As It Happens

Lack of resources, not anti-vaxxers, to blame for Madagascar measles outbreak, says health worker

Peace Corps volunteer Lon Kightlinger says people lined up in the hot sun to get the measles vaccination after deadly outbreak in Madagascar.

Over 1,200 dead from the disease, despite eagerness from communities to immunize

Mothers wait to have their babies vaccinated against measles at a healthcare center in Larintsena, Madagascar. (Laetitia Bezain/Associated Press)

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When the clinic Lon Kightlinger volunteers at in Ambohibary, Madagascar, held a measles vaccine campaign, he says people travelled "far and wide" to line up in the hot sun and get the shot.  

Over 1,200 people have died since last September, many of them children, in the largest outbreak the small island nation has ever seen. 

But unlike outbreaks in Europe and North America, where vaccines are readily available but parents are skeptical, most of Madagascar's population is eager to vaccinate — the country's health-care infrastructure is just limited.

Kightlinger is a retired epidemiologist from South Dakota who lives in Madagascar as a volunteer for the Peace Corps. 

He spoke with As It Happens host Carol Off about what's behind the outbreak. Here is part of their conversation.

This is being called the largest outbreak in Madagascar's history. So why is it happening now, do you think? 

Madagascar is an island, so that is geographically protective against measles. You know, it takes a little more for these diseases to hop the ocean and get over here.

And then secondly, we've had a fairly robust immunization program in Madagascar for many years. So the Ministry [of Health] says 58 per cent of the population is vaccinated.

In fact, our physician at our health centre, she's been a practicing physician for 13 years and she had never seen a case of measles. So the disease, the virus, has been kept away, and it found its way back here, and we had a whole generation of people who were not vaccinated.

A volunteer nurse examines six-moth-old Sarobidy, who is infected with measles, while her mother Nifaliana Razaijafisoa looks on, at a health-care centre in Larintsena. (Laetitia Bezain/Associated Press)

And 1,200 people have already died on the island since September. 

Yeah, it's taking quite a toll here and I've seen some very sick people. Nobody in our clinic has died, I'm happy to report that, but very sick people. People with high fevers, rash, raw mouth, conjunctivitis, coughing, the whole spectrum.

Twenty-year-old young men have to be carried in. They're just so sick. It just wipes them out.

Herd immunity, which is the gold standard, has to be about 95 per cent to be effective. So why do you think that people stopped getting vaccinated? Is it because it slipped their mind ... or have they become infected if I can use that word  by what's happened elsewhere, which is this skepticism about the vaccine?

No, it's not that at all — I don't find anybody here that's really afraid of the vaccine or are skeptical.

It has to do with a lot of things. A lot of it is just the basic infrastructure of the country. Most of the country is off the main road and partly inaccessible. During the rainy season it's very hard to get around.

And it's hard to get from point A to point B in any case, much less [when] you're trying to keep a cold chain going where you're keeping vaccines refrigerated. So just the delivery system is very, very challenging.

People live long distances from the health centre, have to bring their baby in at nine months of age to be vaccinated. So it's just obstacle after obstacle after obstacle.

Mothers wait to have their babies vaccinated against measles. Kightlinger says it's difficult to get the vaccine into communities without roads, and that is part of the problem. (Laetitia Bezain/ Associated Press)

You just have one health clinic among many. You're just one guy. 

One tiny little piece of the puzzle. Yep.

Exactly. But if you could be the puzzle master, if you could be the one who could make decisions, what has to happen in Madagascar ...  in order to get people vaccinated again?

Well, just follow the normal policy that we have here — the Ministry of Health has a great policy. Every child by the first year has to be vaccinated, fully vaccinated, against 10 diseases. 

It's just getting the vaccine out to every health centre. The village health worker has to notify people. And when a baby is born, the parents have to be aware and cognizant and motivated to bring their child in to be vaccinated. 

So it's a lot of things going on here, but I would just augment the policy already in place and get the vaccines delivered where they're needed. 

As you point out ... many people haven't seen [measles] in generations. So how are people reacting? 

People are scared. 

We had the mass vaccination campaign in our community. People came from far and wide to get vaccinated. There was no hesitancy. The lines were long. The days were hot. 

There is fear of the disease. The Malagasy word for it is kitrotro, which to me sounds pretty scary. And people know that their kids are going to get sick and they've heard from ... their elders that kitrotro comes and children die. 

Written by Alison Broverman. Interview produced by Sarah Jackson. Q&A has been edited for length and clarity. 


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