Intended for healthcare professionals


A little bit of measles does you good

BMJ 1999; 319 doi: (Published 03 July 1999) Cite this as: BMJ 1999;319:4

Who brought measles?

History has documented well for us the devastating effects of the
arrival of the measles virus from Europe several centuries ago (e.g.,
Iceland and the Americas). Some will also remember that when measles
vaccine became available on a large scale (late 60's), in the unpublished
and published experience (1970's) of a number of clinicians, the
relationship between measles and susceptibility to other diseases, notably
tuberculosis, was well established, at least in Amerindian and other
population groups living in poverty and not exposed to measles prior to
outbreaks recorded at the time. Studies published then documenting
effects of clinical measles on the immune response were accepted as a
reasonable explanation.

Thus, Dr. Shann's editorial, while no surprise, comes as a welcome
reminder of things forgotten. The implications for public health action
are clear - and not unrelated to the relationship between AIDS and
susceptibility to other diseases, which has cost so much money to "prove".

The point is one of public policy: how to maintain funding for
successful epidemiological activities once their goal has been attained
(in this case, the elimination or eradication of measles, hopefully just
around the corner).

The history of tuberculosis control, while somewhat "glorious" during
the post-World War II years related to strong social support (NGO sales of
stamps), has been a glaring example of successive failures in establishing
political priority for what once was the "disease of kings". It is only
fair to recognize the renewed efforts being made by WHO over the past 4 or
5 years, and the commitment expressed by their new Director General in
this regard. Unfortunately, the national response has yet to materialize
in the intensity and perspective required. More realistic approaches
need to be developed which take into account the financial and logistic
barriers still limiting access to general healthcare across the globe.

Although it is true that our most successful ventures have been in
the pursuit of one creature at a time (i.e., yellow fever, smallpox,
polio), how can we deal effectively with the long and growing list on the

While there are many reasons to be optimistic, lip service to these
causes - and to their integration to the mainstream of primary healthcare
- is not enough. How long do we need to wait and how big a price should
we all pay for the consequences of our inertia? Have we learned the
lessons from our failure in controlling the AIDS epidemic in its early
stages? Are we really ready for another Ebola?
Or is this just a love affair with Mycobacteriae and other creatures that
share our planet and our bodies? Do we really care at all?

Competing interests: No competing interests

06 July 1999
Tomas Engler
Senior Health Specialist
Inter-American Development Bank