International researchers are warning that major measles outbreaks will likely occur in 2021 as an unexpected consequence of the COVID-19 pandemic.
An article published in journal The Lancet says 2020 has been a quiet year for measles due to travel restrictions and national COVID-19 control measures. However, the resulting economic carnage caused by the pandemic will have led to more cases of childhood malnutrition, something that worsens the severity of measles.
Professor Kim Mulholland from Australia's Murdoch Children's Research Institute and the chair of the World Health Organization's (WHO) Sage Working Group on measles and rubella vaccines is the article's lead author.
He says, in the coming months, the world is likely to see "increasing numbers of immunised children who are susceptible to measles".
"Many live in poor, remote communities where health systems are less resilient, and malnutrition and vitamin A deficiency are already increasing."
Mulholland says many children would have also missed out on measles vaccinations this year. With COVID-19 hitting the globe, he says vaccination campaigns were paused and routine immunisation services greatly disrupted in some countries.
The WHO said last week that, as of November, more than 94 million people were at risk of missing measles vaccines as campaigns had been paused in 26 countries.
"Before there was a coronavirus crisis, the world was grappling with a measles crisis, and it has not gone away," said UNICEF executive director Henrietta Fore.
"While health systems are strained by the COVID-19 pandemic, we must not allow our fight against one deadly disease to come at the expense of our fight against another.
"This means ensuring we have the resources to continue immunisation campaigns for all vaccine-preventable diseases, even as we address the growing COVID-19 pandemic".
On November 6, the WHO and UNICEF issued an "emergency call to action for measles and polio outbreak prevention and response".
Prof Mulholland says growing malnutrition and fewer children being immunised means severe outbreaks in 2021 are inevitable.
"All these factors create the environment for severe measles outbreaks in 2021, accompanied by increased death rates and the serious consequences of measles that were common decades ago.
"This is despite the fact that we have a highly cost effective way to prevent this disease through measles vaccination."
In 2019, the number of reported measles cases was the highest in 23 years, with nearly 870,000 cases across all WHO regions. The number of measles deaths climbed nearly 50 percent since 2016, taking 207,500 lives in 2019. A failure to vaccine was the main driver of the increases.
"We know how to prevent measles outbreaks and deaths," Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said last week.
"These data send a clear message that we are failing to protect children from measles in every region of the world. We must collectively work to support countries and engage communities to reach everyone, everywhere with measles vaccine and stop this deadly virus."
The Lancet piece has identified three areas for immediate action:
Help countries reach unimmunised children through catch-up immunisation and campaigns
Better prepare countries for expected outbreaks. WHO and partners have developed a Strategic Response Plan to assist with measles outbreak prevention, preparedness and response
Maintain measles and rubella elimination targets. WHO’s new Measles Rubella Strategic Framework 2021−2030, aligned with the Immunization Agenda 2030 provides a plan for strengthening routine immunisation and surveillance.
"Without concerted efforts now, it is likely that the coming years will see an increase in measles and its severe, frequently fatal, complications," Prof Mulholland said.