Europe making steady progress toward measles and rubella elimination

A growing number of countries in the WHO European Region has interrupted endemic transmission of measles and rubella. The European Regional Verification Commission for Measles and Rubella Elimination (RVC) concluded at its 5th meeting held 24–26 October 2016 in Copenhagen, Denmark, that based on reporting for 2015, 37 countries have demonstrated interruption of endemic transmission of measles and 35 of these countries have also demonstrated interruption of rubella. In many parts of the Region interruption has been sustained for at least 36 consecutive months, allowing the RVC to verify elimination of endemic transmission of measles in 24 countries and of rubella also in 24 countries.

This outcome reflects steady progress in overcoming barriers to region-wide elimination of these vaccine-preventable diseases. At its previous meeting in 2015 the RVC concluded based on 2014 reporting that 34 countries had interrupted endemic transmission of one or both diseases, 21 had eliminated endemic transmission of measles and 20 of rubella.  

Dr Nedret Emiroglu, Director of the Division Health Emergencies and Communicable Diseases, was encouraged by the outcome but stressed the need to continue intensive support to Member States: “This outcome brings us to a critical period for moving this process forward. In the coming months, WHO will pursue a country-by-country strategy to effect the necessary political and technical changes required to get the job done. It is imperative that Member States achieve their goal to eliminate these diseases.”

Annual verification process

The RVC bases its assessments on annual status updates (ASUs) submitted by national verification committees. The RVC’s role is to assess the status of measles and rubella transmission in each country and based on this assessment to verify whether elimination of one or both diseases has been achieved, as laid out in the framework for the verification process.

At its 5th meeting, the RVC welcomed a new member, Dr Robert Linkins, as well as representatives of WHO headquarters and the European Centre for Disease Prevention and Control (ECDC).

Region of the Americas – first across the line

Globally, measles cases have dropped by 79% since 2000. The Region of the Americas was the first region in the world to be declared free of endemic measles on 26 September 2016. The Americas was also the first to eliminate rubella, announced in April 2015. Although contexts differ across and within regions, the Americas’ historic achievements clearly demonstrate that elimination of measles and rubella is possible and within reach in the European Region.

What is holding Europe back?

The RVC noted that the capacity for case-based measles and rubella surveillance throughout the Region was extremely high; however operational challenges persist, particularly for rubella.  Stagnating or declining immunization rates at national level and immunity gaps in subpopulations were also concerning to the RVC and impeding interruption. Variable political commitment at national level to resolve these challenges highlights the need for high-level advocacy in a few Member States. A full set of conclusions and recommendations of the 5th RVC meeting, including each country’s status will be posted in the coming weeks on the WHO/Europe website.