A scorecard of progress towards measles elimination in 15 west African countries, 2001–19: a retrospective, multicountry analysis of national immunisation coverage and surveillance data

Abstract

Summary Background The WHO Regional Office for the Africa Regional Immunization Technical Advisory Group, in 2011, adopted the measles control and elimination goals for all countries of the African region to achieve in 2015 and 2020 respectively. Our aim was to track the current status of progress towards measles control and elimination milestones across 15 west African countries between 2001 and 2019. Methods We did a retrospective multicountry series analysis of national immunisation coverage and case surveillance data from Jan 1, 2001, to Dec 31, 2019. Our analysis focused on the 15 west African countries that constitute the Economic Community of West African States. We tracked progress in the coverage of measles-containing vaccines (MCVs), measles supplementary immunisation activities, and measles incidence rates. We developed a country-level measles summary scorecard using eight indicators to track progress towards measles elimination as of the end of 2019. The summary indicators were tracked against measles control and elimination milestones. Findings The weighted average regional first-dose MCV coverage in 2019 was 66% compared with 45% in 2001. 73% (11 of 15) of the west African countries had introduced second-dose MCV as of December, 2019. An estimated 4 588 040 children (aged 12–23 months) did not receive first-dose MCV in 2019, the majority (71%) of whom lived in Nigeria. Based on the scorecard, 12 (80%) countries are off-track to achieving measles elimination milestones; however, Cape Verde, The Gambia, and Ghana have made substantial progress. Interpretation Measles will continue to be endemic in west Africa after 2020. The regional measles incidence rate in 2019 was 33 times the 2020 elimination target of less than 1 case per million population. However, some hope exists as countries can look at the efforts made by Cape Verde, The Gambia, and Ghana and learn from them. Funding None.

Epidemiology of measles cases, vaccine effectiveness, and performance towards measles elimination in The Gambia

“…When Masresha et al (2018) included The Gambia in their 2012–2016 assessment of the elimination status of measles in 11 African countries with high routine MCV1 coverage [ 17 ], they concluded that none of the countries assessed were ready for the verification of their measles elimination status [ 17 ]. Wariri et al (2021) developed a scorecard which they used to track the progress of 15 West African (ECOWAS) countries towards measles control and elimination milestones between 2001 and 2019 [ 24 ]. They found that although 3 countries including The Gambia have made substantial achievements to measles, the ECOWAS block is not track to achieving measles elimination in 2020 [ 24 ].…”

“…Wariri et al (2021) developed a scorecard which they used to track the progress of 15 West African (ECOWAS) countries towards measles control and elimination milestones between 2001 and 2019 [ 24 ]. They found that although 3 countries including The Gambia have made substantial achievements to measles, the ECOWAS block is not track to achieving measles elimination in 2020 [ 24 ]. Since their aim was to mainly assess progress towards measles elimination, Masresha et al (2018) and Wariri et al (2021) did not include further analysis such as the epidemiology of cases, risk factors, and vaccine effectiveness, which would also be useful in informing measles control and elimination strategies at country level [ 17 , 24 ].…”

“…They found that although 3 countries including The Gambia have made substantial achievements to measles, the ECOWAS block is not track to achieving measles elimination in 2020 [ 24 ]. Since their aim was to mainly assess progress towards measles elimination, Masresha et al (2018) and Wariri et al (2021) did not include further analysis such as the epidemiology of cases, risk factors, and vaccine effectiveness, which would also be useful in informing measles control and elimination strategies at country level [ 17 , 24 ]. In addition to that, the occurrence of sporadic measles outbreaks in parts of the country over time, points to immunity gaps and would require further investigation to effectively address such gaps.…”

Measles outbreak amidst COVID-19 pandemic in Africa: grappling with looming crises

“…Despite the mortality rate from several measles outbreaks, measles remains one of the most vaccine-preventable diseases, which has also yielded tremendous results over the years in Africa—an improvement in vaccination coverage has led to decreased incidence from 145 to 120 cases per million populations between 2000 and 2019 [ 1 , 3 ]. Although the target set by the World Health Assembly to eradicate measles by 2020 was not achieved [ 1 , 3 ]. This is partly due to non-immunization or partial immunization of children in the poor/underserved communities, malnutrition, vaccine hesitancy, poor surveillance, and weak health care systems in Africa.…”

“…The World Health Organization (WHO) had recommended a 95% vaccination for herd immunity against measles. However, according to a retrospective multi-country series analysis of national immunization coverage and case surveillance data in 15 West African countries carried out by Wariri et al, the measles-containing vaccine first dose (MCV1) coverage range from 45% in 2001 to 66% in 2019 and only 7 out of 15 countries has introduced a second dose of measles-containing vaccine (MCV2), since 2015 [ 3 ].…”