A few weeks ago, I was invited to speak to an audience of mostly Latino residents in the Washington, DC, area about the COVID-19 pandemic. While many residents had questions about the evolving public health guidance, a few of them had questions about childhood vaccination requirements. They wondered why their children needed to be immunized against childhood diseases if classes were going to be held mostly online for the foreseeable future.
I explained to them that many children acquire childhood diseases in settings other than school, like day care facilities or when they are visited by or visiting friends and relatives. Most importantly, COVID-19 does not seem to be causing severe disease in children, but vaccine-preventable diseases like measles, mumps, rubella, and meningitis can be deadly. For that reason, we in public health recommend that children receive their immunizations on time even during the pandemic. The last thing we need is a combination of outbreaks of vaccine-preventable diseases along with the pandemic, stretching public and healthcare health beyond its breaking point.
For example, look at what is happening with measles. Even before the pandemic started, measles cases and deaths were on the rise worldwide. , in 2019:
Measles cases have continued to climb into 2019. Preliminary global data shows that reported cases rose by 300 percent in the first three months of 2019, compared to the same period in 2018. This follows consecutive increases over the past two years.
While this data is provisional and not yet complete, it indicates a clear trend. Many countries are in the midst of sizeable measles outbreaks, with all regions of the world experiencing sustained rises in cases. Current outbreaks include the Democratic Republic of the Congo, Ethiopia, Georgia, Kazakhstan, Kyrgyzstan, Madagascar, Myanmar, Philippines, Sudan, Thailand and Ukraine, causing many deaths – mostly among young children.
Over recent months, spikes in case numbers have also occurred in countries with high overall vaccination coverage, including the United States of America as well as Israel, Thailand, and Tunisia, as the disease has spread fast among clusters of unvaccinated people.
Measles is one of the world’s most contagious diseases, with the potential to be extremely severe. In 2017, the most recent year for which estimates are available, it caused close to 110 000 deaths. Even in high-income countries, complications result in hospitalization in up to a quarter of cases, and can lead to lifelong disability, from brain damage and blindness to hearing loss.
World Health Organization, “New Measles Surveillance Data for 2019”
The World Health Organization has now updated its surveillance data for 2019, and it shows an even more worrying picture. From 110,000 deaths in 2017, the year 2019 saw about 207,500 reported deaths from measles. :
Measles surged worldwide in 2019 reaching highest number of reported cases in 23 years. Highlighted in a publication by WHO and the United States Centers for Disease Control and Prevention (CDC), measles cases worldwide increased to 869 770 in 2019, the highest number reported since 1996 with increases in all WHO regions. Global measles deaths climbed nearly 50 percent since 2016, claiming an estimated 207 500 lives in 2019 alone.
After steady global progress from 2010 to 2016, the number of reported measles cases climbed progressively to 2019. Comparing 2019 data with the historic low in reported measles cases in 2016, authors cite a failure to vaccinate children on time with two doses of measles-containing vaccines (MCV1 and MCV2) as the main driver of these increases in cases and deaths.
World Health Organization, “Worldwide measles deaths climb 50% from 2016 to 2019 claiming over 207 500 lives in 2019”
The authors warn that the pandemic response must account for the disruption in the delivery of childhood vaccines:
Although reported cases of measles are lower in 2020, necessary efforts to control COVID-19 have resulted in disruptions in vaccination and crippled efforts to prevent and minimize measles outbreaks. As of November, more than 94 million people were at risk of missing vaccines due to paused measles campaigns in 26 countries. Many of these countries are experiencing ongoing outbreaks. Of countries with postponed planned 2020 campaigns, only eight (Brazil, Central African Republic, Democratic Republic of Congo, Ethiopia, Nepal, Nigeria, Philippines and Somalia) resumed their campaigns after initial delays.
WORLD HEALTH ORGANIZATION, “WORLDWIDE MEASLES DEATHS CLIMB 50% FROM 2016 TO 2019 CLAIMING OVER 207 500 LIVES IN 2019”
As , public health agencies are finding themselves fighting multiple public health threats simultaneously. States like and , and many others, continue to battle the epidemic of opioid use and overdoses. Natural weather disasters as . And diseases like Ebola -- which themselves pose a pandemic threat -- are .