Simulation exercise in Republic of Moldova builds capacity to stop measles and polio outbreaks

To test the preparedness level and capacity to respond to potential outbreaks of measles and poliomyelitis (polio) in the Republic of Moldova, WHO organized a 3-day simulation exercise on 18-20 November 2024 in Chisinau. Participants included key experts from the Ministry of Health, National Agency for Public Health, National Reference Laboratory, regional public health centres and Nicolae Testemițanu State University of Medicine and Pharmacy.

The WHO European Region has been free of endemic polio since 2002 and significant progress has been made towards measles elimination. However, until either disease has been eradicated globally, they can be imported anywhere, and cause outbreaks in the presence of unvaccinated individuals. Every country has to sustain high vaccination coverage, work to identify and address pockets of under-vaccination and be prepared to manage potential outbreaks.

Ever-increasing risk of outbreaks

The Republic of Moldova is considered to be free of polio and has been verified as having eliminated both measles and rubella. However, uptake of routine vaccinations, including against measles and polio, has not fully returned to pre-COVID-19 pandemic levels.

According to WHO/United Nations Children's Fund (UNICEF) estimates, coverage in the Republic of Moldova with the first dose of measles-containing vaccine was 85% in 2023 (compared to 97% in 2019), and coverage with the first dose of polio-containing vaccine was 84% in 2023 (compared to 98% in 2019). These coverage gaps have created a growing pool of susceptible children, which has steadily increased the risk of outbreaks.

Responding to a hypothetical scenario

Simulation exercises can help countries identify and address gaps in preparedness to help reduce the risk of large outbreaks and potentially save lives. The exercise in the Republic of Moldova focused on a hypothetical scenario in which polio was detected and began to spread, while the country was already responding to a measles outbreak. Participants worked in groups to identify public health response measures that would be needed to stop the outbreaks. They were also asked to rapidly develop key messages and decide on the best channels for communicating them, to target high-risk populations. This included correcting misinformation about the diseases and vaccination.

The Republic of Moldova's commitment to remaining polio-free and retaining its measles/rubella elimination status was demonstrated by the participants' active engagement, dedication, transparency, and readiness to share information and intensify collaboration among public health and health-care partners throughout the exercise.