National and Global Options for Managing the Risks of Measles and Rubella

Abstract

Countries currently choose from several different measles and rubella containing vaccine options and use a wide range of vaccination schedules as they control the transmission of measles only or measles and rubella viruses within their borders and cooperate and coordinate to achieve regional and/or global goals. This paper discusses the current national options that countries use or could use for national measles and/or rubella control or elimination and existing associated regional goals to characterize the expected current global path and identify alternative paths. With highly effective, relatively inexpensive, and safe vaccines available we can potentially end indigenous measles and rubella virus transmission. The Pan American Health Organization eliminated endemic transmission of both measles and rubella, which demonstrated the possibility of global eradication, and four other regions of the World Health Organization are now pursuing targets for regional elimination. We discuss the choice of a global strategy of control compared to eradication to highlight the choices, opportunities, issues, and challenges that will ultimately determine the magnitude of human and financial costs of measles and rubella globally over the next several decades and beyond.

Modeling the Transmission of Measles and Rubella to Support Global Management Policy Analyses and Eradication Investment Cases

“…Recognizing the variability in current national measles and rubella immunization programs, experience with historical immunization, population structures, and viral transmission conditions, we model each area separately and then aggregate the results to regional and global levels. The model includes 180 WHO member states and three other areas (i.e., Puerto Rico, Hong Kong, and Macao) for which we found sufficient demographic and immunization data .…”

“…Policy makers responsible for managing measles and rubella immunization programs currently use a wide range of different vaccine formulations and immunization schedules for routine immunization (RI) and some countries increase their population immunity using periodic supplemental immunization activities (SIAs), including preventive SIAs (pSIAs). (1) When outbreaks occur, some countries conduct outbreak response immunization (ORI) (i.e., outbreak SIAs [oSIAs]) and/or other public health interventions (e.g., contact tracing and isolation). Existing models for measles and rubella consider a wide range of different assumptions about the nature of immunity, transmission, population mixing, seasonality, heterogeneity, and other factors applied to real and hypothetical populations on different geographic scales.…”

“…(11) No existing models simultaneously track the dynamic transmission of measles and rubella to support analyses of regional or global control or elimination and prospective risk management options. (2) To support efforts to prepare investment cases (12) for measles and rubella to explore a range of future global management options, (1) we developed a dynamic disease transmission model that tracks measles and rubella virus transmission within a modeled area, and we model WHO member states separately then aggregate the results to the global level.…”

Framework for Optimal Global Vaccine Stockpile Design for Vaccine‐Preventable Diseases: Application to Measles and Cholera Vaccines as Contrasting Examples

“…The overall disease control strategy represents the aggregation of all national strategies, and thus determines the regular global vaccine demand. We assume that a global disease control strategy exists either explicitly or implicitly (i.e., we recognize that even the choice to do nothing or not to coordinate represents a strategy, albeit not a good strategy for supporting ambitious global initiatives like the GVAP). Different stakeholders interact and face different incentives, but for purposes of a global stockpile, we assume a societal perspective and we seek to minimize total social costs (i.e., inclusion of all health and financial costs and benefits) within the context of any constraints.…”

“…Adding complexity to the current system, countries currently use several different formulations of MCVs in their schedules, including measles (M), measles and rubella (MR), measles, mumps, and rubella (MMR), and measles, mumps, rubella, and varicella (MMRV) formulations . Most countries use a single MCV formulation for all doses given within their borders, but as of 2013 a few countries used different formulations .…”