The recent U.S measles outbreak that began in California and subsequently spread to 16 states and the District of Columbia shows that the progress that has been made towards measles elimination can easily be lost without continuing vigilance about the disease. The measles outbreak also is a wake up call about the interconnectedness of our world and the importance of taking a global approach to infectious diseases and immunization programs. Georgia’s global health organizations are already playing central roles in both these areas. An alliance among these organizations could help strengthen this work and move us closer to a world in which measles doesn’t exist.
The entire western hemisphere was declared measles-free early in the 21st century. The United States and other countries had reached this point by ensuring ready access to immunizations and instituting mandatory immunization requirements for students in schools. Large-scale immunization campaigns also have been effective in ensuring children in other countries are protected against a range of infectious diseases. But although measles has been officially eliminated from the western hemisphere, small measles outbreaks have occurred annually in the United States due to importations of the disease from other parts of the world. These events and last year’s Ebola outbreak remind us of the significant challenges in eliminating infectious diseases that easily cross national boundaries.
Despite the significant media attention that the recent U.S. measles outbreak has generated, there have only been 141 cases in the United States and no deaths have been reported. This compares starkly to the 146,000 deaths that occur each year globally from measles, mostly in India and sub-Saharan Africa where many children are still not vaccinated against the disease. Measles is the most contagious and lethal disease known to man. It strikes children with a speed and precision unrivaled by most any other infectious disease. Introduce measles to a classroom of unvaccinated children and more than 80% will become ill one incubation period later. Until a vaccine became available in 1963, at least 3 million people, mostly children, died each year worldwide from measles. The disease was once so feared in parts of Africa that parents would wait to name their children until they had survived the disease. Since the 1960s, immunization programs have reduced measles deaths by more than 90 percent in Africa and nearly 100 percent in the United States.
The prospect for global measles eradication was first suggested in a manuscript published in The Lancet in 1982. Like smallpox, it was believed that the widespread use of an inexpensive, and effective measles vaccine could eliminate measles. Each of the World Health Organization’s (WHO) six regions has since set a goal of eliminating the disease by 2020. While substantial progress has been made, the biology of the disease and other factors including anti-vaccine sentiment in the United States and other countries have posed barriers to the effort.
Success of measles immunization programs has depended on achieving “herd immunity” in which at least 95 percent of the population is protected against the disease. This can only be achieved if a very high proportion of the population receives two doses of measles vaccine. Measles has one of the highest thresholds for “herd immunity” because it is so contagious. Measles has likely gained a foothold again in the United States because “herd immunity” for measles has been breached in some areas. There aren’t enough vaccinated people to protect those who have not have not been vaccinated. While there are many reasons children might not be vaccinated, public health experts believe the anti-vaccine movement play a large role in the loss of “herd immunity.” Global measles elimination, however, will require more than just achieving “herd immunity.” Political will, persistence, and additional funding also are needed to fill the gaps in immunization coverage in the United States and the developing world.
Georgia has a robust community of organizations that could be marshaled to help address the “last mile” of global measles elimination. The Centers for Disease Control and Prevention is actively involved with WHO in implementing measles immunization programs. Other organizations such as The Task Force for Global Health, which played a central role in increasing global immunization coverage for children in the 1980s, has deep experience with immunization programs focusing on other vaccine-preventable diseases including cholera, polio, and influenza, as well as measles and rubella. Several other Georgia global health organizations also are active in the vaccine space; they are working to develop new vaccines for HIV and other infectious diseases, and increase access to vaccines against cancer-causing diseases such as hepatitis B and human papillomavirus.
Georgia’s global health organizations frequently work together, but opportunities exist for more frequent, sustained, and structured collaborations to focus on issues such as immunizations and measles elimination. In Washington State, 63 global health organizations have formed an alliance to mobilize the sector and increase impact. Last year, the Washington Global Health Alliance (WGHA) helped save two important funding sources for life science research and global health programs from state budget cuts. WGHA members also have been speaking out in significant numbers about limiting exemptions for immunizations, which has contributed to the U.S. measles outbreaks. An alliance similar to WGHA among Georgia’s global health organizations would have the firepower to positively affect a broad range of global health issues including the global measles immunization effort. WGHA has demonstrated that working together on important global health issues creates greater efficiency and decreases competition for scarce resources, resulting in outcomes that organizations could not achieve on their own.
Efforts are underway to understand how a Georgia Global Health Alliance (GGHA) could develop and operate. WGHA recently received a grant from the Robert Wood Johnson Foundation to analyze its “global-to-local” formula for creating a regional global health alliance and provide other areas of the country with guidance on how to replicate its model. Several Georgia global health organizations are currently working together to partner with WGHA and learn about its model of collaboration. WGHA’s experiences in leveraging partnerships, raising community awareness, and supporting creative solutions to address local and global health challenges will be relevant to understanding the potential impact of a GGHA on global health issues such as immunizations and measles elimination.