User:Cazharrold/The Final Push

PHP 2013: The Final Push
Measles is a leading cause of vaccine-preventable childhood mortality and this is why there has been much emphasis put on the control and eradication of this infectious disease. In developed countries, vaccination rates have been high enough to make measles relatively uncommon, however there have been recent outbreaks in England and Wales during 2013 suggesting that vaccination rates are not at a level where the disease can be successfully controlled, thus contributing to the global burden of disease. In many developing countries, measles is highly endemic and there has been difficulty establishing control of the disease; especially in areas of high HIV prevalence as the vaccine is less effective in HIV-infected infants than in the general population. In both developed and developing countries, a mass catch-up campaign with an MR (measles and rubella) vaccine combined with the two-dose MMR vaccine keep-up program implemented in schools is what is needed to keep vaccination rates at a level where the disease is controlled successfully, and in some areas may even lead to eradication.

Epidemiology
Measles is a highly contagious disease that causes infection of the respiratory system in humans. It is caused by a virus that belongs to the genus Morbillivirus within the family Paramyxoviridae. The virus is spread by coughing and sneezing via close personal contact or direct contact with secretions and it has been found that 90% of people without immunity sharing living space with an infected person will catch it. Measles outbreaks can result in epidemics that cause many deaths, especially among young, malnourished children. In countries where measles has been largely eliminated, cases imported from other countries remain an important source of infection.

In 2011, the WHO estimated that there were 158,000 measles deaths globally – about 430 deaths every day, and that more than 95% of measles deaths occur in low-income countries with weak health infrastructures. Even though it can be seen that from “the combination of increased immunization coverage and the opportunity for second-dose immunizations [has] led to a 78% drop in measles deaths worldwide”, there are still issues where rates remain high, or drops in rates are not sustained. For there to be successful control and elimination of measles, there needs to be around 95% global vaccine coverage, due to the basic reproduction number of the virus. Being able to achieve this high level of coverage has been one of the main problems faced when trying to challenge this disease.

Global burden of disease
Even though measles may no longer be a leading cause of morbidity and mortality globally (between 1990 and 2010, its’ rank changed from 12th to 38th on the global disability-adjusted life year rank and from 19th to 62nd on the global death rank ), it is still a leading cause of vaccine-preventable childhood mortality for children aged under 5, and there are still high numbers of cases in particular countries in which vaccination coverage is poor. It can also be seen that in developed countries where vaccination levels are generally high; there can be epidemics that lead to a higher than average number of cases. For example, in March 2013 an epidemic was declared in Swansea, Wales, UK with 1,011 cases and 84 hospitalizations to date.

Current funding situation
In response to the global impact of measles the WHO created the fourth Millennium Development Goal, which aims to reduce the under-five mortality rate by two-thirds between 1990 and 2015. To be able to achieve this, the Measles & Rubella (M&R) Initiative was set up. The M&R Initiative is a collaborative effort of WHO, UNICEF, the American Red Cross, the United States Centers for Disease Control and Prevention, and the United Nations Foundation and it has been organizing and implementing mass vaccination campaigns from funding received from donors. Since 2001, with support from the M&R Initiative over 1 billion children have been reached through mass vaccination campaigns ― about 225 million of them in 2011. However, a sharp decline in donor commitment to implement periodic measles campaigns now threatens to reverse progress and potentially prevent the realization of the Millennium Development Goal.

Background
Due to the nature of the disease, global vaccination coverage needs to be around 95% and therefore funding must be prioritized to make sure that enough of the world’s population are vaccinated to meet this target and avoid increased numbers of cases in the future due to poor vaccine coverage now. However, there are difficulties in achieving this level of coverage due to factors such as people living in remote parts of endemic countries and are difficult to reach and vaccinate, the MMR vaccine controversy and claims that it is associated with autism, and mistrust within developing countries due to rumours that Westerners are secretly trying to sterilize Muslims and infect them with HIV.

Justification
The Final Push is an initiative to target the virus that causes measles which can be brought under control with an effective vaccine, the MMR vaccine. A very high level of global vaccine coverage is needed to achieve this and there needs to be more education around the controversies that are associated with this vaccine so that more of the world’s population are willing to be vaccinated. If these levels are not achieved, in future years to come there could be increases in the number of cases and deaths caused by measles.

Proposal
This project proposes to partake in a mass catch-up campaign in the UK and Africa with an MR vaccine for all children in between the ages of 7-18 years old combined with the two-dose MMR vaccine keep-up program for the next 10 years in both these regions, as this was found to be the most cost-effective way of dealing with epidemics and getting them under control. WHO doctors recommend the two doses of vaccine be given at 6 and 9 months of age in developing countries and so this will be the case in Africa, whereas in the UK the first dose will be given at 18 months of age and the second dose will be given at 4-5 years old. Two doses of the MMR vaccine are given because it was found that the vaccine effectiveness was 83.9% for 1 dose and 90.5% for 2 doses. Vaccinations completed in the UK will be done with a traditional needle, however vaccinations completed in Africa will be done with a microneedles patch due to the fact that it does not require a cold chain and can be administered by someone who does not need special training, therefore hoping to reach more people within each of the countries and spending less on transport and storage.

Goals
This proposal aims to reduce global measles deaths by at least 95% compared with the 2000 levels by the end of 2015, thus bringing it under control. This proposal also aims to achieve measles elimination in the UK and Africa in the next 10 years, and if it was then continued at a global scale, it aims to eventually lead to global eradication of measles. There is a suitable vaccine by which to do this, however, if it does not reach the suitable level of vaccine coverage, measles cannot be brought under long term control.