Last week, the World Health Organisation (WHO) released data showing that over 41,000 children and adults in Europe have been infected with measles in the first six months of 2018, resulting in 37 deaths. Ukraine, plagued by conflict between the eastern secessionist territories and the Kiev government, has been the hardest hit with over 23,000 people affected. Other countries such as France, Georgia, Greece, Italy, Russia and Serbia also recorded more than one thousand measles infections each during the same period.
The worry of an emergent measles threat is also felt in Southeast Asia, where two ASEAN countries, the Philippines and Indonesia, are ranked in the top 10 countries with the highest number of confirmed measles cases for the period between July 2017 and June 2018. The Philippines recorded 8,992 cases, while Indonesia recorded 4,897 cases. The Philippines and another ASEAN country, Malaysia, were also in the top 10 countries with the highest incidence of measles per one million total population.
For Malaysia, the upward trend in measles cases signals the dismaying re-emergence of the disease. Malaysia’s Health Director-General, Dr Noor Hisham Abdullah, in a statement stated that the main contributor to the rising number of measles cases was due to low measles, mumps and rubella (MMR) immunisation coverage. According to him, the MMR immunisation coverage on 12-month-old babies fell to 92.08 percent in 2017 compared to 94.37 percent in 2016.
“We need more than 95 percent immunisation coverage to provide herd immunity for measles,” he said. Herd immunity refers to a form of immunity that occurs when the vaccination of a significant portion of a population provides protection for individuals who are not or cannot be immunised. This is impacted by the rise of vaccination refusal by anti-vaccination movements, also known as anti-vaxxers.
Much of the anti-vaxxers’ crusade is driven by a 1998 paper published in the Lancet by British researchers lead by Dr Andrew Wakefield that suggested a link between the MMR vaccine and autism. However, the paper that featured only eight children that were selectively sampled, was retracted by the Lancet. The gastroenterologist was later struck off the medical register in 2010 due to fraud for falsified data and financial gain as he was funded by lawyers involved in lawsuits against vaccine-producing companies.
However, for some anti-vaxxers, vaccination refusal for their children could also be based on religious and health beliefs due to components in the vaccine that were derived from porcine sources. For the Indonesian state-owned pharmaceutical company PT Bio Farma, this was a call for the development of a halal (permissible by Islamic law) measles-rubella (MR) vaccine. The company is working hand-in-hand with the Indonesian Ulema Council (MUI) to develop a version of the vaccination that fulfils the criteria set by the Islamic authority.
"It will take a lot of research and a long time to replace one of the components of the MR vaccine. It could take 15 to 20 years to find a vaccine with a new component," cautioned the company in its written statement to a local media agency.
The statement came a day after the MUI fatwa (a non-binding but authoritative legal opinion) stating that while the MR vaccination is haram as it contains components from porcine sources, it is currently permissible. This is due to the condition of shariah emergency as no halal MR vaccine is available in Indonesia, and the failure of inoculation poses a danger to the public. The fatwa that came out of a two-day debate on the permissibility of the MR vaccine produced by the Serum Institute of India (SII) also stressed that it is the compulsory responsibility of the Indonesian government to ensure the availability of a substitute halal vaccine.
To halt its re-emergence, evidenced-based information is much needed to separate fact from myth surrounding the measles vaccine. After the introduction of the measles vaccine in 1971, deaths caused by the highly transmissible disease were reduced from more than two million to around 100,000 annually. The vaccine has been so effective that we have forgotten what it was like to be plagued by this highly transmissible disease.