Over 200 million children will be vaccinated against measles by 2005 through the Measles Initiative.

Each year measles kills 1 million children, nearly half a million of those in Africa. An international partnership is working to combat this medical emergency.

Measles is the leading cause of death among children in Africa - more than HIV, more than tuberculosis and more than malaria. The tragedy is that it is a preventable disease. But in places where health conditions are extremely poor, living conditions are more than difficult, and access to health care is minimal, measles can kill.

"We are not so strong that we can treat measles. We do not have appropriate medicine always and poor people can't pay for it. Two to three children die from it every day in the hospital," said Dr. Eriamu, a doctor at the Soroti Regional Hospital in Uganda. Because it is so contagious and so common, measles is the only disease that needs its own ward.

Measles can be transmitted by air. Children can contract it in crowded places like a market or at school just by coming into brief contact with someone who has it. They usually do not die directly of measles. It is similar to HIV in that it weakens the immune system leaving the child vulnerable to the myriad of diseases festering in poor living conditions. The direct damage caused by measles can be high fever, peeling of the skin and encephalitis leading to brain damage. But the complications due to measles are even more severe and can include blindness, severe diarrhoea, malnutrition and pneumonia.

A global coalition

The Measles Initiative is a long-term commitment to reduce the number of deaths in Africa from the disease. The initiative will vaccinate 200 million children through both mass and follow-up campaigns in up to 36 sub-Saharan African countries. By 2005, it is estimated that 1.2 million deaths will have been prevented, bringing measles deaths in Africa to near zero. The partners are also exploring potential support for countries outside Africa that have many measles deaths.
"The mission of the Red Cross is to save lives. Leading our global partners in the fight against measles gives us an opportunity to do that on a big scale," said Gerry Jones, American Red Cross (ARC) vice president of international services.

In the battle to reduce mortality from measles, partnership is crucial since each player brings a different strength and talent to bear. The core partners of the initiative are the American Red Cross, the United Nations (UN) Foundation and the Centers for Disease Control and Prevention (CDC), in collaboration with the UN Children's Fund (UNICEF), the World Health Organization (WHO) and the International Federation of Red Cross and Red Crescent Societies. Over 100 other public and private organizations support the initiative. The main in-country actors, actually conducting the immunization campaigns, are the local ministries of health and Red Cross and Red Crescent societies.

UNICEF believes that every child has the right to be immunized and protected from measles and other vaccine-preventable diseases. "Every minute, one child dies from measles in Africa. This is unacceptable," said Carol Bellamy, executive director of UNICEF. "Measles vaccination campaigns will reverse this trend and give children a good start in life."

In February 2001, the ARC, Federation, CDC, UNICEF, UN Foundation and WHO met to discuss the growing problem of measles in Africa. "We looked at problems that afflict the world and we found that measles was a big one. What is so tragic about the deaths is that they are preventable," said Gerry Jones.

In order to accomplish the goal of saving 1.2 million child lives in Africa over five years, mass measles vaccination campaigns will be conducted in countries throughout Africa. The campaigns are a coordinated effort of health workers, volunteers and communities to ensure that within a short period of time vaccination teams reach every child. They are carried out over several days for children under 15 years of age. Follow-up campaigns occur three to four years after the initial mass campaigns for children under five years of age who did not receive the vaccine during the first mass campaign.

Fast facts

• Measles is the leading vaccine-preventable childhood killer in the world
  
• Each year, 30 to 40 million children suffer from measles and 1 million die from the disease
  
• In Africa alone, 200 million children are at risk from measles
  
• More than 12 million cases occur in Africa each year
  
• Every year, more than half the deaths caused by measles occur in Africa (i.e. about 450,000). This means that, in African countries:
  - 1,200 children die every day of measles
  - 51 children die every hour of measles
  - one child dies every minute of measles
  
• Visible signs of measles include fever, rash, running nose, cough, red eyes, red lips, peeling of the skin, and difficulty in breathing
  
• Measles can also cause blindness and brain damage, and make a child susceptible to secondary infections such as pneumonia and diarrhoea
  
• Measles vaccination is the most cost-effective public health intervention available for preventing deaths
  
• It costs less than US$1 to vaccinate a child against measles
  
• During the first year of the initiative (July 2001-June 2002), mass measles campaigns are being carried out in eight African countries, vaccinating more than 20 million children and preventing more than 140,000 death

A saving for all

WHO considers the administration of measles vaccine one of the most cost-effective public health interventions available, at a cost of less than US$1 per child.

Sarah Salamula, whose five-year-old had been in a hospital in Pallisa district, Uganda, for four days battling complications due to measles, said that he is getting better. "We are poor and all our money goes to treating my children." She plans to take her children to be vaccinated hoping that there will be no more unnecessary expenditures and that "it will keep my children healthy and happy and their bodies will be immune".

Mass measles campaigns were carried out in eight African countries in 2001, the first year of the initiative. More than 20 million children were vaccinated, preventing more than 140,000 deaths. Countries involved included: Benin, Burkina Faso, Cameroon, Ghana, Mali, Tanzania, Togo and Uganda. The National Societies were responsible for reaching over 5 million of these 30 million children, in many cases going from house to house to explain that measles kills, that it can be prevented through immunization and that vaccinations are free. The partners anticipate that 12 countries will be targeted for the second year, vaccinating 53 million children and preventing over 90,000 deaths.

One of the first babies brought for immunization during the November 2001 campaign in Uganda, came with his mother who had suffered from polio. She dropped her baby off to the vaccinators so she could get back to tending her garden, their main source of food. "I don't want my baby to have problems like me," she said. Her husband left when the baby was born two and a half years ago. "I could not have managed to get my child vaccinated if the vaccine was not free. I want my child to be vaccinated so he won't be like me."

Julie Irby
Julie Irby is an associate in the international communications department of the American Red Cross.