Geneva, 24 May 2017 (PAHO/WHO) - The greatest challenge facing the Region of the Americas, now that measles and rubella have been eliminated, is to maintain this achievement and support other regions to accelerate the elimination of the two diseases and ultimately to achieve worldwide eradication, said Carissa F. Etienne, Director of the Pan American Health Organization (PAHO) during a technical briefing at the 70th World Health Assembly.
At the briefing, entitled "Reaching everyone, everywhere with life-saving vaccines," Etienne reported how the Region of the Americas eliminated these two diseases in recent years, and described the current challenges involved in maintaining that achievement.
In her presentation, the PAHO Director explained that the Region has suffered from measles outbreaks in the post-elimination era, all due to importations from other regions of the world where the virus still circulates widely. "The Brazilian outbreak was the first outbreak in the post-elimination era with more than 12 months of sustained transmission, putting in jeopardy the measles elimination goal," she reported, adding that it was thanks to the country's firm political commitment that the outbreak was halted. "In North America, vaccine hesitancy contributed to significant numbers of unvaccinated children, thus increasing the risk of endemic transmission of these diseases," she indicated.
In turn, World Health Organization (WHO) Director-General Margaret Chan said that when one speaks of the importance of disease prevention and innovation, one must remember that vaccines continue to be "the single and most cost-effective intervention that we have to prevent diseases." Many elements must be taken into account to implement the Global Vaccine Action Plan that the countries approved in 2012, she said. As examples, she cited thinking about the logistics of using innovative methods to distribute vaccines; collecting more robust data to promote the benefits of vaccination; and the need for political commitment by governments to the actions involved in carrying out vaccinations.
In recognition for Chan's work in promoting vaccines, Luis Sambo, Minister of Health of Angola, presented her with a special award, noting that "the global immunization community wishes to give you this award in recognition of your dedication to the vaccination plan. Thank you for your dedication."
The experience of the Americas
The PAHO Director explained that the Ministers of Health had committed themselves to eliminating rubella and measles from their countries by 2010. She explained that meeting those targets required strong political leadership, as well as the need for countries to take ownership of the idea and support it with financial resources and dedicated personnel, in order to reach the entire population.
Between 1995 and 2002, coverage of the MMR vaccine increased to 95%, through routine immunization programs and with mass campaigns throughout the Region. Cases were reduced as a result of these strategies. The last case of endemic measles was reported in 2002 in Venezuela, while the last case of rubella was reported in 2009 in Argentina.
Etienne underlined the impact of the campaigns carried out in connection with the Vaccination Week in the Americas, which helped to reach more remote populations. She also stressed the admirable role of health care workers, who took this goal on with such commitment, ensuring that everyone received their MMR vaccine dose, even in the most remote areas. The PAHO Revolving Fund for vaccine procurement, by helping the countries acquire vaccines at lower cost, was instrumental throughout the elimination effort: between 2004 and 2016, 544 million vaccines were purchased for 41 countries and territories.
The Region of the Americas was certified free from rubella in April 2015, and one year later was certified free of measles. Among the remaining challenges is that of maintaining the political and financial commitment needed to safeguard the elimination of these diseases. "We must remember that preventing an outbreak is much less costly and disruptive than dealing with it," said Etienne.
Other challenges to vaccination
Representatives of other WHO regions shared their experiences in overcoming various difficulties. The representative of Yemen explained how vaccination was being addressed in that country in the midst of an armed conflict, while the representative of Angola described strategies for reaching remote populations in efforts to eliminate vaccine-preventable diseases. The representative of Denmark spoke of the difficulties involved in introducing new vaccines, such as the HPV vaccine, and the doubts it raised among adolescents.
The GAVI representative pointed out that the advances in immunization in recent years have had mixed results. "There is much to celebrate, but at the same time, much remains to be done to prevent diseases through immunization," she said.