A Tragedy out of the Spotlight: Measles in the DRC

As the COVID-19 virus spreads across the world and rightfully garners media attention for its toll on human life, the international community has turned its singularly focused attention to the crisis. And yet, far from even the cursory glances of this same attention exists an entirely preventable epidemic ravaging hundreds of thousands of victims, and exacerbated by a lack of global aid, a dysfunctional public health system, obstructive militia conflict, and a paper-thin distribution of resources. 

Travelling to the small Koshibanda region of the Democratic Republic of Congo, one witnesses what can only be described as complete and utter devastation at the hands of the measles virus—in this region alone, more than two thousand children have died since January 2019, and roughly two hundred new cases are reported every week. Measles, also known as the Rubeola virus, has victimized the DRC to the tune of more than six thousand deaths as of January 8, with no immediate slowdown in sight in what is currently the world’s largest disease outbreak. 

Measles manifests itself in fever, respiratory problems, and telltale bodily rashes, primarily affects children and adolescents, and can be particularly fatal for those under the age of five. The virus can spread easily on shared surfaces and survive in the air for up to two hours after a person has coughed or sneezed, still retaining the ability to transmit itself to others. Severe complications of measles can include pneumonia, swelling of the brain (encephalitis), seizures, pregnancy problems, and death. Aside from the mortality risk associated with the disease, the virus also has the potential to impart lifelong motor disabilities and, as new research has shown, cause one’s immune system “forget” its resistance to other pathogens. 

Documented in humans as early as the ninth century, measles has long been considered an unfortunate, yet unavoidable, condition both for how debilitating and highly contagious it is (the CDC has said that 90 percent of unvaccinated individuals in the same room as an infected person will also contract the disease). It was only after the creation of a highly effective measles vaccine in 1963 that the virus went from being a global threat, causing millions of fatalities in children each year, to being declared effectively eradicated in much of the Americas and Europe by the early 2000s.

So why does a virus with a highly effective vaccine and once-successful campaigns towards elimination still kill over 100,000 people annually worldwide, and continue to present itself in devastating outbreaks like the one currently playing out in the DRC? The answer is complex and is predicated on both the attention and informed, sustainable aid of the developed world.

Measles Spike Despite Vaccination Efforts

In the DRC, over 300,000 cases of measles have been reported since last year, 25 percent of which occurred in children under the age of five. The outbreak, according to the World Health Organization (WHO), is the world’s largest and fastest moving, and has been reported in all twenty-six provinces of the DRC since it began, with areas like Koshibanda being some of the hardest hit. This, despite the fact that government efforts managed to vaccinate 18 million people (of a total population of over 80 million people) free of charge in the country in 2019.

One reason for the virus’s continued virulence is that the DRC is also simultaneously dealing with its largest ever outbreak of the Ebola virus in the eastern portion of the country. This is the second biggest ever outbreak of Ebola globally, second only to the 2014-2016 outbreak in West Africa. According to the WHO, as of January 29, this outbreak has produced a total of 3,304 confirmed cases and has killed 2,244 in the DRC. For a country already stretched to the margins in allocation of aid, this unfortunate dual outbreak has meant neither disease has received the full attention of the government’s already thin resources.

Additionally, active conflict and security risks in many areas of the DRC have made it increasingly difficult for an already weak public health system to reach vulnerable populations and distribute the essential vaccination. Territorial disputes among Hutu, Tutsi, and Islamist-inspired militias, as well as insurgencies from rebel factions against government forces, have displaced an estimated 4.5 million people within the country, while an additional 880,000 have fled to neighboring countries. This has laid the groundwork for an environment highly conducive to the unchecked spread of disease. The rapid migration of people and high density living conditions due to this instability is particularly problematic for the control of measles, since the virus has a communicable period of approximately eight days, around four of which typically occur before a rash and other major symptoms even present themselves in the host.

Further compounding the outbreak are the consistent obstacles of malnutrition, geographic barriers between vulnerable populations and healthcare access, and general mistrust of vaccinations among local communities. As noted by Eduoard Beigbeder, the United Nations Children’s Fund (UNICEF) representative for the DRC, “cultural beliefs and traditional healthcare practices also often get in the way of vaccinating children against measles and treating those with symptoms.”

And yet, volunteers and officials remain optimistic. Although the WHO had allocated over $27.6 million as of January, the group has said that it requires a further $40 million to get children aged six to fourteen included in free vaccination programs and to properly manage other complicating factors allowing the outbreak to continue propagating. Health education specifically will be a crucial tenet of mitigation efforts going forward, as it is a proven and reliable method of encouraging safe practices despite cultural differences surrounding vaccinations and treatments. 

For every one person that gets infected in an unvaccinated population, fifteen others will also get infected. As a result, the measles virus requires over 90 percent of children to receive both doses of the vaccine to achieve herd immunity (a level of non-susceptible individuals so high in a population that the virus has no new hosts to spread through and dies off), and effective eradication in a population. This is truly the driving factor behind why outbreaks continue to occur in developing countries like the DRC, despite once quick eradication in many developed countries like the United Kingdom and United States. Although extremely effective vaccination and education programs are implemented in these developing countries, the countless obstacles to proper healthcare access means achieving a vaccination rate of over 90 percent for both doses, particularly in children, remains extraordinarily difficult.

Struggling Without International Attention

It should also be noted that the DRC and other developing countries are by no means alone in the burden of this problem in recent years. The United Kingdom, Albania, Czech Republic, and Greece were all nations that lost their measles elimination status (as defined by the WHO) in 2018, while the United States reported its highest number of measles cases in twenty-five years in 2019, in large part due to increased pushback, misinformation, and fear of vaccinations for children from parts of the public. Accordingly, information campaigns and educational programs remain some of the most vital and pertinent tools to invest in, in the effort to combat further spread of the virus across the globe. Increasingly, it is becoming evident that so long as a persistent movement to ignore (intentional or otherwise) scientific recommendation and eschew treatments like vaccinations exists in developed and developing countries alike, the presence of infection anywhere should be considered a threat to health everywhere.

Support from the international community through monetary aid and systemic investments enabling self-sufficiency in places like the DRC is therefore vital to efforts to eradicate the disease, for it is a matter of self-interest for countries beyond simply humanitarian grace. And yet, the international responses to both the COVID-19 and DRC measles outbreak demonstrates that action and aid from the developed world is still largely a disproportionate exercise. 

Indeed, the impact of COVID-19 should by no means be minimized, for there is rightful concern over the deaths it has caused, its rapid spread across the world, its biological novelty, and its potential impact on global markets; and by all accounts, both COVID-19 and the measles outbreak deserve international attention. However, as things currently stand, issues in the developed world seem frightening for their apparent immediacy, while the affairs of developing countries are treated with the relative ambivalence of something distant, exotic, and unprioritized. Such ambivalence does nothing but perpetuate the cycle of inadequacy in healthcare infrastructure and response to such crises in places like the DRC, and dooms these regions to continue miring in the grips of these debilitating diseases for the foreseeable future.

And so, as the world refocuses its attention on infectious disease as a viable threat under a barrage of high-profile media coverage, it would be a travesty to simultaneously continue ignoring public health emergencies like the measles outbreak in the DRC that are far more understood and treatable, yet continue to remain underfunded and underreported. Where socioeconomic status remains forever hostage to the lottery of birthplace, sufficient healthcare should not. For, as put by Dr. Tedros Ghebreysus, director-general of the WHO, “The fact that any child dies from a vaccine-preventable disease like measles is frankly an outrage and a collective failure to protect the world's most vulnerable children.”

The photo used in this article was taken by Julien Harneis and is licensed for reuse under the Creative Commons Attribution-ShareAlike 2.0 Generic license. No changes were made to the original photo, which can be found here.