Two weeks ago, the World Health Organization (WHO) issued an epidemiological warning that must be taken very seriously: the year 2023 ended with 306,000 cases of measles, almost 80% more than in 2022. And that there is certainly under-registration. He also warned that the rise in numbers worldwide was constant, even though the disease was considered extinct in most countries until a few years ago.
“If the necessary corrective measures are not taken, outbreaks will occur in more than half of the world's countries this year,” said Natasha Crowcroft, WHO chief for measles and rubella, a few days ago. Measles is a highly contagious disease. The virus is transmitted through the air through speaking and breathing. A sick person can infect 18 people who have been in contact with them. It is even more contagious than Covid-19.
In Peru we have not yet had a major outbreak, but we have recorded two cases: one local (a 10-month-old baby) and another imported (a 21-year-old young man). On this topic, Dr. Carlos Zegarra, Head of UNICEF Health in Peru, said that even before the Covid-19 pandemic, our country already had a weakened first tier of care, with poor infrastructure and staff shortages, which affected the vaccination plan. With the arrival of the coronavirus, the situation became even worse.
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“Minsa has also had difficulty reaching the most vulnerable populations, such as the Amazon regions. Another point is that as a result of Covid-19, there has been misinformation about the safety of the vaccines. Some minority sectors took advantage of this and it was extended to the rest of the vaccines in the national program. Although the majority of the population supports vaccinations and trusts that they are safe, these sectors express their fear and resistance to vaccination,” he says.
May. The anti-vaccine movement is strong in several states in North America and is even funded by politicians. Photo: Distribution
Peru has not had a domestic case recorded since 2000. And between 2008 and 2019, there were 50 imported cases from different continents. Dr. Elmer Huerta warns that if this time it is a domestic case, it is because someone infected the baby and the virus is therefore circulating in the community. To avoid the risk of an epidemic outbreak, 95% of the child population should be vaccinated. Today we are significantly below that.
The world and the anti-vaxxers
The United States, a country close to Peru, is the country with the highest number of cases in the Americas region this year: 20 cases (as of February 15). One episode has caused a stir in recent days: an outbreak of six cases of measles recorded in an elementary school in Florida. There, Public Health Director Joseph Ladapo has indicated that he will not require children to be vaccinated so they can go to school. He even sent her parents a letter telling them they could send her to study during the outbreak.
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Why this decision? It turns out that Ladapo and the person who put him in office, Republican Gov. Ron DeSantis, are openly anti-vaccination. And that movement is very strong in this country: There are foundations like Children's Health Defense, founded by Robert F. Kennedy Jr., the former independent presidential candidate, that advocate against vaccinations and link them to autism and autoimmune diseases. Former President Donald Trump also takes similar positions.
“Welcome to the 21st century. This is what public health will look like. Unfortunately we have already seen it with Covid, now we are seeing it with measles. Politics will have a lot to do with it,” said Dr. Huerta on a podcast this week.
Conservative. Florida Gov. Ron DeSantis doesn't believe in vaccines and won't take action against measles in the state. Photo: Distribution
In Brazil, for example, the governors of the Bolsonaro strongholds of Minas Gerais and Santa Catarina have indicated that they will not follow the Brazilian federal government's line and not require vaccination certificates for children attending school. The governor of Minas Gerais, Romeu Zema, is even being touted by Bolsonarism as a presidential candidate for 2026.
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In Europe, according to the WHO, there is “an alarming increase in cases”: in 2023, there were 42,200 cases of measles in 41 member countries, a huge increase compared to the 941 cases reported in all of 2022. It also explains that the resurgence of measles is largely due to a setback in vaccination coverage. In the WHO European Region, more than 1.8 million babies did not receive their measles vaccination between 2020 and 2022. And why did that happen? Because opponents of vaccination are increasing: they spread false information about vaccinations and create mistrust among parents.
Many of these movements were strengthened during the pandemic and persisted once the pandemic was under control.
On this continent, low vaccination rates have led to epidemics of the disease in Romania (2,000 cases in 2023) and the United Kingdom (1,600 cases last year). The reasons for this resurgence in these and other European countries are varied: falling vaccination rates, the spread of misinformation and a lack of awareness of the importance of vaccinations. Furthermore, population mobility and global connectivity have facilitated the transmission of the virus, highlighting the need for internationally coordinated action.
Bell jar. In Peru, Minsa brigades tour the city to vaccinate children and adults against measles. Photo: Distribution
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“The situation is worrying in Europe, where the first case imported to Peru came from. These are more advanced countries with more developed health systems, but there is a rise in anti-vaccination movements and parents' refusal to vaccinate their children. “This has contributed to the vaccination rates being quite low in these areas,” says Carlos Zegarra from UNICEF Peru. Also worrying is the proximity to the cases in the United States, a country with a high percentage of travelers arriving in our territory.
Measles can cause serious complications, including blindness, encephalitis, acute diarrhea, ear infections and pneumonia, and is experiencing a resurgence worldwide. For Zegarra, measles vaccines are very safe and have proven effective over the years. Two doses are required, one at 12 months of age and another at 18 months of age, to ensure 95 percent immunity in the child. And when population coverage reaches that percentage, protection becomes community-based.
The WHO recommends that governments increase vaccination rates. This is the only way to avoid outbreaks. It is not for nothing that this institution declared “vaccine rejection” one of the top ten threats to global health.