While Canada copes with a rise in measles, Madagascar already has 118,000 cases

As North America confirms more cases of measles every day, halfway around the world they're experiencing the worst outbreak in decades.

According to UNICEF, Madagascar has reported more than 118,000 cases of measles in the past six months. There have been 818 confirmed deaths from measles and another 870 deaths reported to have been caused by measles which are still being investigated.

Madagascar, an island nation off the southeast coast of Africa, is among the poorest countries in the world. More than three quarters of the 25 million Malagasy population live off of $2 per day, according to the World Bank. A small percentage of the population have electricity, with access being particularly difficult in rural areas.

In conditions like this, keeping up with routine immunizations for measles has been tough for much of the population, says Michel Saint-Lot, UNICEF's representative in Madagascar.

"You have a clear setup for an epidemic to spread quickly," Saint-Lot told Day 6 host Brent Bambury.

"The outbreak is clearly giving us the clear picture that something has not been working right," he said, referencing the country's struggling health care system.

The vaccine for measles needs to be kept refrigerated, but because so little of the country has power that's a challenge.

Saint-Lot says it was common for parents, especially in rural communities, to walk several kilometres to a health centre to vaccinate their children. But upon arrival, there would often be no vaccine because the centre didn't have fuel to keep the fridge working.

"It's very hard to convince those parents to come back a second time because they don't know if they come back [whether] there will be vaccines or not.," said Saint-Lot.

He says that has deteriorated the trust between health officials and the population. Adding to the problem is the preference of traditional medicine over health care centres among some of the Malagasy population.

But even getting the vaccine distributed throughout the country is no easy feat due to poor road infrastructure in the country. Saint-Lot says he recently took a drive that would take 30 minutes in any other country, but it took them four hours in Madagascar.

UNICEF is part of an ongoing effort to help rebuild the health care system in Madagascar, which currently includes mass emergency immunizations of children in the country.

Starting in January, the government, UNICEF and a coalition of other organizations began vaccinating millions of children. According to Saint-Lot, in six days at the beginning of this year more than two million children were immunized against measles.

This week, the campaign hopes to bring those numbers up to seven million.

"The good news is the response rate has been very good," said Saint-Lot, with almost all parents bringing their children to health centres.

Saint-Lot says help from international communities is badly needed. He says they have seen "a lot of compassion" from other governments and organizations during the measles crisis, but that the country needs more.

"What Madagascar needs is not support only when you have a measles crisis, they need more steady support," he said.

Saint-Lot says the country is investing in solar energy and moving away from petroleum, so there will be "no shortage of fuel" in the future.

"The outbreak is giving us the opportunity to highlight that the health system needs to be strengthened; to be reinforced, in order to build back the confidence of the population," said Saint-Lot.

His hope is that those improvements will stop crises like the measles outbreak from happening again.

To hear the full interview with Michael Saint-Lot, download our podcast or click 'Listen' at the top of this page.