Pakistan at the precipice: The looming threat of measles amidst the COVID-19 pandemic

Abstract

The global focus on curbing the COVID-19 pandemic has reduced the overall immunization rates worldwide. This, coupled with increasing malnutrition and strained healthcare, has increased measles cases and mortality globally. Many countries are thus facing outbreaks, with Afghanistan having reported 372 deaths between January and September 2022. Therefore, Pakistan, a country in a similar economic state and the world's fourth highest reported measles cases in 2022, must take action. Moreover, the current flooded state of Pakistan and the subsequent mass movement of population, deterioration of health services, and worsened living conditions all contribute to put the country at a high risk of potentially devastating Measles outbreaks. With vaccination rates down by 42% since the start of the pandemic and the threat of an outbreak increasing daily, there is only so much time before the situation spirals out of control.

Vaccine Trends in Pakistan: A Review of Immunization Challenges and Setbacks Prompted by Inadequate Disaster Management

“…Yet, this trend is not a singular occurrence as Figure 1 depicts a marked increase in measles cases to about 33,000 in 2018 corresponding to severe monsoon activity near Punjab [ 16 , 17 ]. Given this, over one-third of the country, or approximately 33 million people, experience severe flooding or monsoons every year, and while these events have been associated with increases in various diseases, the risk of measles does not share the same recognition [ 18 ].…”

“…Excessive rainfall has heightened the severity and occurrence of floods in Pakistan, yet the significance of Measles, Mumps, and Rubella (MMR) vaccination is undermined. Despite each disease being vaccine-preventable, Pakistan experienced a 65% decline in MMR vaccination and had the sixth most global cases of measles with 6,199 in January 2024 [ 18 - 20 ]. Although not all floods may compare to one Pakistan encountered in 2010, recent natural disasters may exhaust what little resources are left after the COVID-19 pandemic.…”

Endemic, epidemic and pandemic infections: the roles of natural and acquired herd immunity

“…However, geopolitical and environmental calamities over the last two decades have driven a resurgence in such childhood diseases, including measles. For example, after the 2010 floods in Pakistan, there was approximately an eight-fold increase in measles cases [5 ▪▪ ]. In 2018, the WHO established a global target of a 95% vaccination rate for children of kindergarten age in order to achieve herd immunity and various vaccination campaigns were initiated.…”

“…However, in 2022, millions of Pakistanis again lost their homes to historic flooding resulting in large-scale evacuations to congested living conditions. These events interrupted vaccine delivery, putting this population at huge risk of measles-related morbidity and mortality [5 ▪▪ ] as well as other life-threatening infectious diseases. Sadly, since the start of the COVID pandemic, childhood vaccination rates in Pakistan are down by 42% [5 ▪▪ ]; worldwide, it is estimated that because of COVID, the postponement of the various measles vaccination campaigns have left 73 million children unvaccinated and at risk [5 ▪▪ ].…”