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Review
. 2024 Jul 22;12(7):814.
doi: 10.3390/vaccines12070814.

Possible Paths to Measles Eradication: Conceptual Frameworks, Strategies, and Tactics

Amy K Winter  1 , William J Moss  2   3
Affiliations
Review

Possible Paths to Measles Eradication: Conceptual Frameworks, Strategies, and Tactics

Amy K Winter et al. Vaccines (Basel). .

Abstract

Measles elimination refers to the interruption of measles virus transmission in a defined geographic area (e.g., country or region) for 12 months or more, and measles eradication refers to the global interruption of measles virus transmission. Measles eradication was first discussed and debated in the late 1960's shortly after the licensure of measles vaccines. Most experts agree that measles meets criteria for disease eradication, but progress toward national and regional measles elimination has slowed. Several paths to measles eradication can be described, including an incremental path through country-wide and regional measles elimination and phased paths through endgame scenarios and strategies. Infectious disease dynamic modeling can help inform measles elimination and eradication strategies, and all paths would be greatly facilitated by innovative technologies such as microarray patches to improve vaccine access and demand, point-of-contact diagnostic tests to facilitate outbreak responses, and point-of-contact IgG tests to identify susceptible populations. A pragmatic approach to measles eradication would identify and realize the necessary preconditions and clearly articulate various endgame scenarios and strategies to achieve measles eradication with an intensified and coordinated global effort in a specified timeframe, i.e., to "go big and go fast". To encourage and promote deliberation among a broad array of stakeholders, we provide a brief historical background and key considerations for setting a measles eradication goal.

Keywords: elimination; eradication; measles; vaccine.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The canonical path to measles eradication. Adapted from Graham M, Winter AK, Ferrari M, Grenfell B, Moss WJ, Azman AS, Metcalf CJE, Lessler J. Measles and the canonical path to elimination. Science 2019, 364, 584–587 [63]. This two-dimensional plot is known as incidence space. The y-position for each country is determined by averaging the annual WHO reported incidence rates since 1980, weighted by a truncated Gaussian distribution that peaks two years prior. The x-position for each country is calculated as the year-to-year coefficient of variation over the previous 10 years, weighted by the same Gaussian distribution. A country’s position in this two-dimensional incidence space is then assigned to the closest point on the canonical path (given a log incidence scale) to determine its country-specific position on the path to elimination. See https://uga-idd.github.io/MeaslesCanonicalPathToElimination_Visual/ (accessed on 3 July 2024) for a visualization of all countries’ positions in incidence space in 1990–2023.
Figure 2
Figure 2
Examples of phased paths to measles eradication through different endgame scenarios and endgame strategies.
See this image and copyright information in PMC

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