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With even Europe falling behind, can WHO meet new goals for measles?

Perhaps it takes falling behind to know that you have to get ahead: shortly after The Lancet released a report today saying the World Health Organization had failed to meet its 2010 goal for global measles reduction, the WHO announced that it has a new, more ambitious target of eliminating measles and rubella—also known as German measles—in at least five of six global regions by 2020. The expanded goals come as Europe, despite its historically strong public health systems, is struggling to recover from more than 26,000 measles cases in 2011, a number on-par with developing countries such as Nigeria and Somalia.

As Europe redoubles its own immunization efforts at home, the WHO now must vaccinate an estimated 19 million children in India and sub-Saharan Africa if it hopes to meet the new 2020 target. “We have already seen India scaling up its efforts,” Jean-Marie Okwo-Bele, director of immunization at the WHO in Geneva, said at a teleconference this morning announcing the new goal. “The new [WHO] plan provides a good roadmap to eliminate measles by 2020.”

Measles is a highly contagious virus that can become airborne, making it crucial that virtually everyone in a region undergo vaccination if the disease is to be eliminated. It can spread rapidly to anyone who is not immune, often leading to death in children under five. The first vaccine against measles came in 1971, and it now costs as little as two cents per dose in developing countries. But as the European outbreak highlights, vaccine cost and availability are not the only barriers to getting people immunized. “Cultural and religious beliefs play a huge role in whether children receive the vaccine, both in Europe and elsewhere,” says Rebecca Martin, director of the global immunization division at the US Centers for Disease Control and Prevention (CDC) in Atlanta. She says one reason so many young Europeans are now susceptible to measles was false perception over the past fifteen years that the vaccine raised the risk of autism.

The failure of European health authorities to circumvent such cultural barriers in its mission to vaccinate citizens against measles has led Europe to become the greatest exporter of the disease to the Americas. Nearly half of US measles cases last year came from the WHO’s home turf, and viruses with a signature European genetic profile also turned up in Canada and Brazil. One globally-pertinent reason for poor vaccination rates in Europe may be that medical providers are not entirely convinced of the vaccine’s importance, says Peter Strebel, medical officer for the WHO’s expanded program on immunization. “This is something in Europe and around the world,” he said in the teleconference. “It is very important that we get medical professional societies onboard in every region.”

As in past eradication campaigns such as smallpox and polio, the WHO and local health agencies in countries outside Europe will have to reach out to doctors, and such outreach must be one part of a larger strategy including the creation of direct disease surveillance systems and broad community mobilization efforts on the ground. “The success in a campaign like this is only as strong as the social mobilization,” says David Meltzer, senior vice president at the American Red Cross in Washington, DC. “Getting people to literally go door-to-door is really the backbone in areas where vaccination is not already the norm.”

Exactly how the WHO expects to achieve such mobilization is still unclear. Residual public health services and relationships between vaccinators and community members from the recently successful campaign to eradicate polio are a starting point, said Stephen Cochi, senior scientist in the CDC’s global immunization division. But for long term success, he says, “we still need to strengthen the overall immunization systems.” And while India is planning to finance its own measles immunization overhaul, strengthening the systems in sub-Saharan Africa requires donations, which have been hard to come by. The UN Foundation said today it still needs to raise $112 million dollars just to fund the first five years of the new WHO plan worldwide. “We don’t know where the money is going to come from,” says Kathy Calvin, chief executive of the foundation, but “we have to raise it.”

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