THE RE-EMERGING THREAT OF MEASLES

Posted by AsiaViews | Aug 27, 2018 | 0 |

By Maizura Ismail,

ASEAN Post-August 23, 2018

First published in the ASEAN Post and accessible at: https://theaseanpost.com/article/re-emerging-threat-measles

Last week, the World Health Organization (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 1,000 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.

Source: WHO.

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) immunization coverage. According to him, the MMR immunization 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 immunization 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 immunized. This is impacted by the rise of vaccination refusal by anti-vaccination movements, also known as anti-vaxxers.

ANTI-VAXXERS

Much of the anti-vaxxers’ crusade is driven by a 1998 paper published in the Lancet by British researchers led 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 However, the paper that featured only eight children that were selectively sampled, was retracted by the Lancet.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 fulfills 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 reemergence, 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.

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EXTRICATING NDONESIAN CHILDREN FROM ISIS INFLUENCE ABROAD

Indonesia urgently needs to revisit the possibility of repatriating the neediest of its young citizens stranded abroad, whose families had earlier joined ISIS. Most of these children are in camps in northern Syria but there are also small numbers in the Philippines, Afghanistan and Iraq. “Extricating Indonesian Children from ISIS Influence Abroad”, the latest report from the Institute for Policy Analysis of Conflict (IPAC) argues that the government could begin by bringing back small groups of unaccompanied children under ten years of age, who pose minimal security risk and are most vulnerable to deteriorating conditions in the camps.“The problem is that health and security conditions are worsening by the day in the Syrian camps, and the children are growing older,” says Dyah Kartika, IPAC analyst. “They need access to schools, a nurturing environment, and medical attention. If the government waits too long, the children will be further exposed to ISIS ideology.” The new report examines a 2019 list of Indonesians in camps and prisons run by the Kurdish Syrian Democratic Forces (SDF). The Indonesian government has been trying to verify their citizenship, but with pseudonyms, misspellings and bad transliterations, it is a daunting task. At the time the data was collected, between March and June 2019, there were 555 Indonesians in SDF camps and prisons, including 367 children. Among the children, approximately 277 were under the age of ten and 34 were unaccompanied. In June 2021, there are fewer than ten children who are both unaccompanied and under the age of ten that could be prioritized for return. Bringing back children of ISIS families is no easy task. The report analyses the main challenges faced by the Indonesian government. These include definitional issues, bureaucratic competition, the difficulty of verifying nationality, evaluating the toll of exposure to conflict, assessing security risk, and finding relatives or others willing to provide care once the children are returned. In addition, COVID has meant stringent restrictions on travel, placing further obstacles in the way of repatriation. There are several models for rehabilitation of children exposed to violent extremism in Indonesia that could be modified to accommodate the needs of children repatriated from abroad. The report examines these models and argues that the government does not need to have every detail of rehabilitation programs in place before it starts extricating children from ISIS influence. It can start by bringing back the most vulnerable children and then modify programs as needed.

“It’s important that the government see these children as victims” says Dyah. “They deserve a chance to be children again.”

THE RE-EMERGING THREAT OF MEASLES