Health officials in China are seeking to vaccinate nearly 100 million children for measles in a 10-day push that concludes on Monday.  The vaccination effort is among the largest ever conducted in the country's history.  While most Chinese residents recognize the need for the vaccine, some initial public skepticism had overshadowed the start of the government's program.

China's government agencies in recent years have been slow or even withheld health information about the spread of SARS, bird flu and an outbreak of cholera last month.  The moves have fostered a sense of public mistrust.

Now the general public has openly questioned the voluntary vaccination of more than 95 million children for measles.  Dr. Robin Nandy is the Senior Health Advisor for Emergencies at UNICEF (United Nations International Children's Emergency Fund). "It really brings to the forefront a very important thing that we are seeing now in China, but we have seen in other places as well, is how important it is for good transparent communication from the side of the government and implementing partners to the population," said Dr. Nandy.

Dr. Nandy said the general public has more sources of information, which can be good or bad when it comes to health care. "There are a lot of options now open globally for people to get information from different sources, from the internet, from news media.  But this is also a double-edged sword because there are also a lot more opportunities for the spread of misinformation."

Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations in New York, says the Chinese government has been slow to improve communication, which has led to public questioning of the safety of the measles campaign. "This case essentially reveals basically the tension between the government incentive to provide more public goods and services to the people.  But the problem here is they still stick to the traditional method of implementation of this policy," he said.

Andrea Gay is the Executive Director of Children's Health at the U.N. Foundation and has lived in China.  She finds the current public reaction to the measles campaign to be positive. "I do not think it was as negative as was portrayed in the press.  It is perfectly reasonable that people should be questioning and it is just again evidence of more openness on the part of the Chinese government.  And also that people feel more confident and secure in asking questions.  So I do not think any of that is very negative.  No child is being vaccinated where the parents have not signed a permission slip.  So it is totally voluntary," she said.

China has reduced the outbreak of measles within the country by 94 percent in over more than 40 years of administering the vaccine.  Dr. Nandy says while the trend is impressive, the goal is total elimination of measles transmission. "China has made a lot of progress in measles control over the last few years.  But despite this progress, in 2009 China still reported more than 50,000 cases of measles.  Given the fact that China and the entire Western Pacific region have a measles elimination goal to stop measles transmissions by 2012, it was thought necessary to embark on this campaign style supplementary immunization activities nationwide in China," he said.

Worldwide, an estimated 164,000 people died from measles in 2008.  Most were children under the age of five.  The number of measles cases in China last year was not high compared to the total population.  Resulting deaths were fewer than caused by rabies, which Yanzhong Huang says helped to fuel public questions of the current measles campaign.

"Each year in China there are more than 2,000 human deaths from rabies.  China is second only to India on that.  But people would naturally ask this question - how come you (the Chinese government) did not commit resources to fighting rabies?  Instead you commit all those resources on fighting a disease which led to only 39 deaths in the country (last year)," he said.

China has a program of routine vaccination for children, including measles.  But Huang says a more comprehensive approach is likely needed by the government to be completely effective. "It would be useful like the liking of vaccination with admission to kindergarten and schools which we use here (in the United States).  But China easily will say 'we are not going to do that. We are not going to force children (to get) vaccinations.  I think some of the methods they should indeed learn from the United States," he said.

The vaccination campaign in China is being conducted by several parties.  Half of the current measles vaccination program is funded by China, with the other half coming from global donors through international health agencies.  Dr. Robin Nandy says outside organizations and governments need to be in harmony to ensure success.

"It is difficult for one agency or two agencies.  And I think it is very important that everybody joins hands and works as a team.  The campaign in China is led by the government and is supported by UNICEF and the World Health Organization and other partners," he said.

Regardless of the reasons for public skepticism about China's measles campaign, Andrea Gay of the U.N. Foundation says early fears seem to have evaporated and the program is so far successful. "The test of all of this is whether people bring their children.  At this time, the campaign has been going very, very well.  They are ahead of their target for the first five days.  So it sounds like at least the population is bringing their children to be vaccinated," she said.

After the measles vaccination program ends Monday, an accounting of doses administered will be finalized and surveys will be conducted to help assess the effort's effectiveness.  Dr. Nandy says there is one final measure of success. "If you are confident that the disease surveillance is good and you do not see cases, that is probably the best way to know that our program has performed well," he said.

Measles is still common in many developing countries, especially in parts of Africa and Asia.  More than 20 million people are affected by measles each year.  The hope is to completely halt transmission of the disease globally by 2020.  Continued funding for vaccination efforts remains perhaps the biggest obstacle.