Democratic Republic of Congo: Fighting measles in the shadow of Ebola
Overshadowed by the Ebola outbreak in the east of the country, the measles response in DRC has been neglected from the start. It took months before the epidemic was officially declared in June 2019. Vaccination campaigns organized by authorities were marked by delays, coordination issues, and a lack of supporting partners, many of whom were focused on the response to Ebola. A supplementary vaccination campaign, intended to reach those children who had been missed earlier, was repeatedly postponed before finally taking place in late 2019.
All of these factors have contributed to the disease’s heavy toll in DRC. More than 6,200 people have died of measles, of whom about 85 percent are children under 5 years old. That is nearly three times the death toll from Ebola (2,268 deaths, according to the World Health Organization), yet the measles epidemic gets only a fraction of the attention and resources it deserves.
“Today, the overall number of cases may have reduced, but the epidemic is far from over,” says Emmanuel Lampaert, MSF operations coordinator in DRC. “Some areas are even reporting increases [in the number of cases], and there are about 100 health zones where action is urgently needed.”
“Since January, more than 50,000 cases and 600 deaths have already been officially notified,” Lampaert says. “But many zones with increasing numbers of cases and deaths are not included in the latest national measles response plan.”
From Haut-Uélé to Kongo Central, from North Ubangi to South Kivu, MSF teams have been deployed in a dozen provinces across DRC in 2020 alone. This year we have vaccinated more than 260,000 children against measles, while caring for more than 17,500 who already had the disease. Last year, MSF vaccinated 816,000 children against measles and cared for more than 50,000 patients with the disease.
Silent killers, but few medicines available
As in many remote places in DRC, local people know all too well the toll taken by “silent killers” such as measles, malaria, diarrhea, and respiratory infections.
“The needs here are huge, but the supply of medicines to health centers is problematic,” says Gédéon Mushadi, the health zone’s chief doctor. “The few medicines available in the health facilities do not cover the needs.”
Alphonsine Ekima, 43, and her family have felt the terrible impacts of this crisis. Six weeks ago her three-year-old daughter, Marie, died of measles. She was buried on the same day as her cousin, who died from the same disease. “Marie was the fourth child taken away from me,” says Alphonsine.
Every delay, every obstacle fuels the outbreak
In this already difficult context, the COVID-19 pandemic has created more barriers to vaccinating children against the disease.
“Implementing preventive measures to reduce the spread of COVID-19 is vital to protect communities and health workers, especially in a country like DRC where the health system is very limited,” says Lampaert. “Unfortunately, these measures are having an impact on the overall measles response, including transporting vaccines, assembling dedicated teams, and launching vaccination campaigns.”
These obstacles are affecting the efforts to bring the measles epidemic under control, says Lampaert.
“Every delay and every obstacle increases the risk of the epidemic continuing to spread, killing more children,” Lampaert says. “The same happened during the West African Ebola outbreak, when measles vaccination activities were disrupted, leading to a resurgence of the disease.”
“COVID-19 will sow the seeds of other health crises”
Today, with all eyes focused on the threat of COVID-19, MSF teams are continuing to respond to other health emergencies such as measles, in DRC and beyond.
“As we adapt our approach to the coronavirus pandemic and support the response to it, it is important to remember that a one-track focus on COVID-19 will sow the seeds of other major health crises,” says Lampaert. “Reducing vaccinations, nutrition support, or malaria prevention in the face of a public health crisis will lead to other crises, making the situation even worse. Neglecting the other health issues would make us complicit in many more future deaths.”