Measles Initiative

This initiative draws on a global partnership to foster cooperation among groups using communication to mobilise communities for vaccination. Each year, collaborators gather for an in-person global measles advocacy meeting. At the first such meeting, in a joint strategic plan, WHO and UNICEF identified 45 countries with high numbers of measles cases in which to implement a plan for measles mortality reduction. The goals of that plan included high routine immunisation coverage of at least 90% in every district being addressed, and ensuring that all children have a second chance for measles immunisation if they miss the first.

The central strategy includes vaccination campaigns for children during a period of up to two weeks. Such campaigns draw mothers and children from wide areas and offer "one-stop shopping" for free lifesaving health interventions. The at-risk population varies from country to country, but in general the population being addressed is children under the age of 15 years. Campaigns can be country-wide or involve only selected regions and districts that have a high risk for measles transmission within a country. The Ministry of Health determines the particular country approach after consulting technical experts and Initiative partners. The common denominator in all countries is that, for less than a dollar, a child can be vaccinated against measles; that dollar covers the cost of all resources needed for a mass measles campaign - from the vaccine, syringes and cotton balls, to the cost of making sure a volunteer has food for lunch during social mobilisation.

Social mobilisation is led by the Red Cross and is the process of educating and gathering communities to create the demand for the vaccine and achieve the highest immunisation coverage possible. To cite one example, in November 2004, Ugandan Red Cross workers recruited volunteers within the communities that were to have mass measles campaigns, educated and trained them on the process, and gave them various resources including Red Cross vests for identification. According to Alice Uwase Anukur, Deputy Secretary of the Uganda Red Cross National Society, "The Red Cross emblem allows a neutral group who people trust to come in to discuss the importance of immunization. Being community-based, using local volunteers and having the humanitarian spirit will make the mass measles campaigns successful." In an effort to reach every family and to personally educate caretakers about the need for immunisation, volunteers go door to door (traveling by whatever method is available). They meet with the caretakers, usually mothers, to communicate the importance of protecting children against measles, the safety of the vaccination process, and the need to continue with routine immunisation. They make lists of children in each household who are eligible for vaccination, cross-referencing the lists with those who received vaccinations to see if any children were missed.

Social mobilisation includes many different tactics, in addition to the door-to-door conversations. Weeks prior to the vaccination weekend, the volunteers distribute banners, brochures, and posters to spread the word and encourage participation. Using costumes provided by the Red Cross, the volunteers put on plays in the centre of the village that emulate the vaccination process, the harm of not vaccinating the child, and the harm of believing that traditional healers have the cure. One organiser explains, "They come here to get entertained, but they leave with information. It is important for people to hear these messages from their friends. They internalize the information and are convinced. They figure 'how can a friend do anything bad to us?'. We partner with the leaders in a certain village who have the ear of the people - religious leaders, tribal chief, teachers, drummers, clan leaders. It is important to speak their language."

As this official implies, a key programme strategy is accounting for cultural particularities throughout campaign design. For instance, in a November 2001 mass immunisation campaign in Kyrgyzstan, a campaign logo was developed as a cooperative effort of all the key stakeholders; it features the colours of state flag to indicate that the campaign is national in scope. The logo also has a fragment of the Kyrgyz traditional nomadic hut - "yurt" - showing the round top with crosspieces over a mother, father, and their child. This picture is meant to symbolise that "vaccination entres into homes to protect children and therefore the future of a whole family". Furthermore, "Attracting volunteers meant overcoming many cultural barriers. Most communities in Kyrgyzstan did not fully understand the concept of volunteering and some did not know the meaning of the word....The Kyrgyz language has a limited medical vocabulary, and the training and promotional material had to be geared for the language used by the ordinary people. There were also many regional differences in language, culture, and traditions that meant that the strategies had to be adapted to accommodate the differences."

Children and youth also mobilise to spread the immunisation message. Schoolchildren learn a "measles song" (click here for lyrics and download options) from their teachers, who tell the students to bring their younger siblings to get immunised. Children also participate by marching through the streets in parades, holding up signs and singing to let all households know about the importance of vaccination. A "virtual village" for kids on the Initiative website is intended to be a colourful, creative means of sharing ideas for ways in which children can get involved. In addition, young people in the United States are participating in a communication-centred campaign to help support vaccination of their peers in developing countries using the tools available on an interactive youth campaign website.

Children, Health, Immunisation & Vaccines.

WHO and UNICEF claim that, since its inception, the Measles Initiative has vaccinated more than 150 million children against the disease. Deaths fell globally by 39% between 1999 and 2003 from 873,000 to an estimated 530,000. In Africa, the change was even greater, with a 46% reduction. Nearly all of the 33 campaigns conducted in Africa with support from the partnership reached at least 90% of the population being addressed.

Organisers stress that social mobilisation has been particularly crucial to the success of various campaigns. For example, in Mbarara district (Uganda), a local anti-government radio station was advising parents against immunisation, saying the vaccine would kill their children. Red Cross activated more volunteers to carry out social mobilisation activities like those described above to allay the fear that had reached parents. The result, according to organisers: Over 155,000 children were immunised, reaching 86% coverage. "This is the highest level of coverage achieved for any health intervention since the radio station began broadcasting and is high enough to effectively control measles." To cite a second example, "the Kyrgyzstan Red Crescent Society mobilized over 3,000 volunteers for a successful immunization campaign that reached 1,834,304 women and children out of 1,859,075 eligible beneficiaries - a 98.7 percent success rate."

Organisers note that a significant proportion of global measles deaths occur in countries experiencing complex emergencies or recovering from them. Infection rates can soar because damages to infrastructure and health services interrupt routine immunisation. Refugees and internally displaced persons are often forced to relocate to camps, frequently resulting in malnutrition, which weakens the immune system. In this context, the American Red Cross is supporting vaccinations for children in the areas affected by the December 2004 tsunami disaster through the Initiative. Activities are underway in Banda Aceh, Indonesia, including measles vaccinations and Vitamin A drops for all children displaced by the disaster aged 9 months to 15 years old.