Measles: "There Are Clearly Systemic Failures in Measles Prevention Programs"

Given the recent upsurge of measles epidemics in stable countries, Thierry Durand, Doctors Without Borders/Médecins Sans Frontières' (MSF) operations director, thinks it necessary to recognize and analyze failures in the prevention of this disease.

Where have MSF teams been involved in measles epidemics?

We have seen a swathe of measles epidemics over the last two years. Our teams have rallied on a massive scale, and are currently supporting the Ministries of Health in Malawi, Zimbabwe, South Africa, and Yemen. They’ve also worked on measles recently in N’Djamena, the capital of Chad, and Nigeria, as well as in Burkina Faso, the DRC (Democratic Republic of the Congo), Mali, and Somalia in 2009. It’s only to be expected that measles epidemics occur in warring countries or conflict zones, such as northern Yemen or the north of the DRC.

We know that in these settings, the health systems are disrupted and can’t take the necessary measures to prevent measles. But I’m astonished to see us intervening, at times on a substantial scale, in stable countries, like Malawi, Burkina Faso, Mozambique or South Africa. These counties have been running vaccination programs for years, supported by international donors, with ambitious aims of eradicating diseases giving rise to high mortality rates, such as measles. There’s a problem if such epidemics occur in countries such as these, and it can only indicate dysfunctions or weaknesses in the routine vaccination system.

An epidemic overview is based on the number of cases and deaths. What other consequences should be taken into account?

The weight of these epidemics is mainly borne by the people themselves, of course, with sometimes tens of thousands of people falling sick in one country alone, and hundreds of them dying. But it also places a heavy burden on the Ministries of Health. MSF offers support, with expertise and a major input of resources, but the hundreds of vaccination teams for these emergency campaigns are put together by the Ministries of Health, drawn from amongst their staffs, who receive our direct support.

It’s a real problem to see large-scale resources mobilized for epidemics that could and should have been avoided. These massive interventions are costly in budgetary terms, as hundreds of thousands, or even millions of children have to be vaccinated. MSF channels considerable resources into responding to these emergencies, both on the funding and human resources front. This is to be expected in conflict zones, but not in stable countries. We cannot spend our time putting out the fires caused by the systematic failures of these prevention programs. We need to analyse them, and propose corrective action.

What’s MSF’s role in this kind of exercise?

We want to raise the alert amongst the different parties involved in measles, drawing their attention to the systems’ failures. We opted for institutional funding for several of our measles epidemic projects, for example. This is a way to get donors involved, and have them square up to the problem. They’re taken aback, given the funding allocated to preventive measles programs, when they receive requests for emergency interventions, and thus are called on to foot the bill twice.

We can also take part in the analysis of these failures, along with all the other parties involved (WHO, UNICEF, Global Alliance for Vaccination and Immunization, donors, Ministries of Health). The high number of players at stake and the parcelling of responsibilities probably give rise to a diminished capacity to fix priorities and address the issue as a whole. Constructive criticism of visibly ineffective prevention programmes should not be considered taboo, but serve to bring about improvement.