"When we started the Measles Initiative ten years ago, we knew that we would help save millions of lives, but we never imagined where the world's support would take us," said David Meltzer, senior vice president of international services with the American Red Cross. "With every dollar donated, we vaccinated another child. Across the globe, we stopped outbreaks, improved treatment and protected future generations from one of the world's deadliest diseases. This milestone in measles control is significant and improves the overall outlook for children's health around the world."

In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year. With accelerated immunization activities spearheaded by governments and the Measles Initiative, global measles mortality has decreased by an impressive 78 percent worldwide from 733,000 deaths in 2000 to 164,000 in 2008. Reductions in measles-related deaths during that same time period accounts for nearly a quarter (24 percent) of the overall decrease in childhood mortality, representing significant progress toward Millennium Development Goal 4 (MDG4). This goal, which was set by the UN, aims to reduce the mortality rate for children less than five years by two thirds between 1990 and 2015.

Even as the Measles Initiative's founding partners marked this significant achievement, they warned that governments and the global health community should not rest or redirect their efforts and resources elsewhere at the expense of tackling measles. Because of the decline in deaths, measles is no longer perceived to be a threat by many and must compete for funding with programs aimed at other diseases.

"The steady march toward a measles-free world is now facing a setback," said Dr. Brent Burkholder, director of the CDC's global immunization division. "Outbreaks in Africa, a high number of deaths in India and global funding gaps threaten the gains made in the last ten years and will hinder efforts to eradicate measles and achieve MDG4."

Since 2009, widespread outbreaks affecting 30 countries in sub-Saharan Africa, including the Democratic Republic of the Congo and Ethiopia, have resulted in more than 320,000 new measles cases and more than 2,400 measles-related deaths. In the past year, several European nations have faced their worst measles outbreaks in more than 10 years, with more than 30,000 estimated cases across the region. The U.S. is also experiencing its largest measles outbreak since 1996, with more than 150 reported cases.

"The rise in outbreaks, especially in Africa, can be attributed in large part to the decrease in financial support to the Measles Initiative," said Andrea Gay, executive director of children's health with the United Nations Foundation. Funding decreased from a high of $150 million in 2007 to $68 million in 2010. "Due to inadequate funding, measles vaccination campaigns have been delayed and the target age groups have been narrowed, resulting in outbreaks and in less children being vaccinated overall," she said.

The WHO estimates that waning support could result in half a million more deaths each year and erase the Measles Initiative's gains by 2013.

Because it costs less than $1 per child to vaccinate against measles, the real stumbling block is the lack of political commitment in many countries. Several economic studies, including those referenced in the Journal of Infectious Diseases July 2011 supplement, however, demonstrate that the eradication of measles is more cost effective than a control strategy and is actually cost saving for countries where measles has already been eliminated.

The Measles Initiative continues to advocate with governments and appeal to donors around the world to maintain an aggressive vaccination schedule, and improve routine immunization and surveillance in developing countries. The support of other nations, paired with financial and technical support from the Measles Initiative, has proven to be influential among those countries whose immunization programs have not kept pace.

For example, three out of four children who died from measles in 2008 lived in India, where persistently low vaccination coverage was the norm. Last year, however, the country initiated measles vaccination campaigns in select districts and has plans to organize additional vaccination campaigns throughout the next two years. India, with a population of more than 1 billion, plans to self-finance these efforts.

Looking ahead to its second decade, the Measles Initiative will focus on achieving a series of interim targets toward the eventual eradication of measles. The first of these milestones will be to reduce measles mortality by 95 percent by 2015 (compared to 2000). The Measles Initiative estimates it will need approximately $212 million between 2012 and 2015 to reach the targets.