Consider these unsavoury facts. Nearly half of all deaths due to measles occur in India. While overall mortality due to this scourge fell between 2000 and 2010 by 74 per cent worldwide, the decline in India was a mere 26 per cent. While, globally, 85 per cent children received protection against measles through routine vaccination, in India this coverage has been far lower, at less than 75 per cent. Overall, India’s record in measles control is poorer than Africa’s. Given that these are the findings of a research study carried out by the World Health Organisation (WHO) in collaboration with a couple of health-related think tanks and published in the foremost medical journal, The Lancet, they merit serious attention. On the whole, this is a sad exposé of the state of India’s public health services, especially the Universal Immunisation Programme. If the deaths of children due to measles and other vaccine-controllable diseases are allowed to continue unabated, India is certain to miss, by a wide margin, the Millennium Development Goal of reducing child mortality by two-thirds by 2015.
Measles is a highly contagious viral disease that is transmitted somewhat like the common cold. It can, therefore, spread very fast, especially in densely populated living areas and among the poor and underfed, not adequately served by the public health system. The ongoing outbreak of measles in Odisha’s Rayagada region is typical. The worst-hit pockets are those where the vaccine coverage is poor and children’s immunity level is low due to rampant malnourishment. Mercifully, fatalities are normally only around 10 per cent. But the disease often leads to several other complications which can be extremely debilitating, even deadly. These include encephalitis (which causes brain swelling), severe diarrhoea, pneumonia, even blindness. That seems why measles has been rated by the WHO as one of the leading causes of deaths of children below the age of five in developing countries with a poor public health record.
This, sadly, is so despite the availability of highly effective and low-cost measles vaccines. Certain blunders committed in the past have cost India dearly. Though the Expanded Programme on Immunisation was launched in 1978, measles was excluded from it under the misplaced belief that it was not a formidable menace. Even subsequently, on the introduction of the Universal Immunisation Programme against several vaccine-preventable diseases, including measles, in 1985, only a single dose of measles vaccine was deemed sufficient — though nearly 15 per cent of children fail to acquire sufficient immunity from it. The much-needed second dose was finally introduced in 2010, but only in about 20-odd better-performing states. Many developing countries have made significant strides in measles control by following a multi-pronged strategy: two-dose based universal vaccination; supplementary doses where necessary; enhanced surveillance; and proper case management. India, too, has successfully tried out such a strategy with polio. It is not too late to make a similar and sustained effort to combat measles.
