Measles in Africa: Operation “Great Catch-up” renewed to halt the fall in vaccination coverage

The long-distance race, started since 2023 in many African countries, will continue in 2024. After the fall in vaccination coverage against measles in particular, but not only, the World Health Organization (WHO) and Unicef ??have launched a “Great Catch-Up” campaign in April, led by the international GAVI-Vaccine Alliance coalition, to try to “restore the progress lost due to the Covid-19 pandemic”.

The challenge is to vaccinate 22 million children, including 6.1 million in Africa, who have not benefited from any vaccination in recent years against measles, a disease ten times more contagious than SARS-CoV-2. “An absolute priority” for Doctor Tedros Ghebreyesus, head of the WHO. The vast majority of these children live in Angola, the Democratic Republic of Congo (DRC), Madagascar and Nigeria, the latter country accounting for more than a third of the needs.

In this race, it is also a question of “catching up” those forgotten with the second dose, who remain vulnerable as long as they have not completed their vaccination schedule, while two injections are supposed to be given every 9 months of the child and between 15 months and 18 months. It is therefore the entire architecture of vaccination coverage on the continent which is today shaken, well beyond the most affected countries, with epidemic outbreaks in 28 countries and a sudden increase in mortality of at least 43 % in 2022, which mainly affects those under 5 years old.

Preventable deaths

In West and Central Africa, for example, the rate of administration of the first dose of the measles vaccine, already too low to ensure herd immunity, fell by two points, to 64%, between 2020 and 2022 A decline which resulted in epidemic episodes in 18 countries in the region. “These performances are insufficient to protect children and explain the persistence of the disease and these avoidable deaths, as well as the recurrence of epidemics,” analyzes Doctor Halima Dao, health specialist responsible for diseases preventable by vaccination at Unicef ??in this zone.

This sharp increase reveals the seriousness and long-term effects of the disruptions experienced by basic health services, destabilized by the response to the pandemic, which mobilized both financial and human resources. “Covid-19 has put a strain on our health systems, leading to many setbacks and even a drop in public confidence”, which has resulted in “a hesitation among communities to return to vaccination”, continues the doctor. Halima Dao.

In 2023, Operation “Grand Catch-up” therefore targeted the four countries already mentioned, to which were added Cameroon, Ethiopia, Somalia, Mozambique, Tanzania and Chad. “In order to protect as many children as possible, testifies Doctor Thomas Noël Gaha, vaccination manager for Unicef ??in the DRC, the target has been extended to 59 months (5 years). In humanitarian or difficult-to-access areas, vaccination can be carried out for up to 15 years depending on the epidemiological situation. And, thanks to everyone’s efforts, we were also able to carry out vaccination campaigns in the eastern provinces despite the security situation. » The DRC, which is currently completing the operation, has thus managed to “catch up” with more than 94% of “zero dose” children (1.2 million).

Restarting routine vaccination

The joint action of UN agencies and States also enabled the slow restart of routine vaccination. This had partly been interrupted by confinements or disorganized by the political instability of certain countries in the Sahel, Ethiopia, South Sudan, eastern DRC. Added to these troubles are the considerable floods experienced in the east of the continent. By the end of 2023, they had thrown at least a million people onto the roads in Kenya, Ethiopia and Somalia alone.

In 2024, GAVI will intervene again in twelve requesting countries: Burkina Faso, Ivory Coast, Eritrea, Ghana, Liberia, Madagascar, Mali (for rubella), Mauritania, Rwanda, Sierra Leone, Tanzania and Chad. Four other countries should be added to this list after study of their request: Guinea, Guinea-Bissau, Mozambique and Zambia.

The urgency of the situation led GAVI to exempt these countries from the obligation to co-finance the operation and to mobilize no less than 29 million dollars (26.7 million euros) to be able to offer the doses provided. Unused funds from the donation reserve of the international solidarity mechanism Covax, set up for the purchase of new vaccines against Covid-19, will be put to good use.

“One-off” help

This “one-off” aid is accompanied by technical support and the assurance that States present “solid vaccination programs which provide in particular for the evaluation of their vaccine stocks, the staggering of supplies so as to avoid waste “, warned the coalition, which brings together, in addition to the WHO and UNICEF, the Bill and Melinda Gates Foundation (partners of Le Monde Afrique), the World Bank, major international donors, and civil society actors. and players in the pharmaceutical industry.

But if the ambition of the “Great Catch-up” is to return as quickly as possible to pre-Covid levels of vaccination coverage and to generate new momentum, the States of the continent will have to make a significant effort to obtain immunity of 90 %, which allows the control of the disease. Especially since Africa is put in difficulty by the dynamism of its demographics, which is increasing faster than its health capacities, and civil status services which are still insufficient.

To help low-income states, the United Nations has authorized them to reallocate the remaining funds, initially intended for the Covid-19 response, to the restoration of their routine vaccination campaigns. But without strong political will from governments across the continent, measles and other preventable childhood diseases will continue to claim victims, primarily children.