Madagascar is facing its largest measles outbreak in history with over 115,000 cases. Parents want to vaccinate their children, but they lack resources, and many people are too poor to afford vaccines.
From a previous death toll of more than 900 in February, deaths due to measles have now risen to over 1,200, according to a recent report.
"The epidemic unfortunately continues to expand in size though" at a slower pace than a month ago, said Dr. Dossou Vincent Sodjinou, a World Health Organization epidemiologist in Madagascar.
Since the start of the outbreak in September 2018, Madagascar has launched a nationwide mass vaccination campaign and surveillance in an attempt to bring the outbreak under control. An emergency response has vaccinated 2.2 million people out of the 26 million population, with majority of those who received vaccines were children.
As of mid-March, the public health ministry reported 117,075 cases affecting all regions of the country, with the highest cases recorded in Analamanga and Boeny. The outbreak has also spread to densely populated urban cities including Toamasina, Mahajanga, Antsirabe, Toliara, and the capital city Antananarivo.
Measles Outbreak Exacerbated By Poverty
A major factor in the outbreak's spread is low vaccination coverage. More than half or 51 percent of the cases reported during the current outbreak have not been vaccinated or have unknown immunization status.
In 2017, only 58 percent of the population on Madagascar's main island have been vaccinated against measles. To prevent the outbreak of infectious diseases, the immunization rate has to be 90 percent or higher. The last vaccination drive was in 2004.
Resistance to vaccination is not the cause of low vaccination in Madagascar. Many people simply cannot afford health care services, and public health care facilities are often understaffed or have poorly qualified workers.
People are desperate for vaccination due to the increasing deaths. The first vaccination is free as part of the government's emergency response program, but a second-dose booster shot costs $15 at a clinic. This is considered costly for a typical family that survives only on $2 a day.
The country is also $3 million short of the $7 million needed to have its entire population vaccinated.
Children Are The Most Vulnerable
According to WHO, most victims of the outbreak are children aged one to 14.
Madagascar accounts for 47 percent or the highest proportion of malnutrition among children under five years old in the African region. This makes children particularly at high risk because malnutrition can increase the risk of serious complications and death from measles infection. Measles can also leave children vulnerable to potentially fatal pneumonia or diarrhea.
The circulating genotype for the current measles outbreak in Madagascar is B3, usually found in Africa and Europe.