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To solve WA's measles epidemic, look to Africa

This Feb. 6, 2015, AP file photo shows a measles, mumps and rubella vaccine on a countertop at a pediatrics clinic in Greenbrae, California. A measles outbreak near Portland has sickened dozens of people in Oregon and Washington, with several more cases suspected. Public health officials scrambling to contain the virus say low vaccination rates are making the situation worse. (Photo by Eric Risberg/AP)

As a mom who spends most of her waking hours thinking about how to improve health around the world, I’ve never thought twice about whether I vaccinate my son. I know that not all of my neighbors in the Seattle area feel this way, but the decision for me is rational. Vaccines are safe, they prevent disease, and they are relatively low cost and easy to obtain.

It may be easier when, in my work with a nonprofit dealing with health systems in Africa, we are reminded constantly that deaths of children under 5 have dropped nearly 60 percent worldwide since 1990, and vaccines are a major contributor to this progress.

Yet Washington state suffers one of the lowest measles vaccination rates in the United States – below that of many low- and middle-income countries. Last Friday, Gov. Jay Inslee declared a state of emergency in response to more than two dozen confirmed cases of measles in our state. 

We are not alone — last year, 26 states in the U.S. and the District of Columbia reported a measles outbreak. Indeed, years of an unfounded fear to vaccinate, such as we have seen in this state, prompted the World Health Organization to name vaccine hesitancy as one of 2019's top public health threats

Contrast this with what I’ve seen while living and working in the Democratic Republic of Congo, Malawi, Mozambique, Tanzania and Uganda to improve access to health care. Mothers and fathers line up with their children outside clinics to ensure their children are vaccinated. I’ve seen caregivers and babies waiting patiently for hours while health workers fill out the paperwork for the 80 children who showed up for an immunization session in a remote village.

With newly confirmed cases in Oregon, New York and Atlanta, we can safely say that the measles is sweeping the nation again. I can’t help but think about what we — as parents, policymakers, and citizens — can learn from our African counterparts.  

  1. African countries provide political leadership on immunization: Unlike the silence or even criticism of vaccines by U.S. political leaders, African leaders speak frequently and publicly about the benefits of vaccination. It is not uncommon for heads of state and other officials to publicly receive a vaccine, deliver an oral dose to a child or publicly endorse the rollout of a new vaccine. Gov. Inslee has the opportunity to do the same, and a place to start would be to take a tour to counties across the state to debunk the fears of vaccination.
  2. Vaccine programs are a platform for providing other health services: In sub-Saharan Africa, where my organization works, vaccine programs are often the first point of contact people have with the health system. Strong vaccine programs at the community level can support the delivery of other preventative care — nutrition for the children, birth planning for new mothers and malaria prevention efforts. Conversely, in Seattle nearly everyone has access to the health system. The Seattle Public School Nursing Program even provides school-aged children with health services right at their school. This year, some schools even had flu shots available to students. School nurses can be strong advocates educating on the importance of keeping to immunization schedules. Hopefully, parents will pay attention.   
  3. Pro-vaccine communications campaigns abound: It is hard to find a sign displaying the benefits of vaccines in a U.S. doctor’s office, let alone in other public spaces. In most African countries, pro-vaccine materials are on display from ministry of health offices to clinics in the most rural villages. And community leaders and parents are enlisted to share reliable information with neighbors and dispel rumors. Washington state has thousands of ferries, buses and trains moving through urban and rural areas — and as part of Washington state’s Health Promotion System, a comprehensive campaign could provide pro-vaccine communications that follow the lead of ministries of health across Africa.
  4. Vaccine programs are viewed with hope rather than with skepticism: While the measles vaccine was used in the U.S. starting in 1963, it took more than three more decades for it to reach many places, like Equateur in the Democratic Republic of the Congo, where one of our colleagues noted how measles epidemics had decimated communities until the vaccine was introduced in 1996.  While progress is still needed, the government has given priority to programs that bring immunizations to remote areas. The country also is embracing the experimental Ebola vaccine, which is expected to help stop the second deadliest Ebola outbreak in history.  

The U.S. is experiencing a resurgence of diseases like measles resulting from low vaccination rates. In Washington state we are watching the number of confirmed cases rise almost daily. Experts warn that as vaccination refusals continue, more outbreaks will occur. 

There are so many other health issues that require our collective time, energy and resources. We can’t afford to backtrack on the ones we’ve already solved. 

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To solve WA's measles epidemic, look to Africa