In Covid wake, India caught off-guard over measles outbreak; exposes fragility of health system

Interestingly, strategies employed during the Covid pandemic are being replicated. Much like the Cowin app was used to track and monitor Covid vaccinations, the Indian government plans an app to monitor every eligible child to ensure that they are up to date with their vaccination schedules

Nilova Roy Chaudhury Dec 23, 2022
Maharashtra Measles (Photo: Twitter)

The horrific Covid-19 pandemic, which effectively wiped out millions of people and 30 months of normal activity and development, appears to be receding in India even as the world looks on warily at reports of the virus mutating, again, to devastating consequences in China. Though India has returned to some normalcy, having contended with the coronavirus through a largely successful nationwide vaccination effort, it now finds itself confronting an alarming threat from the collapse of other basic health parameters.

The Covid pandemic primarily afflicted the older and above-infant level segment of the population, disrupting routine immunization schedules of those newly-born, leaving them prey to deadly diseases like measles, which has made an unwelcome resurgence across the globe and hit India hard.

Health workers across India are scrambling to contain the outbreak of measles among the population aged under five, for whom the disease, typically accompanied by a fever, cough and a distinctive maculo-papular rash, can be fatal. Over 25,000 cases of measles and 1,965 cases of Rubella, a related, more virulent form of viral disease, have been reported in 2022. The worst-hit states have been Bihar, Gujarat, Haryana, Jharkhand, and Maharashtra, but even states like Kerala, widely seen as the best-performing state on vital health parameters, including maternal and child immunizations, have seen localised outbreaks of the highly contagious disease.

Measles, a viral disease that afflicts children and has no cure, can be totally prevented through routine immunization. However, the Covid pandemic threw the regular immunization schedules awry in 2020 and 2021, leading to a resurgence of the disease.

Realising the depth of damage that measles can cause among those below five and the ease with which it can be prevented, the Indian government has targeted the end of 2023 to eliminate measles. Like polio and tetanus, measles will be eradicated, health authorities have pledged, by this time next year.

Measles, a completely preventable disease with just two shots of the vaccine providing lifelong immunity, had been largely brought under control in India, which has among the world’s largest public health immunization programmes. However, the programme stumbled and fell behind in vaccinating infants when the primary focus of the nation’s health administration shifted to containing Covid.

Vaccination delays

The severity and longevity of the Covid pandemic caught the country’s health authorities off-guard, allowing measles, also a highly contagious virus, to enter and catch the infant population in congested areas, including in the financial capital Mumbai, in a deadly grip. At least 43 children have died, 13 of them in Maharashtra, in the current measles outbreak.

While measles is easily preventable through routine MR (measles and rubella) vaccinations, a 95 per cent coverage rate is needed to halt community spread. In India, An estimated 25 million infants are estimated to have missed their first dose in the past two years. Only Nigeria has reported more children left out of immunization coverage. 

According to the health authorities, the outbreaks reported from around 143 worst-hit areas across India have been because of delays in regular vaccination schedules and the migration of large numbers of people because of Covid lockdowns.
The measles outbreak was worst in areas that used to be polio-endemic. Indian health authorities, therefore, appear confident they would be able to tackle, overcome and eradicate measles completely.

Learning from Covid

Interestingly, strategies employed during the Covid pandemic are being replicated. Much like the Cowin app was used to track and monitor Covid vaccinations, the Indian government plans an app to monitor every eligible child to ensure that they are up to date with their vaccination schedules. 

As with Covid, religious community leaders are being roped in to urge their communities to get children vaccinated. Because of the success of the Covid vaccination programme, health authorities believe there is less vaccine hesitancy now and far greater acceptance, even among those afflicted, surrounding the efficacy of vaccinations.

Calling measles a “tracer” of the strength of a country’s immunization system, Unicef’s Dr Ashish Chauhan said, “When immunization coverage is low, measles is the fastest vaccine-preventable disease to return.” Dr Veena Dhawan, Additional Commissioner (Immunization) in the Ministry of Health and Family Welfare (MoHFW) admitted, “States have launched catch-up campaigns to prevent a backslide on routine immunization coverages.”

It is a sad reflection of the fragility of India's already challenged health system that the decline in primary vaccine coverage, weakened vaccination surveillance systems, and continued interruptions and delays in immunization schedules due to COVID-19, have caused this resurgence of a very preventable disease.

While precious lives have been lost, this need not, and must not, recur, particularly if India wishes to showcase itself as a developed country in the year it hosts the G-20. Merely papering over slum clusters will not cover the flaws.

(The author is a veteran journalist and current affairs analyst. Views are personal)

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