Measles

A news story caught my eye over the weekend about measles. It turns out that measles are an issue in Ho Chi Minh City.

MEASLES CASES IN THE US ARE ALSO RISING. SOURCE: CDC

Deputy Director of the municipal Department of Health Nguyen Huu Hung said from 2018 to February 2019, the city recorded 4,327 measles cases, including over 2,600 in the first two months of this year.

If I do the math, that means in 2019 the number of measles cases is already higher than in all of 2018. In 2018 in all of Vietnam, according to the government, there were only 1,963 cases. So 2019 is not looking good.

Vietnam is not the only place with measles problems. The US also has a measles problem, and it’s for the same reason: Not everyone is being vaccinated.

VIETNAM BACK IN 2004 WAS AHEAD OF ITS NEIGHBORS. SOURCE: WHO

I was surprised by Vietnam’s uptick in measles, because the vaccination rates in Vietnam are actually pretty high, at least for the first shot (96% in HCMC for the first shot and 80% for the second). If you follow any of the anti-vax stuff, and I do, you know that there is basically one legitimate reasons to not get vaccinated: if you health doesn’t allow it. Other than that, everyone needs to get the vaccination, specifically so that people that can’t get vaccinated are also protected by the herd immunity. And measles isn’t just a child’s disease that is easily overcome. A recent report by leading health organizations said:

Using updated disease modelling data, the report provides the most comprehensive estimates of measles trends over the last 17 years. It shows that since 2000, over 21 million lives have been saved through measles immunizations. However, reported cases increased by more than 30 percent worldwide from 2016. 

CASES OF MALARIA IN VIETNAM HAVE FALLEN DRASTICALLY. SOURCE: WHO

Vietnam has actually been pretty good on measles. Back in 2004, it was actually ahead of most of its neighbors with less than 0.3 deaths per 100,000 people. That was better than the Philippines, and not far off from Thailand and Malaysia, both much richer countries. And I can only assume that this statistic improved, as every other health measure has improved in Vietnam as the country has gotten richer. For example, here is a chart from the WHO that I pulled on malaria cases. They are down drastically since 2002.

The big problem with vaccines is that you need an extremely high rate of compliance to be completely effective. But getting to that high rate is hard. There is the 80-20 rule that says that you can get 80% of the way there pretty easily. But that the last 20% is the hardest - the hardest to reach, the hardest to convince to get the vaccine, the hardest to follow up with and get the second vaccine. That’s as true in the US as it is in Vietnam. The US has been too liberal with religious and other exceptions that hurt uptake rates, and Vietnam likely has education issues around vaccines that are similar in effect.

Ultimately, Vietnam is getting much healthier, but going the final step to making sure that measles is eradicated is expensive and time-consuming. And there are going to be periods where things get worse. Hopefully this will just be a hiccup in the long downward trend of measles cases and other diseases in Vietnam.