In early October, three cases of measles were confirmed in Antanarivo, the capital of Madagascar. The highly contagious virus quickly spread across the island nation; by the next month, thousands of cases had been confirmed. The crisis only grew from there.
Madagascar has poor health-care infrastructure and a low vaccination rate. But public health experts say its measles outbreak still offers a warning for anti-vaccination campaigners in the United States, where a smaller-scale flare-up has led to more than 100 confirmed cases since the beginning of the year. Conspiracy theories that vaccines are ineffective or can cause certain disabilities and medical conditions have led a number of U.S. parents to resist vaccinating their children.
“Madagascar started with a few cases; now, we are almost close to 60,000 and the cases are still increasing,” said Richard Mihigo, coordinator for the World Health Organization’s immunization and vaccine development program at its regional office for Africa. “I think societies like the U.S. and western Europe should ring the bell and see … this is something that could also happen to them.”
The outbreak in Madagascar is due in large part to weak infrastructure that has made it difficult to achieve widespread vaccination. Both there and elsewhere, health workers face extraordinary circumstances, and at times take immense personal risks, to deliver vaccines to vulnerable communities. In 2013, health workers in northern Nigeria were wrapping up an immunization drive to help vaccinate children against the polio virus when armed gunmen appeared and opened fire, killing at least nine of them.
Targeted killings of health-care workers are even more common in Pakistan, where medical staff have also been killed while delivering vaccines to rural areas or conflict zones in an attempt to control polio.
“When we see that a society where this is not the case sees it as something to take for granted, it’s very sad,” Mihigo said.
Natalie Roberts, emergency operations manager at Doctors Without Borders, said that in parts of Congo, where a measles outbreak is ongoing, staff with the nonprofit group will travel days by motorbike or canoe to access isolated villages. “You can spend five days going from one place to the next area and then spend eight hours trying to get the car out of a hole and reach the village you’re trying to access, and you notice there are maybe 100 children in the village,” she said. “And you’ve spent days and days to get there.”
In places like Madagascar, health workers face similar logistical challenges while delivering vaccines. For measles herd immunity to be effective, public health experts recommend that at least 95 percent of the general population be vaccinated. In Madagascar, the estimated immunization rate was just 58 percent as of 2017. In Washington, the immunization rate is around 90 percent.
In the United States, vaccines that can prevent the spread of measles and other deadly diseases are readily available, stirring frustrations in the public health community over why those who have access to vaccines would refuse them.
“You have at your disposal all the benefits of modern life that are supposed to make your life healthy and strong and long,” said J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies. “And then a segment of the population rejects that. It’s exasperating.”
