Major disruptions in the healthcare systems in West Africa caused by Ebola could trigger a jump in measles cases and deaths among children in the region.
In spite of the success of vaccination programs in past decades, the current Ebola outbreak has left many children unvaccinated for measles and other preventable diseases.
If this trend continues, researchers estimate that within 18 months an additional 100,000 children between the ages of 9 months and 5 years could develop measles. This would likely cause between 2,000 and 16,000 additional deaths from the disease.
These results, published March 13 in the journal Science, represent the researchers’ worst-case scenario. The estimate is based on the healthcare systems being disrupted by 75 percent. But even a smaller disruption could lead to illnesses and deaths that would otherwise be prevented with vaccination.
“Regardless of the exact number, the solution is clear,” said study leader Justin Lessler, an assistant professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, at a press conference on Wednesday. “Supplemental immunization campaigns have been successfully performed in all three countries in the past, and could virtually eliminate Ebola’s effect on measles risk in the region.”
Ebola Crisis Threatens Vaccination Programs
Over the past two decades, efforts to immunize children in West Africa have led to dramatic decreases in the number of measles cases in the region. Infections have dropped from more than 93,000 between 1994 and 2003 to slightly less than 7,000 between 2004 and 2013.
These gains could be lost in the wake of the Ebola outbreak. According to the World Health Organization, more than 14,400 cases of Ebola have been confirmed in Guinea, Liberia, and Sierra Leone, with 10,000 deaths blamed on the disease.
As the crisis in the region continues, there is some evidence that in certain areas people have already stopped using healthcare services. Of particular concern is the decline in the number of women attending postnatal clinic visits. This is a time when infants receive their initial vaccinations — although the measles vaccine is given when children are a bit older.
The researchers estimate that, before the current Ebola outbreak, about 778,000 children between 9 months and 5 years old in the three countries had not been vaccinated against measles. After 18 months of disruption to the healthcare system caused by the outbreak, this could jump to more than 1 million children.
While it will take years to learn the full impact of Ebola in these countries, researchers often see measles as an aftershock of turmoil in any country.
“Measles is one of the first ones in the door when anything happens,” said Lessler, “whether it is political unrest, a crisis like Ebola, or a natural disaster that causes vaccine rates to go down.”
Measles has swept through Syria during the country’s ongoing civil war. And in the 1990s, after political unrest in Haiti, the proportion of deaths caused by measles increased from 1 percent to 14 percent.
Rebuilding a Resilient Healthcare System
The researchers only looked at the potential for a measles outbreak, but other vaccination programs could be affected as well. This includes vaccination efforts to eradicate polio and protect children from whooping cough, hepatitis B, and diphtheria.
Recovering ground lost in the fight against measles will require new vaccination campaigns. Researchers say campaigns were derailed when the Ebola outbreak started in December 2013. The road forward, however, will not be easy.
“These campaigns are extremely logistically complex,” said Lessler. “So they take a while to organize, and everybody has rightly been focused on controlling Ebola recently.”
The healthcare system in West Africa will also need to be rebuilt from the ground up. Not only to head off another Ebola outbreak, but also to boost the use of basic preventative healthcare.
According to the UK-based Institute of Development Studies, a key step in this process of rebuilding is the investment of more resources by governments and the international community.
Another hurdle standing in the way of a resilient healthcare system is the low doctor-to-patient ratio in West African countries. The ratio was subpar even before many health workers died in the Ebola outbreak.
It’s tempting to focus on increasing the number of doctors, but this is hardly a short-term fix. Some experts also say that, for many health problems, other approaches are more effective.
“The diseases that have the highest burden in Sierra Leone, like malaria and diarrhea and pneumonia, don’t need a doctor. They need a community health worker or a nurse,” said Rachel Glennerster, executive director of the Abdul Latif Jameel Poverty Action Lab. “A community health worker can be trained more quickly and is more likely to be around in the community when someone needs her.”
Clinics will also need to regain the trust of people in the community. This includes enticing mothers to bring their children to be vaccinated.
“There is good evidence that people underinvest in preventative health in general, and small costs — walking to the clinic, for example — can make people procrastinate, put it off till tomorrow,” said Glennerster. “The uncertainty about Ebola is likely to make this worse. A small incentive can tip the balance and make more people go.”