While the Democratic Republic of the Congo (D.R.C.) grapple with its latest Ebola outbreak and  COVID-19, other conditions remain a major issue. Resources have been diverted towards fighting a 19-month long outbreak of Ebola that has killed over 2,000 people. In turn, this has weakened the fight against containing measles. Since the start of 2019, over 341,000 people have been infected with measles. As a result, approximately 6,400 have died. This is a figure almost three times higher than the number killed by Ebola during the same time period. UNICEF and its partners are supporting health services in the D.R.C.. However, in response to COVID-19 and other continuing health concerns in the country, UNICEF is calling for more support.

UNICEF’s D.R.C. representative Edouard Beigbeder said, “Strengthening the DRC’s basic health care system is absolutely vital. Unless health facilities have the means to deliver immunization, nutrition and other essential services, including in remote areas of the country, we risk seeing the lives and futures of many Congolese children scarred or destroyed by preventable diseases.”

Henrietta Fore, the UNICEF Executive Director, said in a March 26 statement, “We must not allow lifesaving interventions to fall victim to our efforts to address COVID-19,” adding, “In the days to come, governments may have to temporarily postpone preventive mass vaccination campaigns in many places to ensure that the delivery of immunization services does not contribute to COVID-19 spread, and to follow recommendations on physical distancing. UNICEF strongly recommends that all governments begin rigorous planning now to intensify immunization activities once the COVID-19 pandemic is under control.”

Karel Janssens, Doctors Without Borders’ (MSF) Head of Mission in the D.R.C. said, “The actual mortality rate might be much higher, up to four or five times higher than what we see in official numbers…there’s a lot of community deaths that are not reflected in some of the official reports.”

In response to the measles outbreak in the D.R.C., local authorities launched a vaccination campaign on April 27, 2020. This campaign, which ended the following weekend, targeted over 25,000 children, and follows others that targeted 42,000 children.

Measles remains a global issue, with 10 million cases worldwide in 2018. This has caused 140,000 deaths, which represents a 58% increase since 2016. In poorer countries such as the D.R.C., health system issues, including underfunding, have made vaccine delivery highly problematic. Malnutrition can make measles more deadly and make vaccinations less effective. One such example is vitamin A deficiency. As five million children in the country are acutely malnourished, the measles vaccine’s effectiveness is reduced. This is because, upon vaccination, malnourished children have a diminished ability to develop immunoglobulin against the disease. The death rate in developing countries is around 3-6%, but can be as high as 30% in the worst outbreaks.

Those who recover can be left with lifelong issues. These include blindness, hearing loss, and brain damage. Immunity issues are also a problem for a duration after infection, as these infections can eliminate immunity memory of other illnesses. This leaves children more vulnerable to other pathogens. Further, measles is highly contagious compared to other diseases. In the case of coronavirus, the reproduction number is between two and three. This number refers to the average number of people who would be infected by a single person with a particular virus, in a population lacking immunity to that virus. For measles, this number is between 12 and 18. Hence it is remarkably more contagious, which highlights the importance of vaccination.

It is estimated that because of its contagiousness, 92-95% of the population needs to be fully immunized to prevent an outbreak. Numerous children in poorer countries only receive one vaccine dose, instead of two. This does not provide full protection. According to a UNICEF study, in the D.R.C. only 57% of children received a single dose in 2018. This significant gap creates vulnerable conditions for continued measles outbreaks.

It is difficult to deploy vaccination campaigns in the D.R.C. that can effectively reach vulnerable children. A leading reason for this is that it is a large country lacking in reliable infrastructure. From warehouse to administration, the vaccine must be kept at a temperature range of between two and eight degrees Celsius. Protecting vaccines during a long transport period has proven difficult. This is because only 1% of rural areas have access to electricity from the national grid.

Another issue is health workers being inadequately trained. Safe vaccine injection is essential and more complex than administering liquid polio vaccines. The D.R.C. also has had numerous armed conflicts and civil wars complicating vaccination campaigns. Funding for the campaigns remains an issue. By declaring the measles outbreak an epidemic in June 2019, the country has received international aid. However, in addition to foreign donor contributions, the D.R.C. government is expected to provide financial support.

Across the world, poorer countries are facing extant issues that are at risk of growing in magnitude. This is in the backdrop of the coronavirus pandemic which has led to a mobilization of resources to address it globally. In the D.R.C., one such health concern, amongst many others, is measles. The current outbreak of measles is a significant concern that requires widespread immunization to address. However, the range of issues that the country faces has made vaccination delivery very difficult. There are numerous malnourished children, infrastructure problems including electricity and transportation, and prolonged conflicts.

New vaccination campaigns are a crucial step, alongside the necessary funding. This is, in part, because this issue has been around for some time. A far greater share of aid has been allocated towards Ebola and now the coronavirus, leaving measles campaigns lacking the same intensity of support. Measles has had devastating effects, including leaving vulnerable children even more susceptible to other diseases. Therefore, it is fundamentally important to expand aid efforts towards measles vaccination in the D.R.C. and in other poorer countries that continue to face outbreaks of this preventable disease. Furthermore, it is essential to continue to address fundamental infrastructure issues in the D.R.C.. One reason for this is that such problems can contribute to the widespread malnutrition of children. Addressing child malnutrition is very important to increasing the efficacy of the vaccination programs. It is also essential in improving outcomes among children who become infected with diseases, and to significantly boost overall health.