An vaccination point set up by Doctors Without Borders in the Bangabola health zone. During this emergency intervention, the team vaccinated more than 33,000 children aged 6 to 59 months against measles. Democratic Republic of Congo, 2022. © Pacom Bagula/MSF
Large-scale vaccination campaigns had been organized by the health authorities, supported by international partners such as Doctors Without Borders, enabling the number of cases to be drastically reduced by 2021.
"But last year, nearly half of the country's health zones were once again in an epidemic situation,” laments Dr. Massing. “And it’s not over. In January 2023 alone, close to 20,000 suspect cases of measles have been notified in DRC and our teams have already responded to measles outbreaks in Tshopo, Maniema, South Kivu, North Kivu, Lomami and Lualaba provinces.”
“There can be no weak links”
Measles is one of the most contagious disease in the world. Fortunately, a vaccine exists and offers almost complete protection when a person is inoculated twice. Since a person carrying the virus can infect up to 90 per cent of the unvaccinated people around him or her, ensuring maximum vaccination coverage is vital. This requires massive investments in routine vaccination, surveillance and catch-up campaigns.
The fight against measles is like a chain around the virus: if one link is broken, the virus can escape. First, the country must ensure that sufficient quantities of vaccine are available to avoid stock-outs at health facilities. Then, it is necessary to ensure that the vaccines are delivered to the health facilities and that they have an efficient cold chain to keep the vaccines stored in good conditions. It is also necessary to have staff on site to vaccinate children during consultations, and for families to have the economic and physical means to go there. Finally, regular catch-up campaigns must be organized to protect children who fall through the cracks… Given the virulence of measles, there can be no weak links.Dr. Louis Massing, Medical Referent
Unfortunately, many elements of that chain are weak in DRC, and this situation is further aggravated by security constraints, geographic challenges to reach many areas, and the country’s high birth rate, with over 2 million babies born every year who need to be protected from the disease.
As a result, despite emergency campaigns conducted during each outbreak, immunization coverage remains insufficient. While coverage estimates can vary widely from one source to another, the latest estimates from UNICEF and the World Health Organization (WHO) indicate that by 2021, only 55 per cent of children were covered by one dose of measles vaccine. A minimum coverage of 95 per cent with two doses is recommended to prevent the spread of the disease.
Didier, logistics supervisor, is in charge of transporting the vaccines from the Doctors Without Borders base in Bangabola town to the banks of the Ngiri river. The vaccines will then be transported by canoe to the health area in Lisombo, a health area located 65 km away and only accessible through the river. This will be a 7-hour boat trip with motorised canoes, and 14-hour trip by rowing canoe. Democratic Republic of Congo, 2022. © Pacom Bagula/MSF
“Some areas can only be reached by dugout canoe, or even on foot through the forest," says Alexis Mpesha, logistics manager for one of Doctors Without Borders' emergency teams in DRC. "It is not uncommon for our teams to be the only ones to reach certain villages because the local health authorities do not have the equipment, fuel or human resources to get there.”
For parents wishing to have their children vaccinated, the distance to a functioning health center, transportation costs and sometimes consultation fees can be discouraging. "Care is expensive and our resources are limited," says Anne Epalu, a native of Bangabola village, where Doctors Without Borders responded to a measles outbreak in 2022. "Some children die just because their parents don't have money to pay for treatment."
Our emergency teams in DRC vaccinated more than 2 million children against measles in 14 provinces and treated over 37,000 children with measles. Doctors Without Borders teams deploy in support of the Ministry of Health to organise vaccination campaigns and set-up treatment centres when a rapid increase in measles cases is reported in an area and local response capacity is limited or access is difficult. In addition to emergency interventions during outbreaks, Doctors Without Borders also provides logistical support for routine vaccination activities in health facilities in several provinces where its teams are present throughout the year.
Boosting immunization is urgently needed
In 2022, Doctors Without Borders emergency teams in DRC vaccinated more than 2 million children in 14 provinces and treated over 37,000 patients with measles. Doctors Without Borders teams deploy in support of the Ministry of Health to organise vaccination campaigns and set up treatment units when a rapid increase in measles cases is reported in an area and local response capacity is limited or access is difficult. In addition to emergency interventions during outbreaks, Doctors Without Borders also provides logistical support for routine vaccination activities in health facilities in several provinces where its teams are present throughout the year.
But much greater efforts and investments are needed from the health authorities and their partners to increase immunization coverage in DRC and stop the endless cycle of epidemics.
The implementation of the second dose in routine measles immunization activities needs to be accelerated. This approach was recently adopted by the authorities and can make a real difference. Offering systematic catch-up vaccination activities during pediatric consultations in health facilities could also help increase significantly the immunization coverage in DRC.Dr. Louis Massing, Medical Referent
In the meantime, given the persistence of outbreaks in the country, which put more children at risk every day, it is essential to organize the mass catch-up vaccination campaigns that are planned since the end of 2022 without delay throughout the country.
“Meanwhile, our teams are committed to keep responding to measles flare-ups in DRC in support to the health authorities to the best of their ability. But to do so, it is essential that enough emergency vaccines are available in the country”, explains Dr Louis Massing.
