Vaccines have saved more than 150 million lives over the past five decades.
Without a 5% higher measles, mumps, and rubella (MMR) vaccination rate, measles may revert to endemicity in the United States within 25 years, while a 10% decline in vaccination could lead to 11.1 million cases of the highly contagious illness in that timeframe, according to predictions from a simulation model published in JAMA.Also, the World Health Organization (WHO); UNICEF; and
Gavi, the Vaccine Alliance warn that burgeoning outbreaks of
vaccine-preventable diseases threaten to reverse years of progress.
And a study published in Morbidity
and Mortality Weekly Report (MMWR) details the ongoing US
measles outbreak, which has reached 800 cases.
Measles resurgence looming
The JAMA study, led by Stanford University
researchers, involved creation of a large-scale epidemiologic model of the
importation and dynamic spread of the vaccine-preventable infectious diseases
measles, rubella (German measles), polio, and diphtheria in the United States
using childhood vaccination rates from 2004 to 2023.
The goal was to predict the number of cases and complications (i.e., post measles neurologic conditions, congenital rubella syndrome, paralytic polio, hospitalization, and death) in the next 25 years under current vaccination rates, a 5% rise in vaccination, and a 10% decline.
The model assumed that diseases are imported to the United
States by an infected person—most often an unvaccinated US citizen—who has
traveled overseas.
"Widespread childhood vaccination has eliminated many
infectious diseases in the US," the study authors wrote. "However,
vaccination rates are declining, and there are ongoing policy debates to reduce
the childhood vaccine schedule, which may risk reemergence of previously
eliminated infectious diseases."
At current state-level vaccination rates, measles may reestablish endemicity (83% of simulations; average time to endemicity, 20.9 years), with an estimated 851,300 cases (95% uncertainty interval [UI], 381,300 to 1.3 million cases) in the next 25 years.
If MMR vaccination declines by 10%, 11.1 million (95% UI,
10.1 million to 12.1 million) cases of measles may occur within 25 years, but a
5% increase in MMR vaccination may keep that number to 5,800 cases (95% UI,
3,100 to 19,400 cases).
Other vaccine-preventable diseases will not likely
reestablish endemicity under current vaccination levels. If routine childhood
vaccination fell by 50%, 51.2 million measles cases, 9.9 million cases of
rubella, 4.3 million cases of polio, and 197 cases of diphtheria could occur
over 25 years.
Under this scenario, 51,200 cases of post measles neurologic
sequelae, 10,700 cases of congenital rubella syndrome, 5,400 cases of paralytic
poliomyelitis, 10.3 million hospitalizations, and 159,200 deaths may occur.
Measles may become endemic within 4.9 years and rubella by 18.1 years, while
polio may return to endemic levels within 19.6 years.
"We've seen a worrisome pattern of decreasing
routine childhood vaccinations," senior author Nathan Lo, MD, PhD, said in
a Stanford Medicine press release.
"There was a disruption to health care services during the pandemic, but
declines preceded this period and have accelerated since then for many
reasons."
"People look around and say, 'We don't see these
diseases. Why should we vaccinate against them?'" he added. "There's
a general fatigue with vaccines. And there's distrust and misinformation about
vaccine effectiveness and safety."
Currently, vaccine-preventable diseases don't spread far,
but if fewer people are vaccinated, increasingly larger outbreaks will occur
more often until they circulate continually. "With measles, we found
that we're already on the precipice of disaster," lead author Matthew
Kiang, ScD, said in the release. "Measles is one of the most infectious
diseases that exists, so the number of people who have to be immune to prevent
it from spreading is extremely high."
Kiang likened travelers who import a disease to matches and
undervaccinated US residents the tinder. "With measles, you're throwing a
lot of matches in, and eventually something is going to happen," he said.
Amid World Immunization Week, a news release from the WHO, UNICEF, and Gavi sounds the alarm on how low levels of vaccination against vaccine-preventable illnesses threatens to undo years of progress.
"Immunization efforts are under growing threat as
misinformation, population growth, humanitarian crises and funding cuts
jeopardize progress and leave millions of children, adolescents, and adults at
risk," the release said. "Outbreaks of vaccine-preventable diseases
such as measles, meningitis, and yellow fever are rising globally, and diseases
like diphtheria, that have long been held at bay or virtually disappeared in
many countries, are at risk of re-emerging."
To prevent resurgences, the three agencies urge rapid and sustained political attention and investment to strengthen vaccination programs.
A recent WHO accounting of the vaccination supplies in
108 WHO country offices, most in low- and lower–middle-income countries,
revealed that nearly half are grappling with moderate to severe disruptions to
vaccination campaigns, routine immunization, and access to supplies due to
reductions in donor funds. Disease surveillance, including that for
vaccine-preventable illnesses, was also disrupted in over half of the
countries.
In addition, the number of children missing routine
vaccinations has risen in recent years, even as countries work to bring
children current with doses they missed during the COVID-19 pandemic. In 2023,
roughly14.5 million children worldwide missed all of their routine vaccine
doses, up from 13.9 million in 2022 and 12.9 million in 2019. Over
half of these children live in countries at risk for health-service disruptions
due to conflict, fragility, or instability.
"Vaccines have saved more than 150 million lives
over the past five decades," WHO Director-General Tedros Adhanom
Ghebreyesus, PhD, said in the release. "Funding cuts to global health have
put these hard-won gains in jeopardy. Outbreaks of vaccine-preventable diseases
are increasing around the world, putting lives at risk and exposing countries
to increased costs in treating diseases and responding to outbreaks."
While the WHO, UNICEF, and Gavi have made huge strides in
terms of eliminating certain diseases, lowering the number of infections and
related deaths with some illnesses, and stepping up vaccination in Africa,
parents, the public, and politicians need to increase their support for
vaccination, officials said.
"Gavi's next strategic period has a clear plan to
bolster our defences by expanding investments in global vaccine stockpiles and
rolling out targeted preventive vaccination in countries most impacted by
meningitis, yellow fever and measles," Gavi CEO Sania Nishtar, MD, PhD,
said in the release. "These vital activities, however, will be at
risk if Gavi is not fully funded for the next five years and we call on our
donors to support our mission in the interests of keeping everyone, everywhere,
safer from preventable diseases."
Culturally competent community engagement
The MMWR study describes the ongoing US
measles outbreak, which is centered in close-knit communities with low vaccine
uptake in New Mexico, Oklahoma, and Texas. Eighty-five patients (11%) have been
hospitalized, and three died. Last week the outbreak reached 800
cases.
"To prepare for and prevent measles cases and
outbreaks, health departments should work with trusted messengers on culturally
competent community engagement, education, vaccination efforts, and other
infection prevention approaches," the researchers, from the Centers for
Disease Control and Prevention and elsewhere, wrote. "Increasing national
and local measles, mumps, and rubella vaccination coverage is essential to
preventing measles cases and outbreaks."