More Than 700 Children Have Died in a Measles Outbreak in Zimbabwe

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Global Health

It is driven by a decline in child immunization during the pandemic and the influence of an anti-vaccination evangelical church.

A view from behind of a mother, in a black shirt and black cap, holding her baby at her shoulder, while a medical worker takes notes wearing a blue apron, blue cap and blue face mask and pink shirt. In front of the mother is a large scale for weighing the baby, and in the background, a group of health workers in blue P.P.E. are talking.
A mother and baby waiting for measles vaccination at a clinic in Harare, Zimbabwe.Credit…Tsvangirayi Mukwazhi/Associated Press

BULAWAYO, Zimbabwe — A measles outbreak has killed more than 700 children and infected thousands of others across Zimbabwe, highlighting the risks of faltering childhood immunization campaigns around the globe.

As of Sept. 6, the country’s Ministry of Health and Child Care was reporting more than 6,500 cases and 704 deaths. It has not released numbers since then.

The outbreak is the result of a grim confluence of factors endangering child health in many countries.

Routine immunization dropped significantly in Zimbabwe during the Covid-19 pandemic. Anxious parents stayed away from health centers; health care workers were reassigned from routine vaccination programs to the Covid-19 pandemic response; and school closures and lengthy lockdowns scuppered the usual outreach campaigns.

In July, the World Health Organization and UNICEF warned that millions of children, most of them in the poorest countries, had missed some or all of their childhood vaccinations because of Covid lockdowns, armed conflicts and other obstacles. The U.N. agencies called the situation the largest backslide in routine immunization in 30 years and warned that, combined with rapidly rising rates of malnutrition, it created conditions that could threaten the lives of millions of children.

Vaccination coverage was already flagging in Zimbabwe before the pandemic, declining each year since 2017, because a decades-long political and economic crisis has gutted the public health system.

Zimbabwe’s health system is desperately short-staffed. Health care workers have moved to neighboring South Africa or high-income countries for jobs where they will earn much higher salaries than the meager wages in Zimbabwe that often don’t arrive at all.

Twenty-five years ago, Zimbabwe had one of the highest rates of vaccination coverage in sub-Saharan Africa, but vaccine hesitancy has swelled, amplified by influential churches that discourage immunization and urge members to rely on prayer and the intercession of pastors instead. The Johane Marange Apostolic Church, which has hundreds of thousands of members, is at the center of the measles outbreak.

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A gathering of the Apostolic Church outside Harare, where members were given vaccine information fliers.Credit…Tsvangirayi Mukwazhi/Associated Press

Some Apostolic and evangelical pastors have long opposed vaccination, saying their prayers and sacred stones are enough to protect the faithful, and have threatened to expel women who take children to clinics. This rhetoric, fueled by social media, ramped up in opposition to Covid-19 shots, which some evangelical leaders warned would contain “the mark of the beast.” The hesitancy has spilled over into resistance to routine childhood shots.

A spokesman for the federal health ministry said it was making clergy a focus of the government’s renewed efforts to get young children vaccinated.

“Government has embarked on a mass vaccination campaign reaching out to faith leaders to garner support and awareness,” Donald Mujiri, the spokesman, said. “Children aged between 6 months and 15 years are the most affected, especially in those religious sects who do not believe in vaccination. The ministry remains committed that no child should die of measles.”

The first measles cases in this outbreak were reported in April in the village of Makabvepi near the border with Mozambique. While district health officers were alerted to the presence of measles, the first children to die were buried quickly and their deaths were not reported, said Dr. Cephas Fonte, the medical officer for Mutasa District. The children who died came from families that belonged to the Johane Marange Apostolic Church; after the group held a large Easter service, and then a Passover celebration in July that drew worshipers from across the country, measles spread across Zimbabwe.

The group publicly opposes vaccination. It represents a powerful voting bloc and is closely aligned with President Emmerson Mnangagwa, who attended the Passover gathering.

The Ministry of Health and Child Care recognized by late 2020 that Covid had derailed vaccination campaigns, but a catch-up measles campaign targeting children from infancy to age 5 began only last month, as the reported death toll began to climb. Major international health agencies are supporting that campaign, but would not speak to The New York Times on the record because the subject is perceived as politically sensitive.

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Waiting for appointments at a clinic in Harare. The country last had a measles outbreak in 2009 during a hyperinflation crisis; that epidemic killed at least 500 children.Credit…Tsvangirayi Mukwazhi/Associated Press

Monica Mutsvangwa, Zimbabwe’s information minister, said that she believed most evangelical families wanted to have their children vaccinated.

“Contrary to the usual resistance, the Apostolic Church worshipers in Manicaland have come out in their numbers for measles vaccination,” she said. “The process was, however, slow at first. And there are still some religious groups that continue to resist. A lot of advocacy and work with leaders of these groups is ongoing.”

Zimbabwean children are more susceptible to acute illness from measles because many are malnourished. Per capita income has dropped in each of the last four years, while food prices have surged because of numerous factors, including grain shortages caused by Russia’s invasion of Ukraine and drought and higher temperatures related to climate change.

Zimbabwe last had a severe measles outbreak in 2009, at the peak of a hyperinflation crisis. There were more than 8,000 cases, and at least 500 children died. The cash-starved health system has struggled since then to boost vaccination coverage.

A typhoid outbreak last year led to a 10-day campaign in which three million children were immunized against typhoid and polio and given vitamin A, which reduces the severity of measles, but they were not vaccinated against the measles virus.

Viola Mombeyarara’s 20-month-old daughter, Anenyasha, died on Sept. 4. Measles struck each of her three older children, and they recovered, but vomiting, diarrhea and fever left the baby fatally dehydrated.

Anenyasha was diagnosed with measles by a nurse at a clinic near her family’s home in Muzarabani in the north of the country, but her mother, a farmer who is a member of the Johane Marange church, believes there were other causes of her death.

“We could see she was getting better when I brought her home, but witchcraft was used against us,” Ms. Mombeyarara said. “Why did she die, when the others overcame measles? This is the work of evil.”

She said she was still hesitant about vaccinating her other children.

“I don’t know — the herbs we used cured the other children, so they work,” she said, adding: “I still believe in our way. We can’t vaccinate.”

Jeffrey Moyo contributed reporting from Harare, Zimbabwe.

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