Transcript
Charlotte Nouette-Delorme, MSF Communications Advisor: Hi everyone. Today I’m going to be talking about measles. This highly contagious disease can cause deadly epidemics. Our teams are fighting the disease in the Democratic Republic of Congo, Niger, Nigeria, Chad and Yemen as I speak. The World Health Organization estimates that measles cases in Africa rose 700% between 2018 and 2019. Responding to an epidemic is a race against time requiring difficult choices. But to help you understand it all, let’s start with some facts.
Super: The Fundamentals
Charlotte Nouette-Delorme: Measles is a viral disease that affects young children. If complications occur, it can be fatal. In developing countries, when measles is combined with malnutrition or malaria, it’s effects can be devastating. But, thanks to a safe, cheap and effective vaccine, measles is a preventable disease. As part of the World Health Organization’s Expanded Program on Immunization, efforts have been made in the past 40 years to ensure the vaccine is accessible to all children. The results are undeniable, as measles-related deaths have decreased 84% since 2000. For the vaccine to protect a group, it has to be administered to over 90% of the children. This requires extensive, regular vaccination campaigns, with no gaps or interruptions, to avoid creating pools of unvaccinated children.
Super: So what's the problem?
Charlotte Nouette-Delorme: The problem is that this percentage is rarely attained. It requires the support of the population, which we know is declining in western countries, where some parents are refusing to have their children vaccinated. It also requires an effective vaccination campaign, and in the countries where we operate this isn’t always possible. The war in Yemen that began over four years ago has caused the collapse of the entire health system, and therefore its vaccination program. In Chad, Niger, and Nigeria, supply and cold chain issues, lack of staff and resources have all affected recent vaccination campaigns. As a result, epidemics that broke out in 2018 continue to claim lives.
Super: In the field
Super: In Democratic Republic of Cong, MSF teams contend with recurring epidemic outbreaks. During the first 5 months of 2019, MSF teams vaccinated over 360,000 children in DRC. In the Kasai region, in the centre of the country, their work is complicated by the large distances to be covered, the state of the roads, a scattered population, and the lack of medical facilities. Malnutrition and malaria badly affect children already weakened by measles. Other regions such as Katanga, have similar issues.
Super: The interview
Charlotte Nouette-Delorme: Taking action in contexts like these necessitates a series of strategic decisions.We have to react extremely fast and step in as early as possible.
Anne-Marie Pegg, MSF Head of Clinical Epidemic Response: In Katanga, MSF has launched a program supporting the Ministry of Health to improve their response to outbreaks, and ideally prevent measles epidemics. Unfortunately, when our teams arrive in a community, they often discover an epidemic has already struck.
Charlotte Nouette-Delorme: We have to rapidly establish the zones where we’re going to vaccinate.
Anne Marie Pegg: We prioritize our interventions in places with lots of complicated cases and relatively high mortality rates. We also prioritize areas around the outbreak, or areas with relatively low vaccination coverage or a higher percentage of vulnerable children.
Charlotte Nouette-Delorme: Then we have to be able to vaccinate the children who are most at risk.
Anne Marie Pegg: We’ve decided to vaccinate children under 5 years old because this age group represents a fairly large percentage of the region’s population. But it also ensures we’ll be vaccinating children who’ll be the most affected and most vulnerable to complications.
Charlotte Nouette-Delorme: We also need to be able to treat other diseases which aggravate the health of sick children.
Anne Marie Pegg: This area has several challenges in terms of access to medical treatment, especially for children. The idea behind our clinical program for treating measles is therefore to provide care to children who not only have measles, but are also malnourished or infected with malaria. But it’s also to treat children sick with other diseases because they’re just as vulnerable, especially in this region.
Charlotte Nouette-Delorme: Recurring measles epidemics present particular challenges for the teams. It’s not just a question of dealing with issues specific to the area, but also understanding why the disease keeps coming back. The teams in Katanga have to adapt their response to what they learned during the previous epidemic. They hope that setting up new early warning systems at specific sites will help them identify at-risk communities sooner, so they are not constantly chasing after recurring epidemics. Thank you for watching our video. Please share it on social media.