KABUL: Children in Afghanistan are facing a devastating measles outbreak, resulting in tragic fatalities. The United Nations estimates that by 2022, a staggering 1.1 million malnourished children in Afghanistan will be at a heightened risk of succumbing to this deadly disease. However, the administration of two doses of the affordable and highly effective measles vaccine can effectively prevent infection, illness, and death. Regrettably, the major obstacle hindering measles prevention in Afghanistan lies in the inability to reach all children in need.
Between January and August 2022, Afghanistan reported a concerning number of cases, with 65,470 suspected measles cases and 367 deaths attributed to the disease. It is important to note that these figures may underestimate the true extent of the outbreak as causes of illness and mortality are not systematically recorded by the public health system.
While measles might present as a seemingly benign illness in high-income countries that have successfully eradicated the disease through comprehensive childhood vaccination programs, it poses a grave threat to infants in countries like Afghanistan, where primary healthcare systems are fragile. Measles-related deaths can occur due to primary infection, as well as secondary infections and complications such as diarrhea, pneumonia, and encephalitis. The prevalence of malnutrition further amplifies the vulnerability of infected individuals, increasing the risk of severe measles complications and death.
Disturbingly, even those who survive a measles infection may experience a phenomenon known as “immune amnesia,” which erases existing immunity to previously encountered illnesses. This leaves them even more susceptible to subsequent infections, exacerbating their health risks.
Measles stands out as one of the most highly contagious viruses among humans, with a single infected individual capable of infecting up to 90 percent of non-immune individuals in close proximity. As a result, measles outbreaks rapidly spread through unvaccinated populations, overwhelming already weakened primary healthcare systems. When a measles outbreak occurs in an area, it serves as a warning sign indicating a lack of immunization within the community. These outbreaks also highlight the potential for other vaccine-preventable diseases to emerge in such areas. In fact, measles outbreaks effectively serve as a program indicator, identifying regions with weak immunization services that require urgent strengthening. They test the resilience of primary healthcare systems and expose the limitations in accessing essential healthcare services.
The root causes of extensive and disruptive measles outbreaks, such as the ongoing crisis in Afghanistan, can be traced back to healthcare systems failing to vaccinate large numbers of children. Following 25 years of armed conflict, the Afghan government underwent a transition in 2001, inheriting a severely weakened health infrastructure. Measles was highly endemic at that time, continuously circulating within the population due to decades of minimal routine measles vaccination coverage. In 2001 alone, one in four children died before the age of five from various causes, with a district-level survey revealing that measles was responsible for 15.7 percent of all childhood deaths.