After years of stagnation and disagreement, leading public health agencies last month drew up a joint plan to tackle measles, which kills some 880,000 children a year—more than any other vaccine-preventable disease. The plan, produced by the World Health Organization (WHO) and UNICEF, in collaboration with the US Centers for Disease Control and Prevention (CDC) and others, aims to cut measles deaths worldwide by two-thirds between now and 2005, and thereafter to prevent 600,000 deaths per year.

Efforts to control measles have been hampered by a paralyzing debate among public health bodies and funding agencies—not over the need to save lives, but over the question of whether measles can or should be eradicated. By postponing any decision on eradication until after 2005, and focusing instead on reducing the death toll, the parties have managed to reach consensus.

Since most developing countries' already-overstretched immunization programs are fully focused on polio eradication, it was argued that a second eradication campaign was not feasible.

However, the pressure to act has been growing because of serious outbreaks of the disease. Half of the total deaths are concentrated in just four countries, the Democratic Republic of Congo, Ethiopia, India and Nigeria.

The new plan aims to help countries with a high measles burden reach 80% of each year's birth cohort with one dose of measles vaccine. Countries are then advised to provide a second immunization opportunity.

Ana Maria Henao-Restrepo at WHO, who coordinates the agency's measles activities, says that this second “opportunity” was not thought necessary in the past but is now recognized to be essential if death rates are to fall. The vaccine costs just 26 cents and the estimated cost of increasing coverage to 80% in the 20 countries with the highest measles burden is $150 million a year.