More than six months after the worst outbreak of measles ever recorded in Democratic Republic of Congo (DRC) was declared over by the country’s Ministry of Health, Doctors Without Borders/Médecins Sans Frontières (MSF) is concerned that cases of the deadly viral disease are once again on the rise. There have been more than 13,000 new measles cases since January 1.
MSF was part of the response to the 2018–2020 epidemic, which infected more than 460,000 children in DRC and killed nearly 8,000, three quarters of them under five years old. At the time, we deployed emergency teams in 22 of the country’s 26 provinces, tracking virus hotpots, treating 90,000 patients, and vaccinating more than 2.3 million children. The emergency response was followed by supplementary vaccinations set up by the authorities for millions of children, which greatly reduced the number of patients, but did not cut the chain of transmission. Despite this, in August 2020, the Minister of Health declared the end of the epidemic.
An alarming increase
“Unfortunately, since the end of 2020, several provinces have started recording new increases in patients with measles, notably the North and South Ubangi provinces,” said Anthony Kergosien, coordinator of MSF’s emergency response team in DRC. "We had to urgently send mobile response teams again to help stem the progression and save as many lives as possible."
In December, MSF sent a team to the Bogose-Nubea health zone in South Ubangi. The needs they found there were massive. In only a few weeks, we treated nearly 5,000 patients with measles, the vast majority of them children. We vaccinated 70,000 children, quickly halting the spread of the disease. The team then headed to the neighboring province of North Ubangi, where the Bosobolo health zone was also in critical condition.
"Since we arrived in Bosobolo in mid-February, we have been helping staff to care for their patients in eight health centers and in the general hospital to which complicated cases are referred," said Faustin Igulu, who leads the MSF project in Bosobolo. We are supervising provision of care, notably for patients with severe cases of measles, and have trained local staff on how to manage patients suffering from the disease.
“More than 1,200 patients have already been treated thanks to our support,” he added. "The hospital’s capacity had been quickly overwhelmed, so we increased the number of beds where they could treat children, some of whom were in a very advanced stage of measles and associated malnutrition."
MSF also launched a vaccination campaign for 66,000 children in this isolated health zone and the work is ongoing with a focus on those living in hard-to-reach areas. Our teams also trained local health workers in disease surveillance to improve the early detection of new measles outbreaks. However, like many other health zones in DRC, the resources available to local health authorities fall far short of what is needed.
“The local health authority only has one motorbike, and it doesn't work,” said Igulu. “How can they supervise vaccination activities? How can they bring vaccines to the most remote areas? It's very complicated."
The most contagious disease in the world
Measles is a viral disease spread by coughing, sneezing or through direct contact with nasal or laryngeal secretions. Children with the disease can face severe complications, as measles “erases” their immune memory, putting their health and lives at risk for years to come. An inexpensive and 85 percent efficient vaccine exists, which protects vaccinated people for decades.
“Measles is the most contagious disease in the world, nearly 10 times more than COVID-19,” said Kergosien. "Winning the fight in DRC against this killer will require a vaccine coverage of 95 percent with two doses per child, and regular mop-up campaigns to vaccinate those who slip through the cracks, including in the most vulnerable, difficult-to-access areas. But we are still very, very far from this."
A larger response is urgently needed
In Bosobolo, as in too many areas of DRC, the fight against measles sometimes feels never-ending. Efforts to curb the spread of the disease face enormous challenges. A national vaccination and surveillance program has been hampered by major weaknesses; a very high birth rate exposes new children to the disease every day; an under-equipped health system is unable to ensure consistent quality health care; and health providers trying to access certain regions must overcome entrenched geographic and security challenges.
Working to overcome these challenges is the key to tackling measles in the long-term. But right now, we must not lose sight of the urgent need for an immediate response to control transmission and save lives, said Kergosian.
"MSF teams have been deployed in North Ubangi, South Ubangi, Bas-Uélé, and Maniema provinces, but we sometimes feel quite alone in caring for patients and supporting local health teams. Given the current increase in cases, it is imperative to increase the emergency response."