Every two to three years, measles outbreaks affect hundreds of thousands of children in Democratic Republic of Congo (DRC).
Last year was no exception, with more than 148,600 cases and 1,800 deaths reported. How can this recurring emergency be explained? And, more importantly, how can we put an end to it?
"We have five emergency teams mobilized almost around the clock to respond to the various measles outbreaks throughout the country,” says Dr Louis Massing, MSF’s medical team lead in DRC.
“But as soon as we put out a fire here, it flares up on the other side. In 2022, we carried out 45 measles-related emergency interventions; that’s more than three-quarters of our emergency response in DRC.”
The largest measles outbreak ever documented in DRC occurred between 2018 and 2020. At that time, nearly 460,000 children contracted the disease, and 8,000 of them died.
Large-scale vaccination campaigns had been organized by the health authorities, supported by international partners such as Médecins Sans Frontières / Doctors Without Borders (MSF), enabling the number of cases to be drastically reduced by 2021.
Life-saving measles care, thanks to your support
The generosity of people like you means expert MSF medical teams can respond to deadly measles outbreaks and provide life-saving vaccinations across the world.
"But last year, nearly half of the country's health zones were once again in an epidemic situation,” says 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 percent of the unvaccinated people around them, 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,” says Dr Massing.
“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."
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 percent of children were covered by one dose of measles vaccine.
A minimum coverage of 95 percent with two doses is recommended to prevent the spread of the disease.
CHILDREN VACCINATED AGAINST MEASLES BY MSF IN DRC IN 2022
PEOPLE TREATED FOR MEASLES BY MSF IN DRC IN 2022
OF POPULATION NEED TWO DOSES TO PREVENT THE SPREAD OF MEASLES
“Some areas can only be reached by dugout canoe, or even on foot through the forest," says Alexis Mpesha, logistics manager for one of MSF's 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 centre, 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 MSF responded to a measles outbreak in 2022. "Some children die just because their parents don't have money to pay for treatment."
Boosting immunization is urgently needed
In 2022, MSF emergency teams in DRC vaccinated more than 2 million children in 14 provinces and treated over 37,000 patients with measles.
MSF 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.
As well as emergency interventions during outbreaks, MSF also provides logistical support for routine vaccination activities in health facilities in several provinces where our 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," says Dr Louis Massing.
"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.”
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 have been planned since the end of 2022 without delay throughout the country.
Meet the emergency team
- MSF/Pacom Bagula
Dr Théophile is responsible for the supervision of MSF case management teams in Bangabola. He has been a doctor with MSF for over 14 years and has more than 30 emergency interventions under his belt. During this emergency measles response in Bangabola, MSF managed complicated cases of measles, malaria, and malnutrition.
- Pacom Bagula/MSF
Alexis is the logistics manager for the MSF emergency team deployed in Bangabola. He checks the refrigerated boxes that will contain the vaccines headed to the different health areas. An efficient cold chain is essential to ensure that vaccines are kept at the right temperature - and are therefore effective - during transport and at the sites.
- Pacom Bagula/MSF
Berthe is a pharmacy storekeeper with MSF's emergency team. Her job is to manage the stock of medicines and medical equipment from receipt to distribution and control. "I prepare the orders to be sent to the teams, and I receive the reports every weekend. I do an inventory at the beginning and end of each intervention. I enjoy my job. Over the years, I have gained a lot of experience. I feel like I belong and that motivates me."
- Pacom Bagula/MSF
Charles is an MSF laboratory technician and a part of the MSF emergency team. In addition to measles vaccination and the provision of care for patients with measles, the MSF emergency team also provided care to children with malnutrition and malaria. Children with severe malaria may develop signs of anemia, and blood transfusion is often needed to help them regain their strength. Charles is notably in charge of performing blood tests linked to such transfusions.
- Pacom Bagula/MSF
Didier is a logistics supervisor with the MSF emergency team. He is in charge of transporting the vaccines from the MSF 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, located 65 km away and only accessible by river. This will be a seven-hour boat trip with motorised canoes, and 14-hour trip by rowing canoe.
- Pacom Bagula/MSF
Water and sanitation supervisor
Gaston Lufungula is a water, hygiene and sanitation supervisor for MSF's emergency team. He has been working with MSF since 2013. "Part of our job is to bring enough quality water to patients", he says. "We pump water, store it and treat it with chlorine before distributing it."
MSF in DRC
The second-largest country in Africa by area, the Democratic Republic of Congo (DRC) is plagued by conflict. It has endured decades of multiple overlapping crises and severe limitations in medical capacity.
In DRC Médecins Sans Frontières/Doctors Without Borders (MSF) continues to run some of its largest programmes, working in 20 of the country’s 26 provinces.