28 September 2000
The tragedy of measles is that it is entirely preventable. In many countries the national Ministry of Health has implemented an Expanded Programme on Immunisation, which is usually known by its abbreviation, EPI. This targets all young children and vaccinates them against a total of six diseases, of which measles is one. There are many places, however, where civil strife, war, population displacement or sheer poverty have prevented immunisation taking place. It is in these situations that MSF will implement mass immunisation campaigns. The other classical situation where MSF teams set up mass campaigns is during an influx of refugees. The target age group for a mass measles campaign is usually from 6 months to 12 years. A preventive dose of vitamin A is usually given at the same time as the measles injection. These campaigns may cover tens of thousands of children. The logistics of organising such a campaign are complex. One of the most important aspects is the cold chain, which is the unbroken series of refrigerators and insulated cool-boxes that carried the sensitive measles vaccine from its place of procurement to the field where it is to be administered. To speed up mass campaigns MSF has developed immunisation kits that contain all the needles, syringes and other equipment needed by our teams in order to be able to start work immediately in an emergency. An example - Preventing an outbreak of measles. In 1988, following an outbreak of violence in neighbouring Burundi, more than 50,000 refugees suddenly crossed the border into southern Rwanda. There were already reports of measles among the local villagers and given the extreme crowding of the refugees the MSF exploratory team there feared a major outbreak. The team estimated the target population of ages 6 months to 12 years at some 20,000 children. They ordered the necessary quantities of vaccines and supplies by radio. During the following 24 hours they made certain that the cold chain in the local hospitals and dispensaries could store their vaccines, and at the same time began briefing and training the national staff and volunteers on how the campaign would proceed. When the vaccines arrived they started work at once. Travelling along the border to all the sites where the refugees had come to rest they were able to complete the campaign within a period of three days. Subsequent to this there was no outbreak of measles among those refugees and a major risk was thus averted.