Measles and rubella elimination: learning from polio eradication and moving forward with a diagonal approach

Abstract

In 1988, an estimated 350,000 children were paralyzed by polio and 125 countries reported polio cases, the World Health Assembly passed a resolution to achieve polio eradication by 2000, and the Global Polio Eradication Initiative (GPEI) was established as a partnership focused on eradication. Today, following eradication efforts, polio cases have decreased >99% and eradication of all three types of wild polioviruses is approaching. However, since polio resources substantially support disease surveillance and other health programs, losing polio assets could reverse progress toward achieving Global Vaccine Action Plan goals. Areas covered: As the end of polio approaches and GPEI funds and capacity decrease, we document knowledge, experience, and lessons learned from 30 years of polio eradication. Expert commentary: Transitioning polio assets to measles and rubella (MR) elimination efforts would accelerate progress toward global vaccination coverage and equity. MR elimination feasibility and benefits have long been established. Focusing efforts on MR elimination after achieving polio eradication would make a permanent impact on reducing child mortality but should be done through a 'diagonal approach' of using measles disease transmission to identify areas possibly susceptible to other vaccine-preventable diseases and to strengthen the overall immunization and health systems to achieve disease-specific goals.

Keywords: Elimination; eradication; immunizations; measles; polio; rubella; vaccine-preventable diseases.

Figure 1.

Annual expenditures of the Global Polio Eradication Initiative (GPEI), Measles & Rubella Initiative (M&RI) and Gavi, the Vaccine Alliance* (Gavi), 2001–2016. Data sourced from: http://polioeradication.org/Financing. http://measlesrubellainitiative.org/. Midterm Review of the Measles and Rubella Global Strategic Plan, 2012–2020. *Represents measles-related Gavi expenditures. Not shown here, approximately US$800 million available to Gavi-eligible countries during 2016–2020, approved by the Gavi Board in December 2015, as part of a new Gavi comprehensive measles and rubella strategy.

Figure 2.

Global reduction in estimated measles deaths* and annual expenditures of the Measles & Rubella Initiative (M&RI) and Gavi, the Vaccine Alliance** (Gavi), 2001–2016. Data sourced from: MMWR Morb Mortal Wkly Rep. 2016;65:1228–33. Midterm Review of the Measles and Rubella Global Strategic Plan 2012–2020. *In 2010, the World Health Assembly established three milestones for measles control by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine for children aged 1 year to ?90% nationally and ?80% in every district; 2) reduce global annual measles incidence to <5 cases per million population; and 3) reduce global measles mortality by 95% from the 2000 estimate. **Represents measles-related Gavi expenditures. Not shown here, approximately US$800 million available to Gavi-eligible countries during 2016–2020, approved by the Gavi Board in December 2015, as part of a new Gavi comprehensive measles and rubella strategy.