World Immunization Week Ends Sans Vaccines or Sensible Policy

Venezuela is a monument of all the reasons why vaccination should be a top priority for every health system and the unimaginable things that can happen when it isn’t. When it comes to health, it’s always better to be safe than sorry.

Photo: Flickr, retrieved

From April 24 to April 30, the World Health Organization (WHO) celebrated World Immunization Week, an event meant to remind everyone how vaccines have dramatically improved our lives, and how important they are to keep people healthy. During this week, the WHO celebrates some of the most important landmarks of modern public health, like the over 116 million kids around the world who received a complete vaccination scheme against diphtheria, and how vaccination has caused an 84% drop in cases of measles since 2000. These numbers contrast with the Venezuelan situation, where two decades of socialism and corruption have left us with nothing to celebrate.

According to the Pan-American Health Organization’s (PAHO) latest report on diphtheria, Venezuela has 976 confirmed cases since the current outbreak erupted almost two years ago. In the same period, 142 patients (mostly children) have died. Additionally, one Venezuelan child died in Colombia, and another in Brazil. The situation with measles doesn’t look any better; since the Venezuelan outbreak, that started last June, 1,006 cases have been confirmed, with two deaths. Venezuelan cases have also been exported to Brazil (34 cases), Colombia (five cases) and Ecuador (one case).

This is not a coincidence: according to WHO/UNICEF’s latest bulletin, by 2016 only 84% of children between 12 and 23 months had received the complete three-dose vaccination scheme against diphtheria, the second lowest percentage in the region, following Ecuador. This might seem like a high number but Zimbabwe, for example, reported a 90% coverage that same year. A similar, yet more dramatic situation, is seen with the measles-containing vaccines (MCV) scheme, completed in only 53% of susceptible children. Similar numbers can be seen in most vaccines, with the Rotavirus vaccine having the sharpest drop, going from 84% in 2015 to a astonishingly low 47% in 2016.

The fact that an organisation like PAHO remains silent about the fake cards situation is irresponsible and goes against the spirit of WHO.

The Maduro administration announced a “massive”, PAHO-sponsored vaccination plan, saying they’ll distribute 11 million vaccines to protect the population from 14 different diseases. This, as everything the government says, is a lie. The number of vaccines is simply too small. Take for example the pentavalent vaccine, used in Venezuela to prevent diphtheria and five other diseases. The government imported 317,354 vaccines meant to cover the population from six months to five years old, which based on projections from the 2011 National Census, is almost 3 million children, each of whom needs at least three doses in a 18 month period to grant full protection. The situation was denounced by NGO Médicos Unidos por Venezuela, and a detailed explanation can be found on this twitter thread by paediatrician Alejandro Crespo.

We won’t elaborate on how vaccines are being administered in squares, malls and other public places in the middle of an unprecedented electrical crisis, where the refrigeration needed can’t be guaranteed. And low coverages are not even the worst thing happening.

Several countries, including Brazil, Ecuador and Peru (three of the most popular destinies for Venezuelan migrants) regularly report cases of human-to-human transmission of yellow fever, so they demand a vaccination certificate to foreigners entering the country. Theoretically, the vaccine is available for free at any of the outpatient clinics the Venezuelan Health Ministry manages in the country, and it was like that until a few months ago. Recently, massive emigration, coupled with the Ministry’s incompetence, have made the yellow fever vaccine hard to find. Back in January, people were forced to wait for fifteen days to get the vaccine, which must be applied at least ten days before traveling, to grant full protection.

We ended up in Caracas, but it was impossible to find it, so my mom met someone who sold us a card with a health center seal, all fake.

Today, it’s nowhere to be found. What are migrants doing?

They take advantage of corruption.

The international certification card (not the vaccine) that “proves” an individual has been vaccinated against the disease is being directly sold to travelers.

“We visited several outpatient clinics where they told us the vaccine was only available for children,” Sofía (not her real name) told us from Puerto Ordaz. “We ended up in Caracas, but it was impossible to find it, so my mom met someone who sold us a card with a health center seal, all fake.”

We can’t stress how terrible this is. Yellow fever is not a joke. It’s a deadly, viral mosquito-transmitted haemorrhagic fever with a mortality rate of 20%. It begins as an undifferentiated condition with fever, vomits and muscle aches and most patients recover after a couple of days, but some develop jaundice, massive bleeding and multiorgan failure leading to death. This is the disease that drew Napoleon away from Hispaniola and that almost stops the construction of the Panama Canal, not a common cold, for God’s sake.

An unvaccinated Venezuelan traveler holding a fake Carte Jaune could get infected in another country and spark an urban outbreak right there, or here if he comes back soon enough. You only need a single carrier to unleash a deadly, easily transmitted infectious disease in the country with the most fragile health system in the continent.

The fact that an organisation like PAHO remains silent about the fake cards situation and the evident farce of Maduro’s vaccination plan, with his government’s ultimate responsibility in the development of current (and likely future) regional health crisis, is irresponsible and goes against the spirit of WHO and this whole World Immunization Week thing.

If something, Venezuela is an example of how horrible things go when vaccines aren’t taken seriously, and must be acknowledged as such by the whole world.