Impact of COVID-19 on measles vaccination

21 February, 2021

Dear HIFA and CHIFA colleagues,

Below are the citation and selected extracts of a Comment in The Lancet Global Health, and a comment from me.

CITATION: Comment| The Lancet Global Health volume 9, issue 3, e223-e224, march 01, 2021

Measles: the long walk to elimination drawn out by COVID-19

Etienne Gignoux, Linda Esso, Yap Boum

March, 2021 DOI:

At the end of 2020, WHO warned that the target set by the World Health Assembly to eliminate measles in five of six WHO regions would not be met. Despite an improvement in vaccination coverage and a decrease in the incidence from 145 to 120 cases per million population between 2000 and 2019, we are far from the elimination target of maintaining less than 1 case per million nationally. The low vaccination coverage and still high incidence of measles translates to an estimated 207 500 measles deaths in 2019. More worrying, the situation had worsened compared with 2016, when only 18 cases per million had been reported.

The COVID-19 pandemic has also worsened the implementation of immunisation campaigns. We are likely to see increasing numbers of unimmunised children susceptible to measles and increasing numbers of measles case fatality ratios that create an environment for measles to return in 2021. These potential measles outbreaks will take us back to decades ago with increased mortality and serious consequences of measles.2 To prepare for the post-COVID-19 era and to move towards measles elimination, there are five actions that need to be taken by countries and the international community. First, provide leadership and management training to the EPI teams to adequately use strategic problem solving, political advocacy, and other tools to find innovative and homegrown solutions to prevent measles in the post-COVID-19 era. Second, African countries should track progress using a scorecard developed by Wariri and colleagues and report yearly progress to WHO and Africa Centres for Disease Control and Prevention for a concerted effort. Third, reach unimmunised children through catch-up vaccination schedules and campaigns, including supplementary immunisation activities. Fourth, prepare for the expected outbreaks in 2021 using lessons learnt from ongoing pandemics. Fifth, do not lose sight of measles and rubella elimination targets and implement the new Measles and Rubella Strategic Framework 2021–2030.

Oghenebrume Wariri and colleagues provide a detailed overview of the situation in 15 west African countries... 80% countries are off-track to achieving measles elimination milestones; however, Cape Verde, The Gambia, and Ghana have made substantial progress.

Comment (NPW): The true impact of COVID on child vaccination and vaccine-preventable disease will not be known for years. Are HIFA/CHIFA members aware of actual and predicted impact in this area? For example, what do we know about COVID and current access to immunisation services?

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Best wishes, Neil

Coordinator, WHO-HIFA Collaboration: HIFA project on Essential Health Services and COVID-19

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: