Sustaining measles and rubella elimination through the Regional Monitoring and Re-Verification Commission in the Americas.

The elimination of endemic rubella and measles transmission in the Region of the Americas was verified by the Pan American Health Organization's (PAHO) Regional Verification Commission in 2015 and 2016, respectively. Upon achieving this success, this Commission was disbanded. Shortly afterwards, the Region faced challenges in the post-elimination era, notably responding to and stopping transmission of imported measles cases. As a result, Brazil and Venezuela (Bolivarian Republic of) lost their measles-free status in February 2019 and July 2018, respectively. These events spurred PAHO to form the Measles and Rubella Elimination Regional Monitoring and Re-Verification Commission (MRE-RVC) focused on re-verifying these two countries and providing intensive evaluations of all countries in their efforts to sustain elimination. The MRE-RVC was tasked with advocacy to help revitalize the necessary political commitment to provide sufficient resources to sustain measles and rubella elimination in the Americas. Maintaining measles and rubella elimination in the Region is important, despite the challenges such as the global circulation of measles and rubella viruses elsewhere. This paper outlines the activities of the MRE-RVC to address the challenges and the lessons learnt, and provides insight on sustaining the gains. The main reasons to sustain efforts are: measles vaccine saves more lives than any other vaccine; congenital rubella syndrome is still the leading cause of infectious disease birth defects in the world; and measles vaccination performance remains an indicator of national capacity to maintain health security and a timely response to future infectious disease threats. A global target for measles and rubella elimination is crucial.