Measles was described by Muhammad ibn Zakariya ar-Razi (860-932) or Rhazes – a Persian philosopher and physician, in the 10th century A.D. as a disease that is “more dreaded than smallpox”. Razes published a book entitled “The Book of Smallpox and Measles” (in Arabic: Kitab fi al-jadari wa-al-hasbah). Interestingly a lot of myths and misconception had been carried with Measles, especially calling it as “Sheetla Mata” (the gift of Goddess) and/or “ouri Maata”. Interestingly while working in one of the Hindu communities in an urban squatter of Karachi, I had observed that the child who had developed Measles was put in a separate room and it was pretty cleaned with some ‘Naeem’ branches. In fact I had heard from my parents and some elder relatives that it is much better to allow the disease to come out rather than suppress it. I thought that these must be related to a particular ethnic group or religious group, however, while discussing just yesterday with one of the colleagues, I was told that in Sindh in Muslim families, this myth still persists. However the children are managed differently. They are not give bath, the room is not cleaned, rather closed and to add to miseries, other children are also put in that room, so that they also “benefit” from this gift!!!
Almost 4 decades back, as a student and then as House Officer, I had seen not only the early signs but also all types of complications ranging from, Koplik’s spot, Maggots in mouth (because of unhygienic conditions and Pneumonia and meningitis. Unfortunately, we are still having Measles complications being manifested as Pneumonia, ultimately leading to death.
The recent WHO estimates about the status of Measles in Pakistan are very disturbing to all of us. We are still grappling with communicable diseases, without realizing that quite a population has now also contracted non-communicable diseases and last but not the least, MNCH/RH issues and rapidly aging population. Of course not to forget the rapidly increasing population which is adding more and more and children.
The government alognwith bilateral and multilateral partners have been coming up with lot of projects/interventions including the so called “surveillance system, the vaccination campaigns and yearly MNCH days etc etc. I really what had happened to all these efforts and suddenly WHO comes with the news that 65% of Measles cases in South East Asia are from Pakistan. It seems that our vaccination efforts has not made a difference due to ineffective surveillance system which has not been able to pick due to faulty data; ineffective vaccination; lack of awareness and willingness to vaccinate their children and above all no advocacy by our leaders to make a difference.
Considering a health systems approach, availability of vaccines by GAVI may be just one component, converting it into success will require the need to put attention on other components. We have yet to get rid of Polio, but if take that “single-targeted” approach for controlling the immunizable diseases, we may not achieve our targets in the so many future targets. Let us do something out of box; there are examples of success stories from different parts of the world, it is high time that rather than inventing a new wheel, we try to adapt the wheel already prepared by someone