Q: What is the Measles Initiative?
A: The Measles Initiative, launched in 2001, is a long-term commitment and partnership among leaders in public health and supports the goal of reducing measles deaths globally by 90% by 2010 compared to 2000 estimates. . This goal is achievable but will require sustained effort to increase awareness, build capacity, and raise the necessary funds. The Measles Initiative includes partners from domestic and international organizations committed to reducing measles mortality. To harness this interest, the American Red Cross hosted the "Meeting for Measles Advocacy" in Washington, D.C. in January 2001 to bring the partners together and to formulate a strategy to turn their commitment into action. Most leading international public health agencies attended. One of the most significant results of the meeting was the formation of the U.S.-based Measles Initiative, a group that pledged to work together in partnership to significantly reduce measles mortality, and to advocate for sufficient funding and human resources to achieve that goal.

The Initiative has five main founding partners - the American Red Cross, the United Nations Foundation (UN Foundation), the United States Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), and the World Health Organization (WHO). Other key players in the fight against measles include the International Federation of the Red Cross and Red Crescent Societies, and countries and governments affected by measles.

Q: Why is the American Red Cross concerned about measles?
A: The American Red Cross charter (1905) says: "The purpose of this corporation shall be to carry on a system of national and international relief in mitigating the suffering caused by pestilence, famine, fire, flood and other great national calamities, and to devise and carry on measures for preventing the same."

Before the Initiative began in 2001, measles was the single leading cause of death due to infectious disease in Africa and is a leading vaccine-preventable cause of children's death in the world. Before introduction of the measles vaccine in 1962, essentially all children acquired measles and about five percent died from it. Measles can be particularly devastating during famines and to refugees and other displaced persons. With effective routine vaccination campaigns, the Western Hemisphere has essentially eliminated measles cases and deaths. In 2004, an estimated 410,000 children under the age of five died from the disease. Children in many developing countries are particularly susceptible due to poor health conditions and difficult living situations.

Q: What does measles look like?
A: Children usually do not die directly of measles, but from the complications which attack their already weak immune systems in the days following. Measles attacks the body, inside and out. It is similar to HIV in the sense that when it knocks down the immune system, the child becomes susceptible to the myriad of diseases festering in poor living conditions. While the typical red spots of a measles rash in developed countries may signal a mild disease, that same rash becomes a severe attack on all of a child's skin surfaces including the gut, cornea and lungs. The direct damage caused by measles can be high fever, peeling of the skin, and encephalitis leading to brain damage. The complications from measles are even more severe and can include blindness, severe diarrhea, malnutrition, and pneumonia. Measles is just one more assault on already unhealthy bodies.

Q: How does a child get measles?
A: Because measles is one of the most highly contagious diseases known and carried in the air, some susceptible children contract it in crowded places like a market or at school just by coming in brief contact with someone who has it. These children will develop measles within seven to 10 days. When these children are at home, they live in cramped quarters, many times sharing a bed with their younger brothers and sisters. Then, when their younger siblings become sick, they may be at particularly high risk of severe disease and death because of the large dose of measles virus they have contracted.

Q: Why should strategies to reduce measles deaths be such a high priority, when HIV is such a huge problem for other countries and continents?
A: It is true that HIV is a huge global problem. However, given that a safe, effective and relatively inexpensive measles vaccine exists, every child should have the right to be protected against measles.

The measles disease can be devastating to HIV-infected children. At the start of the Measles Initiative (2001), measles was the leading cause of death for children with AIDS who were not vaccinated. Since secondary diseases such as pneumonia and diarrhea can kill a child with measles, imagine what happens when a child with an already weakened immune system from HIV gets measles. If the Initiative can prevent children from getting measles, it removes the leading cause of death in these children. WHO and UNICEF have adopted a policy that all children living with HIV and AIDS MUST be vaccinated against measles. Except for those persons who are highly immuno-compromised, HIV infection is an indication, not a contra-indication for measles immunization.

Investing in the goal of reducing measles deaths provides a tool for strengthening national immunization programs and improving health systems for the long-term. This same health infrastructure will be beneficial to other health interventions and potentially to HIV.

When an HIV vaccine is available, the experience gained in sustainably reducing measles deaths can be used to develop appropriate vaccination strategies for preventing HIV infection.

Q: How will eliminating measles help children who are suffering from other diseases?
A: Since health resources for children are typically quite poor in developing countries, diseases 'compete' for these limited resources. So, when there are measles campaigns, measles wards empty and don't fill up again, and beds open up for children suffering from other diseases including HIV and AIDS. The Initiative effectively increases hospital capacity to treat more kids. Statistics show that after measles campaigns, within three weeks, hospital bed capacity increases 10-15%, due to the decrease in measles cases. Also, since thousands of volunteers are recruited during measles campaigns, these same volunteers help provide education and social mobilization for other diseases. After measles campaigns are complete, the same successful process and strategies can be instituted for other diseases.

Q: How do you know how many lives were saved/deaths averted based on the number of children vaccinated?
A: The World Health Organization makes estimates about the number of deaths present in any country for most causes, including measles. After measles campaigns, disease surveillance in the country provides an estimate of the decrease in deaths due to measles. Usually, this is a 100% decrease. Thus, the deaths prevented in the year following the campaign is equal to the number of deaths that WHO estimated to have occurred in the year of the campaign. Also, the impact of a particular campaign lasts for three or four years (until the next campaign). Thus, each year following the campaign, as long as in- country surveillance shows there to be a low level of cases, the 'lives saved/deaths prevented' number is equal to the WHO estimates of deaths in the absence of campaigns.

Q: Who pays for the vitamin A doses that are given to children under five years of age during campaigns?
A: The Canadian Government (Canada International Development Agency (CIDA) pays for all vitamin A used in campaigns, through UNICEF.

Q: How much has the Measles Initiative spent so far?
A: The cost of the Measles Initiative, years 1-5, was approximately $200 million. The cost to vaccinate a child against measles is less than U.S. $1!

Q: How much has the American Red Cross contributed so far?
A: The American Red Cross commitment to the Measles Initiative partnership through 2006 was $118 million. Funds were used for general vaccination campaign activities and for malaria research and keep-up programs. A large part of these funds were designated to tsunami-affected countries to provide emergency vaccinations and help to rebuild health infrastructure.

The Measles Initiative partners combined have committed more than $308 million from 2001-2006 to support campaigns in more than 43 countries in Africa and Asia.

Q: Why is measles such a concern during times of conflict, and in refugee camps?
A: Measles can be a particularly severe disease in conflict and refugee settings as victims may be nutritionally compromised and the health system may not be able to provide either prevention or treatment. A significant proportion of global measles deaths occur in countries experiencing complex emergencies or recovering from them.

Infection rates soar because damages to infrastructure and health services interrupt routine immunization. Malnutrition weakens the immune system and leaves people more susceptible to diseases and less able to fight the disease. A damaged water and sanitation system also contributes to both.

Refugees and internally displaced persons are often forced to relocate to camps frequently resulting in malnutrition and overcrowding.

In emergencies, immunizing children against measles is a priority preventative public health intervention.

Measles cases and deaths among refugees and internally displaced persons can be prevented through measles campaigns that are conducted as rapidly as possible. Well- planned measles campaigns have proven to be highly successful in complex emergencies.

It is critical to work with national authorities and partners to implement a measles control plan as rapidly as possible, ensuring high coverage and the maintenance of cold chain/logistics and immunization safety.

There has been considerable success in having "Days of Tranquility" during which conflicts have been temporarily stopped to allow health workers and the population to receive polio vaccination.

Q: How is the Measles Initiative funded?
A: The main mechanism for funding was created following discussions between the American Red Cross, the UN Foundation and the CDC. The UN Foundation matches CDC and American Red Cross contributions, up to $5 million each. Each organization committed the maximum amount bringing the first year total to $20 million.

Q: What are the roles of the five core Measles Initiative partners?
A: Each partner has several specific interests and competencies. Click here to read specific partner roles

Q: What is the long-term future of measles control?
A: WHO and UNICEF have developed the Global Plan for Reducing Measles Mortality 2006-2010. The current goal is to reduce global measles deaths by 90% by 2010 compared to 2000 estimates.

Q: Can I volunteer overseas?
A: The American Red Cross has many opportunities for volunteers in America who wish to help us inform their communities in the U.S. about the need for funding to pay for vaccinations. The Red Cross role in the Measles Initiative is to support private fundraising and advocacy efforts in the United States. We do not have opportunities to work short term in other countries on this Initiative, because there are many trained medical workers and ministry of health workers who live in-country and are certified to carry out the hands-on work of vaccinations and organizing the campaigns there. What they need most are funds to pay for the vaccinations.

You can make a difference by volunteering at your local Red Cross chapter. You can find your chapter by visiting www.redcross.org and putting in your zip code in the space on the left. We have a number of tools we can share with you in carrying out any volunteer efforts in your community.

Q: What are the Measles Initiative’s successes for the first five years?
A: To date, Measles Initiative partners have mobilized more than US $200 million to support the vaccination of more than 217 million children in over 40 countries, preventing an estimated 1.2 million deaths.

Global measles deaths have plummeted by 48%, from 871,000 in 1999 to an estimated 454,000 in 2004, thanks to major national immunization activities and better access to routine childhood immunization.. The largest reduction occurred in sub-Saharan Africa, the region with the highest burden of the disease, where estimated measles cases and deaths dropped by 60%.

Because of the Initiative’s success in supporting countries to carry out measles campaigns to reach the most at-risk children, other health interventions such as vitamin A distribution, insecticide treated net distribution to prevent malaria, polio vaccinations and de-worming medicine were added into some campaigns.

Q: The Measles Initiative originally gave measles vaccinations and vitamin A drops. Why were other health interventions such as malaria prevention and polio vaccine added?
A: The Measles Initiative strategy includes national vaccination campaigns for children during a period of up to two weeks. Such campaigns draw mothers and children from wide areas and offer one-stop shopping for much needed lifesaving health interventions for free. Because of the Initiative’s proven cost-effective and equitable strategy of implementing campaigns to reach more than 90% of the targeted population with vaccinations, other health interventions such as malaria prevention, polio vaccinations and de-worming medicine were added into some campaigns.

Q: Why is the Measles Initiative also combating malaria?
A: Nearly 1 million children under five years old die of malaria, Africa’s number one cause of child mortality. Ninety percent of deaths due to malaria worldwide occur in sub-Saharan Africa. The global Roll Back Malaria Partnership strives to halve the burden of malaria by 2010, and aims to have 60 percent of high risk populations (young children and pregnant women) sleep under the nets. So far this target has not been met, because people who are in greatest need are unable to access or afford a net- even at a cost of US $5.

Insecticide-treated nets are a key component in fighting death and illness due to malaria. In the largest integrated health intervention of its kind to date, the Measles Initiative evaluated a nationwide approach to combat malaria, the leading cause of childhood death in Africa, in Togo the week of December 13-19, 2004. More than 800,000 insecticide- treated nets were distributed during the campaign. Togo is one of four West African countries that will synchronize measles and polio vaccination campaigns in 2004. While several other countries will also distribute and provide other services in certain districts, Togo is the only country to date that has taken this integrated strategy to a national scale.

The Lawra District of Ghana was the first area to successfully integrate nets, having distributed 14,600 nets during a one-week immunization campaign in December 2002. Prior to the campaign, only 7 percent of families in Lawra District had a net. After they were given for free to any caregiver accompanying a child under five years old to the vaccination post, the coverage rate jumped to 80 percent.

In Zambia, during one week in June 2003, the Measles Initiative vaccinated 5 million children under five years old, while the International Federation of Red Cross and Red Crescent Societies and the Canadian Red Cross provided 90,000 nets in five districts. In these districts, household coverage increased from 29 percent (pre-campaign) to 85 percent, and measles vaccine coverage reached more than 95 percent. The cost of logistics for delivering a net was 32 cents and 36 cents in Ghana and Zambia, respectively.

Click here to read about malaria efforts

Q: What are the Measles Initiative’s current plans?
A: In 2005, the Measles Initiative completed its original plan and was able to implement vaccination campaigns in 40 sub-Saharan African countries, vaccinating 217 million children, and saving 1.2 million lives. Because of the Measles Initiative’s success in Africa, the program has expanded into Asia, where the measles burden remains high. There are more than 25 measles vaccination campaigns scheduled for 2006. Of these, approximately 10 will include the distribution of insecticide treated nets to help prevent malaria.

FUNDING:
Over the next five years, from 2005 to 2009, partners have pledged annual funding for the Measles Initiative: CDC $5 million and UNF approximately $10 million. The Global Alliance for Vaccines and Immunizations (GAVI) will contribute a total of $37 million. The total amount of mobilized resources is anticipated to be approximately $35 million annually. The American Red Cross will commit $5 million over five years, more based on the generosity of our partners and donors.

There is an ongoing and growing need for the unique non-financial contributions of Red Cross, such as coordination, communication and leadership. Tour support to national societies for social mobilization and in-country NGO leadership gives additional encouragement to donors of operational excellence.

Finally, integration of other health services into measles campaigns such as vitamin A, de-worming medicine, and insecticide treated malaria nets (ITNs) is being enthusiastically welcomed by existing and new donors.

Q: Can measles be eradicated?
A: Measles is one of the most infectious diseases known. Although great progress has been made, global measles eradication has not been achieved. Even if measles virus circulation were to be interrupted globally, it is unlikely that measles immunization could be discontinued. The overriding global goal is sustainable measles mortality reduction, meaning preventing measles deaths.

Q: What did the Measles Initiative do to help families affected by the tsunami?
A: To help prevent measles outbreaks and child deaths after the December 2004 devastating tsunami, the Measles Initiative partners developed a two phased plan consisting of emergency response and long-term rebuilding of immunization programs throughout some affected areas including Somalia. The American Red Cross committed $35 million to the United Nations Foundation (UN Foundation) to support the plans developed by the Measles Initiative.

Emergency activities in Aceh included measles vaccination and vitamin A for all displaced children from nine months to 15 years of age. The Measles Initiative partners worked closely with the Indonesian Red Cross to support the Indonesian Ministry of Health in rebuilding the devastated immunization programs through replenishing destroyed vaccine storage and logistical equipment and implementing a catch-up measles campaign for all affected children.

The children of Sumatra are especially at risk from measles. Years of civil strife contributed to low vaccination coverage in Aceh and crowded conditions in camps for Internally Displaced People allows measles to spread rapidly. Last year, Sumatra had an estimated 10,000 measles deaths with an estimated 1,000 deaths in Aceh alone. Since the tsunami hit, 20 measles cases have been reported in Aceh.

Measles and other infectious diseases such as malaria and dengue fever present an imminent and long-term threat to tsunami survivors. Three main factors contribute to the illness and death from disease after a disaster:

• Crowded areas such as refugee camps contribute to the spread of disease and increased transmission. Measles is the most contagious disease known and can be transmitted quickly through airborne droplets from person to person.
• A breakdown of existing health services impedes prevention of diseases and an inability to treat diseases. If not treated early, people and especially children can die from diseases like measles and malaria.
• Malnutrition weakens the immune system and leaves people more susceptible to diseases and less able to fight the disease. A damaged water and sanitation system also contributes to both.

Q: When measles was prevalent in the United States, why did American children have a better outcome than children in developing countries?
A:

1. Some American children did die of measles. In 1990, more than 100 American children died of measles
2. American children are healthier to begin with, particularly their vitamin A status
3. There are fewer exposures to the follow-on (sequelae) diseases - bacterial pneumonia and diarrheas
4. There is better access to health care - particularly antibiotics for sequelae diseases
5. American doctors are better trained and know how to recognize impending serious situations
6. The initial exposure (viral load) is lower in the U.S. because of brief exposure, for instance at a school as opposed to heavy exposure (such sleeping in the same bed as many children do in other countries)
7. American parents are better informed and know not to do harmful ritualistic things (such as withholding food) from their sick kids
8. Even when parents from measles burdened countries know what to do, they lack the resources to do it (such as giving their children clean water, treating fevers, transportation to hospital)

Q: In the United States, children are given a combined vaccination including measles, mumps and rubella. Why does the Initiative only give the measles vaccine?
A: The Measles Initiative follows the recommendations given by the participating countries as to which vaccinations to use. The scientific reason as to why the rubella vaccine is not used is complex, but these recommendations are endorsed by WHO and UNICEF. In these countries, rubella and mumps are much less of a problem than measles.

Q: Why is the Measles Initiative also combating malaria?
Click here to read more about malaria efforts

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