Rwanda's measles-rubella vaccination campaign, which is being launched today, is the beginning of an effort to vaccinate more than 700 million children under 15 years of age against two disabling and deadly diseases.
The combined measles-rubella vaccine will be introduced in 49 countries by 2020 thanks to financial support from the GAVI Alliance. The support builds on the efforts of the Measles & Rubella Initiative (M&RI) that have helped countries to protect 1.1 billion children against measles since 2001.
Rwanda, which is already effectively controlling measles, becomes the first sub-Saharan African country to provide measles-rubella vaccine nationwide with GAVI support. The vaccine will not only stop the transmission of rubella from mother to child, preventing children being born with severe birth defects, but also protect children against measles, which is highly contagious.
Full immunisation package
"Rwanda has made great strides over the past four years in child survival by introducing vaccines against leading child killers, including pneumonia and diarrhoea," said Dr Agnes Binagwaho, Rwanda's Minister of Health. "The introduction of the combined measles-rubella vaccine is one more important step to ensuring that all children in Rwanda receive the full immunisation package. In our efforts to eliminate measles, we have raised measles coverage through campaigns and routine immunisation to higher than 95%."
Starting in Rwanda, GAVI-funded rubella vaccines, an underused vaccine, will benefit women's and children's health. In pregnant women, rubella can lead to miscarriage or severe birth defects, including blindness, deafness and heart problems. The combined measles-rubella (MR) vaccine provides a 2-in-1 shot against these two diseases and will accelerate global efforts to control rubella and measles.
No child is missed
Rwandan health workers will vaccinate close to five million children between the ages of 9 months and 14 years during the four-day measles-rubella vaccination campaign, which begins today in a village outside Kigali. All children under age 5 will be vaccinated at Rwanda's health centres and school-aged children will be vaccinated in schools. Community health workers, present in every village, will do their best to ensure no child is missed.
Five other countries - Bangladesh, Cambodia, Ghana, Senegal and Viet Nam - are expected to introduce the MR vaccine through vaccination campaigns with GAVI support by the end of 2013.
"One step closer to every child everywhere immunised"
"Investing in rubella will provide a much-needed boost to improving women's and children's health in poor countries. GAVI's support for measles-rubella campaigns will help accelerate global progress in controlling two life-threatening diseases," said Dr Seth Berkley, GAVI Alliance CEO. "Rubella vaccine has been available since the 1970s in many parts of the world. Accelerating the introduction of rubella vaccine in developing countries will spread the benefits of the vaccine to those in most need and build on country efforts to control measles with a cost-effective combined vaccine. It brings us one step closer to ensuring that every child everywhere is fully immunised."
"The introduction of measles-rubella vaccine leads to several critical outcomes for children's health. Infants won't be born with the blindness, deafness and heart defects associated with congenital rubella syndrome (CRS), and, through high vaccination coverage, countries can reduce and even eliminate measles, rubella and CRS," said Dr. Susan Reef, the US Centers for Disease Control and Prevention rubella expert and member of the Measles & Rubella Initiative.
The measles-rubella vaccine offers protection against two unrelated diseases which cause some of the same symptoms and are frequently confused with each other. In their common form, both viruses cause a rash and fever. Measles can be deadly for children with poor nutrition and weakened immune systems. The virus still causes about 430 child deaths every day worldwide, mainly in developing countries.
The introduction of measles-rubella vaccine leads to several critical outcomes for children's health. Infants won't be born with the blindness, deafness and heart defects associated with congenital rubella syndrome
Dr. Susan Reef, US Centers for Disease Control and Prevention rubella expert
Rubella, also known as "German measles", is also very contagious but causes relatively mild disease in children. More than 100,000 children are born with the birth defects, known as Congenital Rubella Syndrome (CRS), each year - of which 90,000 live in GAVI's eligible countries.
Need for rubella vaccine
Countries' efforts to vaccinate children have reduced measles deaths globally by 71% from 2000-2011, from an estimated 548,000 to 158 000 deaths with support from the M&RI.
As countries reduce measles and improve laboratory identification of the disease, cases of rubella - which in the past may have been mistaken for measles - begin to emerge, demonstrating the need for rubella vaccine.
Rwanda, for example, has reduced measles deaths to zero through high routine immunisation coverage and three measles vaccination campaigns supported by the M&RI.
Safe and cost-effective
GAVI is investing more than US$ 600 million in the fight against measles and rubella through large-scale campaigns. GAVI's financial support for the Rwandan campaign totals close to US$ 7 million, of which US$ 3.5 million is for the vaccines (including syringes and safety boxes) and US$ 3.3 million to cover the campaign's operational costs.
GAVI will also support the introduction of the MR vaccine in Rwanda's routine immunisation programme in January 2014. The MR vaccine is considered safe and cost-effective at around 50 cents per dose - about 25 cents higher than measles vaccine alone.
Africa, highest number of CRS cases
Thanks to widespread vaccination, rubella is no longer the threat it once was in many countries. But for millions of mothers and their children in poorer countries, rubella poses an ongoing danger. Africa and Southeast Asia have the highest number of estimated CRS cases and the lowest uptake of rubella-containing vaccine. The human and economic toll of rubella in those regions is staggering.
"GAVI funding for measles and rubella vaccine campaigns will help countries to rapidly scale up introduction of rubella vaccine, and protect women and children," said Dr. Louis Z. Cooper, Professor Emeritus of Pediatrics at Columbia University and past President of the American Academy of Pediatrics. "In fact, every day of delay means approximately 300 newborn children enter the world with life-altering disability because of rubella infection in pregnancy. With the technical know-how available, we have a chance to make history by eradicating measles and rubella once and for all."
Measles kill an estimated 430 people - mainly young children - every day. In 2000, about 548,000 children died from measles, whose symptoms include a high fever, severe skin rash, and a cough. At least 90% of children must be covered with measles vaccine to protect communities against measles.
The M&RI continues to support country efforts to raise measles and rubella vaccination coverage and plans to financially support 16 measles campaigns in 2013. It will provide technical support to GAVI-funded MR campaigns and introduction of MR into routine vaccination programs.
GAVI is funded by governments [Australia, Canada, Denmark, France, Germany, Ireland, Italy, Japan, Luxembourg, Netherlands, Norway, Republic of Korea, Russia, South Africa, Spain, Sweden, United Kingdom, United States], the European Commission, the Bill & Melinda Gates Foundation, as well as private and corporate partners [Absolute Return for Kids, Anglo American plc., The Children's Investment Fund Foundation, Comic Relief, Dutch Postcode Lottery, His Highness Sheikh Bin Zayed Al Nahyan, JP Morgan, "la Caixa" Foundation, LDS Charities and Vodafone].