17 July 2020 Vol 369, Issue 6501
COVID-19 policies: Remember measles
By Debarati Guha-Sapir, Maria Moitinho de Almeida, Mory Keita, Gregg Greenough, Eran Bendavid
Science17 Jul 2020 : 261
Nearly 120 million children in 37 countries are at risk of missing their measlescontaining vaccine (MCV) shots this year, as preventive and public health campaigns take a back seat to policies put in place to contain coronavirus disease 2019 (COVID-19) (1). In March, the World Health Organization (WHO) issued guidelines indicating that mass vaccination campaigns should be put on hold to maintain physical distancing and minimize COVID-19 transmission (2). The disruption of immunization services, even for short periods, will lead to more susceptible individuals, more communities with less than the 95% MCV coverage needed for herd immunity, and therefore more measles outbreaks globally. A mere 15% decrease in routine measles vaccinations—a plausible result of lockdowns and disruption of health services—could raise the burden of childhood deaths by nearly a quarter of a million in poorer countries (3). Solutions for COVID-19, especially among the global poor, cannot include forgoing vaccinations.
Suspending mass vaccination campaigns is particularly pernicious in countries embroiled in conflict. Malnutrition among children and mothers in these regions is all too common—and increases mortality for those also infected by measles (4). In the conflict-affected regions of Ituri and North Kivu in eastern Democratic Republic of the Congo (DRC) alone, COVID-19 precautions are expected to delay measles vaccinations for nearly a million children (1).
COVID-19 mortality has so far been low in most poorer countries and trivial compared with the immediate risk of mortality due to measles. In the DRC, for example, the total number of deaths due to COVID-19 as of June was 37 (5), whereas the 2019 measles outbreak in the conflict region of eastern DRC killed more than 6000 people in a matter of months, mostly children (6). In some poor countries, more than 40% of the population is younger than 14 years old (7). This demographic group is the least affected by COVID-19 (in terms of symptoms, mortality, and transmission) (8) but at serious risk of measles (9). In addition, because many people in these countries live in cramped housing with unavoidable crowding, policies to minimize COVID-19 at the expense of measles prevention may not even be effective (10).
Postponement of measles campaigns prioritizes panic-driven policies for controlling COVID-19 without consideration of these policies’ costs. If children are not immunized within the correct age window, they forgo benefits of lifelong immunity (11). Whole cohorts of children may be left unprotected. We must balance priorities of containing COVID-19 with efforts to control other high-transmission disease threats in poor countries, especially those affected by conflict.