Werra Maulu Botey struggled to close his daughter’s coffin, repeatedly adjusting her small head and smoothing the cloth that cradled it. Olive, aged 5, died of measles the evening before, becoming the first child to die that weekend at an emergency measles treatment center in Bikoro, northwest Democratic Republic of Congo. Her cousin, a 1-year-old girl, was the second casualty.
Measles is currently affecting children in Bikoro, as it does every few years, spreading across the vast country. The disease is also on the rise globally, including in some U.S. communities, despite the measles vaccine being in use since 1963 and credited with saving millions of lives.
Last year, Congo reported over 311,000 measles cases, with approximately 6,000 resulting in death. This year, cases have decreased to about 97,000, but the virus has become more lethal, claiming over 2,100 lives. The reasons for this increase in severity remain unclear.
Globally, measles cases rose by 20 percent in 2023 compared to the previous year, totaling 10.3 million cases and over 107,000 deaths. The World Health Organization noted that 57 countries experienced significant outbreaks, a nearly 60 percent increase from 2022.
In regions like Minnesota and New Brunswick, outbreaks are attributed to vaccine mistrust among parents, who often underestimate the seriousness of the virus. In the U.S., the incoming federal health secretary has opposed vaccine mandates, advocating for parental choice regarding vaccinations.
In contrast, many parents in Congo lack the opportunity to vaccinate their children, despite their desire to do so. Olive lived about 28 miles from Bikoro in a village without a health center. Her father worked in Bikoro, while her mother was in Mbandaka, leading her to stay with her grandmother. When Olive showed severe symptoms, her grandmother arranged for a lengthy journey to the treatment center.
Upon arrival at the measles treatment center, established by Doctors Without Borders, Olive was one of 28 children admitted that day. She required oxygen and a blood transfusion, but the hospital lacked a blood bank, necessitating a donor search. Despite efforts, Olive passed away by 7 p.m.
Her mother, Gisele Mboyo Ekongo, learned of her daughter’s illness only after Olive’s death, having traveled overnight from Mbandaka. She expressed frustration over the challenges of obtaining vaccinations, stating, “The vaccines don’t come; the care is so far away.”
Measles can lead to severe complications, including immune amnesia, which increases vulnerability to other infections. In Congo, where malnutrition is prevalent, the combination of measles with other illnesses can be fatal. The country struggles with high rates of measles due to low vaccination coverage, estimated at 52 percent, with some impoverished areas reporting as low as 13 percent.
Logistical challenges hinder vaccine distribution in Congo, where infrastructure is poor and the rainy season often renders roads impassable. The vaccine must be kept cold, complicating storage and transportation in a country with limited electricity. Additionally, healthcare workers often lack motivation due to inadequate compensation.
Ongoing civil conflicts have displaced millions, further complicating access to healthcare. Even when vaccines are available, reaching children remains a challenge, as many parents work long hours and may miss vaccination opportunities.
Efforts to improve the situation include the development of rapid diagnostic tests and potential vaccine delivery methods that do not require refrigeration. Experts believe that controlling measles in Congo is achievable with political commitment and improvements to the healthcare system.
As Olive’s family gathered to bury her, her mother remained behind, unable to witness the burial. Olive was remembered for her love of playing football in the rain and dancing, as her friends and cousins danced in her honor before the burial.