July 5, 2017

Romania is struggling to come to grips with a measles outbreak that has seen roughly 7,500 registered cases and 31 deaths since last September, most of them young children.

The epidemic, which has hit much of the country, has been tied to a shortage of vaccines as well as parents choosing not to immunise their children or unable to get access to see a doctor. The lack of available vaccines within the EU country has raised particular concern.

In late April the country’s then-prime minister, Sorin Grindeanu, said the situation can no longer be tolerated or accepted. “It’s inadmissible for multiple vaccine shortage crises to occur in Romania each year. It’s also inadmissible because this situation caused suffering to those families whose children died of measles. There are no excuses for these tragedies, nor for the fact that for certain vaccines only one in two children are immunised,” he said.

Measles, one of the communicable diseases targeted for elimination, has been making a bit of a comeback in Europe. In the past year measles outbreaks have also appeared in Italy, France and Germany, as well as other European countries, though so far Romania is the worst hit.

The European Centre for Disease Prevention and Control found that between March 2016 and February 2017 46% of measles cases within the EU and EEA regions were found in Romania, with a further 24% found in Italy.

In late March the World Health Organisation released a statement saying that with the steady progress made towards eliminating measles over the past two years “it is of particular concern that measles cases are climbing in Europe. Today’s travel patterns put no person or country beyond the reach of the measles virus.”

In Romania measles, mumps and rubella (MMR) vaccination coverage has fallen sharply over the last decade.

“There has been a constant decrease in coverage of vaccination in the last 10 years,” says Alexandru Rafila, president of the Romanian Society of Microbiology. “Little by little the coverage, not just for MMR, has decreased because of a lack of interest in immunisation as many of the diseases have practically disappeared from many regions of Romania. Vaccines are a victim of their own success,” he adds.

Yet, while reports suggested that around 7% of Romanian parents refuse vaccination, one in three families are thought to be unable to see a doctor or get access to the vaccines.

Measles immunisation rates in Romania are reported to have dropped from 95% to 86% over the past decade, and in some regions of the country the rate of vaccination is estimated at just 80% for the first dose and 50% for the second. The WHO recommends two doses of MMR vaccine, the first occurring before the child’s first birthday, and an overall immunisation rate of 95% to protect the population as a whole.

“It is important to increase coverage to 95% as recommended by the WHO otherwise we will face every two, three or four years such epidemics,” says Rafila.

The shortage of vaccines was exacerbated by the epidemic, with resources becoming more strained as those who previously missed vaccinations rushed to catch up. Romania also lowered the age of administering the first vaccine dose from 12 to nine months.

In early May the European Commission endorsed a decision by the Romanian government to temporarily suspend any exports of MMR vaccines.

“In Eastern Europe we have lower prices than Western Europe, so what comes out of this is wholesalers buying the drugs in these countries and selling them again in countries in Western Europe. This is a major problem,” says Vlad Voiculescu, a former Romanian health minister.

Voiculescu adds that until recently Romania lacked an effective system to monitor available medical supplies across the country. “You need to know how many vaccines are available and need to know in real time and plan acquisitions. This is something we didn’t have but something I was able to set up towards the end of last year,” though he adds that it could have reduced the epidemic if it was in place earlier.

To try to combat future epidemics, authorities in Romania have recently launched a major pro-vaccination and immunisation campaign. The government has also introduced legislation for public debate that would make vaccinations mandatory for children if they are to attend schools or kindergarten, as well as draft legislation for the stockpiling of vaccines to cover future eventualities.

“We have this tragic example, we don’t need other examples,” says the Romanian Society of Microbiology’s Rafila. “We need to solve it, and the only way we can solve it is we need to have this legislation in order to have these stocks and avoid any other shortages in the future.”

According to a spokesperson for the Ministry of Health, Romania now has enough vaccines to last through the end of the year, with 118,812 doses available as of mid-June and a further 455,450 doses already bought by the Ministry, with 417,950 of those set to arrive this week.

This is likely to help resolve the crisis in the short term, but going forward it is clear that Romania and other countries will need to be increasingly vigilante.