage: 90% national level and 80% in every district – Reported incidence: <5 cases of measles per million – Mortality reduction: 95% (vs 2000) 5|

Measles and Rubella Elimination Goals by WHO Region, August 2011 Americas, Europe, E. Mediterranean, W. Pacific, Africa have measles elimination goals Americas and Europe have rubella elimination goals 2015 2000 2015 2020 SEAR: 95% Measles Mortality Reduction by 2015 6| 2012

Feasibility of Measles Eradication l July 2010 – Global Consultation – Measles can and should be eradicated – In the context of strengthening immunization and primary health care systems – Opportunity to accelerate rubella control and the prevention of congenital rubella syndrome – Target date of 2020 feasible if measurable progress 7|

SAGE, November 2010 l Measles can and should be eradicated l Measurable progress towards 2015 global targets and existing regional elimination goals is required before establishing a target date l Requested frequent updates on progress l Executive Board (Jan 2011) endorsed SAGE approach 8|

Progress towards 2015 global targets

Since 2001, 1 st dose coverage up by 12% 2015 Target 10 | Source: WHO/UNICEF coverage estimates, 2011 revision. Date of slide: 29 July 2011

Scaling-up 2 nd Dose Strategies Number of doses of measles vaccine administered, by delivery strategy, 2000 -2010 Measles Initiative 1 billion vaccinated as of July 2011 11 | 1 st routine dose: WHO/UNICEF coverage estimates, The World Population Prospects New York, 2011. 2 nd routine dose: WHO/UNICEF Joint reporting form, (not all countries report 2 nd dose). SIA dose; : WHO SIA database, July 2011 (Provisional data)

Reported measles cases down by two-thirds Reported number of measles cases by WHO Region, 2000 -2010 12 | Source: Cases from annual Joint Reporting Form 193 WHO Member States, Data as of August 2011

Estimated Global Measles Deaths have decreased by three-quarters, 2000 -2010 76% 2015 Target 13 | PROVISIONAL ESTIMATES Source: 2010 WHO/IVB measles model, Sept 2011 Shading indicates uncertainty bounds

Reduction in Estimated Measles Deaths by WHO Region 2000 to 2010 26% 87% 85% 79% 76% 78% 85% 95% 2015 reduction goal 14 | * SEAR excluding India Source: 2010 measles burden model, WHO/IVB, September 2011

Major causes of mortality among children <5 years, 1990 vs 2008 Measles accounts for ~23% of overall decrease in child mortality 1990: 12. 1 mil 15 | Van den Ent et al (2011) J. Infect Diseases 2011; 204: S 18 -S 23 2008: 8. 8 mil

Measles Deaths Averted, 2000 -2010 5. 0 million deaths averted (32%) 10. 8 million deaths averted (68%) 16 | *Provisional estimates Based on method of Wolfson et al, Lancet 2007

Challenges

#1: India l 134 million children need vaccination l High quality – Coverage >90% – Immunization safety including needle disposal 18 |

#2: Resurgence in Africa l 4 -fold increase since 2008 l Large outbreaks in Burkina Faso (2009), S. Africa (2010), and DRC (2011) l Outbreaks in drought affected Horn of Africa – High case-fatality 19 | Weekly Epidemiological Record (2011) 86: 129 -136

#3: Weak Immunization Systems Measles 1 st dose coverage among infants, 2010 l 1 st dose: – 67 Countries have MCV 1 coverage <90% l 2 nd dose (routine): – 54 countries do not have routine 2 nd dose l Campaigns: <50% (2 countries or 1%) 50 -79% (41 countries or 21%) 80 -89% (24 countries or 12 %) >=90% (126 countries or 66%) 20 | – Variable quality – Delayed

#4: Financing is late and unpredictable l Lack of multi-year funding Measles Initiative Annual Donations, 2001 -2011* l Countries not committing 50% of the operational costs of SIAs l Outbreak response not budgeted for *Excluding country contributions 21 |

The Next Decade

Surveillance l Network of 673 laboratories l Outbreak and virus tracking l Diagnosis in the field 23 |

Innovation l New vaccine delivery methods – Needle-free injection – Aerosol vaccination – Skin patch vaccination? 24 |

Synergies Polio eradication Routine immunization Measles New vaccines JE, Men A 25 | Rubella/CRS prevention

Summary l Achievements – – 1 st dose coverage up to 85% 1 billion doses delivered in campaigns 2/3 reduction in cases 3/4 reduction in deaths l Challenges – Cases and deaths unchanged in past 3 years l Enhance program performance – Surveillance, innovation, synergies 26 |

Remarks by William H. Gates Sr. Lions Club, July 7, 2011 One of the challenges of the fight against measles, and of immunization in general, is that you’ve got to keep at it. You’ve got to be relentless, tireless. Because children who need to be protected … are born every day. You don’t vaccinate once. You do it year, after year. 27 |

Anne Ray Charitable Trust