Measles, a health crisis

Tongai Mashonga/Irene Kalulu

Measles is a highly contagious respiratory disease that if not treated, can lead to blindness, ear infections, brain swelling, pneumonia and even death. 

Young, malnourished children with chronic illnesses and with no access to health care service, are particularly vulnerable to the disease.  

More than 700 children have died from the current measles outbreak in Zimbabwe. 

James Dube (not real name) who is living with HIV says he nearly lost his son to measles. 

“All my children were vaccinated for measles before the outbreak. But I think their immune system is not strong enough for them to quickly recover whenever they are attacked by disease,” he says.

Pardon Mlambo, a community leader chronicled how children with underlying conditions are struggling with the current measles outbreak. 

“Whenever there are outbreaks of diseases, children with underlying conditions suffer the most and die. A lot of factors are at play, for instance poor nutrition and lack of proper health care services. Public health institutions don’t have medicine available and people have to buy medication from expensive privately owned pharmacies. The only way to survive during this measles outbreak is to be vaccinated as early as possible,”  he said.

Children under five with underlying conditions that impair the immune system will have more severe infection from measles. 

Malnourished children with kwashiorkor or marasmus have immune suppression and tend to suffer very severely from measles. Any other form of immune suppression like AIDS will also cause severe disease usually leading to mortality. 

Dr. Henry Madzorera, former Minister of Health and Child Care (MoHCC) says it is important to ensure that the immune system of children is good.

Zimbabwe mandates children to be immunised against a variety of diseases, including measles. However, members of the Apostolic Church, reject conventional treatment and put their trust in religion for healing. 

This has indirectly led to the death of hundreds of apostolic sect members including children as the church has barred them from seeking medical treatment. 

The sects that are distinctive with their white garments and open-air worship are estimated to have nearly five million members in Zimbabwe. They don’t allow their members to seek medical assistance, as a result, children from these sects do not get immunised leaving them prone to disease. 

Pamela Dude, a community leader who frequently interacts with these sects says most of their children were attacked by measles during the current outbreak. 

Their solution has been to make the sick drink and apply a certain type of Okra which they believe to have healing properties. The affected person is not allowed to bath until they recover. During this period the father of the child is not allowed to be sexually active.

“To them measles is like a flue, it comes and goes,” says Dube.

Ntombizodwa Revesai, the Midlands Provincial Spokesperson for Apostolic Women Empowerment Trust (AWET) an Inter-Faith based, non-governmental organization mandated to advance the rights of adolescents and women issues and mainstreaming of gender in apostolic church activities says apostolic members were not spared from the outbreak. 

AWET has held advocacy campaigns to create awareness on the importance of immunisations. 

“Some apostolic members prefer to go to the clinics secretly. They are highly patriarchal societies and the women don’t have much say on what happens,” said Revesai.

The Zimbabwe National Statistics says that 38% of the country’s female population are apostolic sect members. This is a large percentage of the population that gets to decide if children get immunised or not. 

“The problem with these apostolic sects is that their children are not immunised and don’t have any immunity against measles. It’s a whole lot of people living together in a commune and there is zero herd immunity in those communes. There is very high mortality and members usually don’t report the deaths of those children so they are not counted,” he said. 

The case fatality for measles is higher in Zimbabwe compared to other African states. 

As a result the World Health Organisation (WHO) has put in place a three flagship initiative in Africa. This, according to Dr. Fiona Braka, Operations Head for the WHO emergency operations in Africa speaking during an online meeting. 

“The case fatality is relatively higher when compared to other outbreaks across the continent. It is the first in many years at this scale and it has been progressing quickly among a community that is reluctant to accept vaccines,” she says.

The three flagship initiatives proposed by Dr. Braka have already been launched to ensure that other countries are not taken by surprise by disease outbreaks as in Zimbabwe’s case. The three initiatives encompass preparedness, detection and response to all kinds of emergencies.

 “It is anticipated that these flagships will improve the capacities in the member states to prepare, detect and respond to public emergencies,” she said.

Zimbabwe has not been able to reach the highest level in immunisation coverage. Over the last 10 years, the country has achieved the same levels of immunisation of slightly over 90 percent coverage in immunisation. 

Professor Davison Munodawafa a lecturer at the Midlands State University Department of Community Medicine in the Faculty of Medicine and former WHO Regional Adviser says the 4-6 percent gap is caused by the unreached population that has never received immunisation. 

“It’s a clear issue of policy adherence. You need consistency in application of policy and legislation or regulatory frameworks that are put in place,” he said.

He reiterates that the apostolic sects do not need more health information as they already have it. He says these are people who have made a conscious decision based on belief systems handed down over a very long period and now there is historical continuity. He adds that what the country needs is a set of strong policies and legislation that will ensure adherence within these groups. 

“There should be policy coherence, we should not be sending out mixed messages about the current policy on immunisation. When children are the victims, the estate has to take over to protect the minors because the parents are not responsive or compliant,” he says.   

The current outbreak has also been interpreted as an after-effect of the COVID-19 pandemic. The extended lockdowns and travel restrictions meant that people were not able to easily access health services.

Professor Munodawafa says it is important to take lessons from the current COVID-19 outbreak and look closely at the performance of the health system. He says that during the peak of Covid, the focus of medical interventions became verticalised at the expense of other services that were also critical, like immunisation of children. 

“There is need for re-orientation of our health manpower, they need to be in a position to do multiple tasks in an inclusive manner and not focus only on the condition that has been declared an outbreak. When you start integrating services into a health emergency it would require that resources are made available by the government,” he said.