Responding to the resurging measles epidemic
Since the beginning of 2020, the Central African Republic (CAR) has been facing a resurging measles epidemic. From 1 January to 22 September, 28,633 cases were reported, including 137 deaths, compared to 3,388 cases registered in 2019 and 241 in 2018. The epidemic has affected more than half of the country's 35 health districts with a high prevalence in the capital Bangui, the west and the centre-east.
This resurgence is the result of a poor immunization coverage of children that has accumulated over the years. Routine vaccination coverage rates are generally low in CAR, often reaching less than 75% of the population. This situation has resulted in a large number of children at risk of contracting the measles virus.
On 24 January 2020, the Ministry of Health and Population declared a national measles epidemic. Subsequently, a response plan and a resource mobilization strategy were developed with the support of the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and non-governmental organizations. The main action adopted in the response plan consisted of a national vaccination campaign targeting 2.65 million children aged between 6 months and 10 years, with an emphasis on the children aged 6 months up to 5 years, given their particular vulnerability. Due to the limited availability of vaccines and medical equipment, a difficulty which was further amplified by COVID-19, the vaccination campaign was planned in two phases: a first phase in February and March covered the 13 most affected health districts and a second phase followed in August in the remaining 22 health districts.
A positive outcome despite difficult circumstances
The vaccination campaign was made possible with the support of GAVI, the World Bank, WHO, UNICEF, Médecins Sans Frontières, the Centers for Disease Control and Prevention and other national and international NGOs. Final evaluations reveal that almost 100% of the targeted children or even more, due to the lack of up-to-date census data, were reached by the campaign, with the exception of two health districts. In Vakaga Prefecture in the far north, only 65% of all children were vaccinated and in Haut-Mbomou Prefecture in the east, less than half of all children could be reached.
After an initial phase between January and March, where measles cases continued to increase, a decrease was observed in the 13 health districts that had already implemented the immunization campaign. In September, a considerable drop in suspected cases was noted with less than 50 new infections per week in the last two weeks of the month. However, it is important to remain vigilant and to continue strengthening epidemiological surveillance, to organize mini-campaigns in those locations not fully covered and to accelerate routine vaccination in general to avoid outbreaks.
Although the vaccination campaign proceeded well overall, it faced challenges related to insecurity in several parts of the country, poor road conditions, especially during the current rainy season, and the absences of some parents and children, explained by their pursuing of activities related to survival such as finding food. In August, a vaccination team of six was kidnapped by an armed group in Mboki in the Haut-Mbomou Prefecture. The vaccination team was released after several days following negotiations between the UN Office for the Coordination of Humanitarian Affairs (OCHA), UN peacekeepers and the local authorities, but medical equipment and money were taken away. Children in the remote Vakaga Prefecture were not all vaccinated because the heavy rains that fall this time of the year rendered some roads impassable. In a next step, healthcare stakeholders are planning a census of the areas poorly covered by the measles campaign and will mobilize additional resources to complete the immunization.
Beyond measles and for a global vaccination coverage
On 9 September 2020, the Minister of Health and Population launched the preparatory work for the High Level Forum on Immunization with the aim of obtaining political commitment to make routine immunization – against polio, measles, yellow fever, tuberculosis, diphtheria, tetanus, pertussis, hepatitis B and Hemophilus influenzae – one of the country’s development priorities and to achieve a 95%-immunization coverage of all mothers and children.