The hidden cost of Ebola: thousands of measles deaths

As if being stricken by the most deadly virus known to man weren’t enough, now, it seems, West Africa is on alert for outbreaks of vaccine-preventable diseases including measles, whooping cough, and tuberculosis.

In a new study in the journal Science, researchers focused on measles — the most contagious virus recorded — and applied statistical models to quantify the likelihood of an epidemic in the three countries worst hit by Ebola, Liberia, Sierra Leone, and Guinea.

The scientists wanted to explore this question because during the Ebola crisis, routine vaccinations essentially ceased: many health facilities shut down, health workers walked off the job, and people weren’t seeking routine health-care even when they could out of fear of catching Ebola.

The researchers found that due to the health-system disruptions over 18 months, there could be up to 100,000 additional measles cases and between 2,000 and 16,000 additional deaths. (The range comes from various levels of reduction in vaccination rates that they looked at, from 25 to 100 percent drops in coverage.)

The researchers noted that an outbreak of this size wouldn’t be entirely unprecedented: between 2010 and 2013, there was a measles outbreak in the Democratic Republic of the Congo that resulted in nearly 300,000 cases and over 5,000 deaths.

“The secondary effects of Ebola — both in childhood infections and other health outcomes — are potentially as devastating in terms of loss of life as the disease itself,” said study leader Justin Lessler, an assistant professor at the Johns Hopkins Bloomberg School of Public Health in a release. “While the downstream effects of Ebola are many, we can actually do something about measles relatively cheaply and easily, saving many lives by restarting derailed vaccination campaigns.”

The researchers also noted that measles cases tend to follow crises — from political issues to natural disasters — since it’s a highly contagious disease against which we quickly lose herd immunity. The key reason is that measles vaccination rates usually tend to be lower to begin with, because the shot can’t be given as soon as a child is born and requires parents to return to the doctor after a year.

The Ebola outbreak, which started in December 2013 in Guinea, has already stricken more than 24,000 people and killed more than 10,000. But the researchers writing in Science weren’t the first to warn that the majority of Ebola deaths may not be from Ebola.

Of this epidemic, the World Bank said Ebola may deal a “potentially catastrophic blow” to the West African countries reeling from the outbreak. Businesses are shutting down, people aren’t working, construction is on hold, kids aren’t going to school. A report from the bank in December 2014 noted:

GDP growth estimates for 2014 have been revised sharply downward since pre-crisis estimates. Projected 2014 growth in Liberia is now 2.2 percent (versus 5.9 percent before the crisis and 2.5 percent in October). Projected 2014 growth in Sierra Leone is now 4.0 percent (versus 11.3 percent before the crisis and 8.0 percent in October). Projected 2014 growth in Guinea is now 0.5 percent (versus 4.5 percent before the crisis and 2.4 percent in October).

The epidemic has also led to widespread food insecurity.

Besides measles, people are going to suffer and die more from other diseases, too. “West Africa will see much more suffering and many more deaths during childbirth and from malaria, tuberculosis, HIV-AIDS, enteric and respiratory illnesses, diabetes, cancer, cardiovascular disease, and mental health during and after the Ebola epidemic,” wrote disease researchers Jeremy Farrar, of the Wellcome Trust, and Peter Piot, of the London School of Hygiene and Tropical Medicine, in an article in the New England Journal of Medicine.

The health and economic consequences will undoubtedly linger longer than the epidemic itself, and the fact that there will be a cohort of children who are unvaccinated will put Liberia, Sierra Leone, and Guinea at a higher risk of vaccine-preventable outbreaks for decades to come.

To learn more, see 9 things you need to know about measles.