India, hit by the measles virus, aims to eliminate the disease by end 2023

While cases of Covid-19 appear to be receding in India, in the aftermath of a widely successful nationwide vaccination campaign, the threat from that virus continues even as devastating effects of two and a half years of the coronavirus pandemic on other basic health parameters have surfaced.

The Covid pandemic primarily afflicted the older and above-infant level segment of the population, disrupting routine immunization schedules of those newly-born, leaving them prey to deadly diseases like Measles, which has made an unwelcome resurgence across the globe and hit India hard.

Measles, a viral disease that afflicts children and has no cure, can be totally prevented through routine immunization. However, the Covid pandemic threw the regular immunization schedules awry in 2020 and 2021, leading to a resurgence of the disease. Having realised the depth of damage the disease can cause among the under-five year old population, and the ease with which it can be prevented, the government has set a target to eliminate measles by the end of 2023. Like polio and tetanus, measles will be eradicated, health authorities have pledged, by this time next year.

Health workers across India are scrambling to contain the outbreak of Measles among the population aged under-five, for whom the disease, typically accompanied by a fever, cough and a distinctive maculo-papular rash, can be fatal. Over 25,000 cases of measles and 1,965 cases of Rubella, a related, more virulent form of viral disease, have been reported in 2022. The worst-hit states have been Bihar, Gujarat, Haryana, Jharkhand, and Maharashtra, but even states like Kerala, widely seen as the best performing state on vital health parameters, including maternal and child immunizations, have seen localised outbreaks of the highly contagious disease.

Measles, a very preventable disease with just two shots of the vaccine providing lifelong immunity, had been largely brought under control in India, which has among the world’s largest public health immunization programmes. However, the programme stumbled and fell behind in its schedule of vaccinating infants when the primary focus of the nation’s health administration shifted to containing Covid.

The severity and longevity of the Covid pandemic caught the country’s health authorities off-guard, allowing Measles, another highly contagious virus, to enter and, this time, catch the infant population in congested areas, including in the financial capital Mumbai, in a deadly grip. At least 40 children have died, 13 of them in Maharashtra, in the current measles outbreak.

While Measles is easily preventable through the routine MMR (measles, mumps and rubella) vaccinations, a 95% coverage rate is needed to halt community spread. The outbreaks reported from around 143 worst hit areas across India have been because of delays in regular vaccination schedules and the migration of large numbers of people because of Covid lockdowns.

In India, 25 million infants are estimated to have missed their first dose. Only Nigeria reported more children left out of immunization coverage.

Dr Veena Dhawan, Additional Commissioner (Immunization) in the Ministry of Health and Family Welfare (MoHFW) said, “States have launched catch-up campaigns to prevent a backslide on routine immunization coverages.” Speaking at a Media Workshop organised in Mumbai by Unicef and the MoHFW to raise awareness of the vital importance of routine immunizations she said, “Measles is one of the most contagious human viruses, but is almost entirely preventable through vaccination.”

Dr Meeta, a Surveillance Medical Officer with WHO, said the measles outbreak was worst in areas that used to be polio endemic. The health authorities now appear confident they would be able to tackle, overcome and eradicate measles completely. Strategies employed during the Covid pandemic are being replicated, with religious community leaders also being roped in to urge their communities to get their children vaccinated. Because of the success of the Covid vaccination programme, there is now far greater acceptance among those afflicted surrounding the efficacy of vaccinations.

Calling Measles a “tracer” of the strength of a country’s immunization system, Unicef’s Dr Ashish Chauhan said, “When immunization coverage is low, measles is the fastest vaccine preventable disease to return.”

It is a sad reflection of the vulnerability of the economically challenged segments of society that the decline in vaccine coverage, weakened measles surveillance system, and continued interruptions and delays in immunization schedules because of COVID-19 caused this resurgence of an eminently preventable disease. Globally, and not just in India. While precious lives have been lost, this need not, and must not, recur. – INDIA NEWS STREAM