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

As at Sept 6, the country’s Ministry of Health and Child Care had reported 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 immunisation dropped significantly in Zimbabwe during the Covid-19 pandemic. Anxious parents stayed away from health centres, healthcare workers were reassigned from routine vaccination programmes to the Covid-19 pandemic response, and school closures and lengthy lockdowns scuppered the usual outreach campaigns.

In July, the World Health Organisation 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-19 lockdowns, armed conflicts and other obstacles.

The United Nations agencies called the situation the largest backslide in routine immunisation 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.

Zimbabwe had one of the highest rates of vaccination coverage in sub-Saharan Africa 25 years ago, but vaccine hesitancy has swelled, amplified by influential churches that discourage immunisation 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 centre of the measles outbreak.

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, fuelled 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 the clergy a focus of the government’s renewed efforts to get young children vaccinated. “The government has embarked on a mass vaccination campaign reaching out to faith leaders to garner support and awareness,” spokesman Donald Mujiri added. “Children aged between six 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 worshippers 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 recognised by late 2020 that Covid-19 had derailed vaccination campaigns, but a catch-up measles campaign targeting children from infancy to age five began only in August, 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.

Ms 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, diarrhoea 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 took 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 added that 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.” NYTIMES