As reason and science proved critical in bettering the quality of life of millions, modern medicine was finally able to take shape. Though medicine has succeeded in eliminating various infectious diseases, measles continues to devastate human populations around the globe despite the invention of a cure in the 1960s. What is the global response to measles and why has the disease resurged in countries that had eliminated it decades ago? We explore the history of this disease as well as its current global status.
Developing the Measles Vaccine
Francis Home, a Scottish physician, proved in 1757 that measles was the result of a blood infection. Though he attempted to create a vaccine for the illness, he lacked the necessary tools needed to separate the virus from the blood.
Centuries later, in 1954, John F. Enders and Thomas C. Peebles were finally able to develop the vaccine. They successfully isolated the measles virus in the blood of an ill 13-year old boy after an outbreak occurred in Boston, Massachusetts. Prior to the widespread use of the vaccine, measles affected millions as the worldwide epidemic raged. In the U.S. alone, from 1958 to 1962, an average of 508,282 cases and 432 deaths occurred as a result of the disease every year.
In 1963, public health officials made the newly licensed measles vaccine available to the public. Thanks to proper vaccine storage refrigerators and scrupulous methodology in vaccine handling, the CDC quickly eliminated endemic measles in the United States. By 1981, reported cases of measles were down a shocking 80%. However, a 1989 outbreak prompted the CDC to modify its vaccination program, recommending two measles vaccines (known as MMR) per child. The elimination efforts consisted of high vaccination coverage in preschool-aged children, constant surveillance of cases, and thorough outbreak control. This rigorous program did the trick—by 2000, scientists and medical professionals eradicated measles in the U.S.
Global Vaccination Efforts
All around the globe, we have been able to greatly reduce the prevalence of infectious diseases due to better hygiene and sanitation efforts, clean water, vaccinations, antibiotics, effective health systems, and a greater average global income. However, certain regions of the developing world afflicted with poverty and poor education still battle against old pathogens. Measles is just one of many fatal diseases that have resurfaced in recent years. For example, in 2017, there was an outbreak of the plague in Madagascar, causing 209 deaths before it was contained.
There are ongoing efforts to make life-saving vaccinations available in developing countries. In the 1990s, UNICEF (United Nations International Children’s Emergency Fund) and WHO (World Health Organization) took the lead in distributing vaccines for tetanus, pertussis, and measles. The distribution of these vaccines has driven down global death tremendously. The measles vaccine alone is attributed to saving the lives of 20.4 million children from 2000 to 2016. Another implemented tactic, called tiered pricing, resulted in less costly vaccines in countries with meager economic development.
It is also during this time that epidemiology of disease and vaccine science advanced even further. Scientists and medical experts introduced adjuvants, which are components of vaccines that enhance immune response, to offer longer-lasting protection from disease. Experts envisioned administering a robust vaccine that could protect against a variety of diseases to reduce the number of injections administered to children. Though incredibly challenging to design, scientists succeeded in their vision. Modern-day vaccination programs distribute pentavalent vaccines that target up to five diseases at a time.
The GAVI Alliance has been another key player in facilitating the creation and distribution of vaccines globally. GAVI, known as the Global Alliance for Vaccines and Immunizations, which launched in 2000, unified 72 developing countries into one conglomerate to enable better fund-raising efforts from donors such as industrialized countries and large corporations. The GAVI Alliance works closely with UNICEF’s immunization program to increase access to vaccines via increased global demand and tiered pricing systems.
World Perspectives on Vaccines
Despite advances in the science and distribution techniques of vaccines, measles remains on the WHO’s list as a top contributor to child mortality around the world. Though GAVI reports that in 2016 alone they successfully delivered the measles vaccine to over 5.4 million infants, other figures show large-scale immunization efforts have plateaued in the last three years. Unfortunately, preventable diseases still take their toll in the poorest nations in the world, and many nations’ children remain in danger of contracting measles, diphtheria, rotavirus, and more.
While humanist organizations work with developing countries to increase vaccine coverage, many developed nations are slipping back into old habits. Global measles cases increased between 2017 and 2019 by 48.1%, with Ukraine, the Philippines, and Brazil leading the charge for the most dramatic escalations. Ukraine is not the only European country experiencing the measles surge—Italy reported 4,521 cases, Romania 4,276, and Germany 1,124. Reports for the entirety of the European region demonstrate that nearly 82,596 people in 47 countries contracted measles in 2018—the highest numbers in a decade and 3 times the number reported in 2017.
It’s quite distressing to see measles making a comeback as a public health concern. The effects of regional conflict, weak health care, and antimicrobial resistance are just a few aspects that are compounding the challenge of reaching more afflicted people with vaccines (especially in poor countries). However, developed countries suffer from a different sort of impediment.
Vaccine hesitancy—the reluctance or refusal to vaccinate—surges in the richest and most medically equipped countries. Vaccines are one of the safest and most cost-effective measures for disease prevention, a fact lost among generally well-informed groups. The WHO lists a complex myriad of factors they attribute to vaccine hesitancy including complacency, inconvenience, and lack of confidence in vaccines due to misinformation. There are many areas of intervention when tackling the issue of vaccine hesitancy, but the following are the main components of the WHO’s strategy:
- Firstly, to identify the populations most at risk of contracting preventable diseases.
- Identify deterrents to the supply and demand of vaccination.
- Develop and spread evidence in support of vaccinations to sustain uptake.
- Create country-specific community engagement to bolster support and acceptance of vaccines.
- Properly educate health workers as they most commonly influence vaccination decisions.
According to Amesh Adalja, a scholar at Johns Hopkins, “Measles has persisted and now it’s not so much a question of access to the vaccine, it’s actually trying to convince people that the vaccine is worthwhile.” Some may trace the roots of vaccine hesitancy back to reports of a causal link between the MMR measles vaccine and autism in the late 1990s. Though studies have concluded time and time again no causality between the vaccine and autism, negative sentiment towards vaccines continues—especially in Europe.
Though the global response to measles has been pervasive, prevention efforts must continue. The tireless work of dedicated medical professionals and world organizations tremendously improved the health of the underprivileged, at-risk populations. With greater global support and education regarding vaccinations, we will likely be able to save more children from measles and other needlessly devastating infectious diseases.