Somalia and Equatorial Guinea are also the countries with the worst vaccination rates (44% and 17% respectively), along with Ukraine, for the third dose of the DPT vaccine, which covers diphtheria, pertussis (whooping cough) and tetanus. Ukraine is another case of regression: the country saw its immunisation rates drop sharply from 76% in 2012 to 23% in 2015.
The DPT vaccine requires three doses, with an additional booster dose also due in certain countries. As with measles, the vaccination rate falls sharply from the first dose to the final dose. In Guatemala, 96% of children received the first dose of the vaccination, a commendable figure and high enough to achieve herd immunity, but only 73% received the third dose of the vaccination. Panama is a similar case, the rate falling from 99% to 74%.
This vaccine protects from diphtheria, tetanus and whooping cough, three illnesses that remain present, although in some countries they sound like a bad memory from a bygone age. In 2015, over 10,000 cases of tetanus and over 4,500 cases of diphtheria were recorded worldwide. The figures for both diseases have fallen drastically, largely due to vaccines.
Whooping cough, on the other hand, continues to cause large numbers of illness and deaths in children, and figures have not improved in recent years. In some years, such as 2012 and 2014, the figures have actually increased. 142,412 cases were recorded in 2015. 56,696 children died, 15% of those from Nigeria.
The slump in vaccinations in Guatemala
Guatemala has moved from a controlled situation of over 90% vaccination coverage to risking an epidemic. The collapse has not been gradual, it has happened very suddenly. According to WHO data, the vaccination rate in the country fell from 93% in 2013 to 67% in 2014. A survey carried out in 2016 by the Guatemalan Human Rights Council, Action Against Hunger, ALIANMISAR (National Alliance for Indigenous Women’s Organisations for Reproductive Health, Nutrition and Education) and the Alliance for Nutrition showed that the current situation is even worse. In April 2016, according to this survey, seven out of ten children under the age of two had not received their basic quota of vaccinations. The current government attributes the problem to a lack of coordination and control and financial problems, having defaulted on payments to the Pan American Health Organization (PAHO), through which they acquire the vaccines. Civil organisations also add claims of corruption to the argument.
In addition to the lack of vaccines are the scant staffing levels, following ruptures in government agreements that were in place with various NGOs that took responsibility for medical services in the most disadvantaged areas. Also, 46.5% of the population suffer from chronic malnutrition.
In October 2015, vaccine stocks began to recover, and in recent months some measures have been taken to catch up the backlog of children that missed their vaccinations over the past two years. In an area where diseases such as polio have been absent for years, and in a country where no case of measles has been recorded since 2007, risk of relapse is high.
The path to total eradication of a disease is long and paved with pitfalls. Because of this, it is important to remain vigilant, keep the shield strong and not become complacent about the fact that certain diseases have disappeared just because we no longer see them (or suffer them) in our immediate environment.
Since the measles vaccine was invented and introduced worldwide, the disease has nearly disappeared in certain regions and countries, to the point where many young people do not even remember it.
In other regions, where the situation had previously improved and the disease had been practically eradicated, outbreaks have rebounded. This was the case in Iraq in 1998 and 2009, linked to the problems of access and lack of resources before, during and after these conflict periods. Bulgaria had gone nearly a decade without a recorded case, when in 2009 the country saw a resurgence of measles with over 2,000 cases. In 2010, this figure reached 22,000, the greatest number ever recorded in the country.
In Mongolia, an outbreak in 2015 and extended to 2016 reported thousands of cases and killed more than a hundred people, most of them babies under eight months old, those who should have been protected by herd immunization. The lack of confidence in vaccines has much to do: 26.8% of those surveyed in that country for The Vaccine Confidence 2016 project were against the claim that the vaccines were safe.
Estimates sent by the country to the WHO claimed that the country’s coverage levels exceeded these minimum thresholds. But if the data is not accurate or population segments remain under the minimum threshold, the shield does not work either.
Whilst there are reasons to be optimistic in some areas, the difficulty of vaccinating all children in conflict zones or areas with a lack of resources or infrastructure, and to a much lesser extent, opposition to vaccines, does not allow for total eradication of diseases for which we have had a more than effective shield for decades. According to the WHO, 21.8 million babies do not receive the basic vaccinations.
The latest report from the WHO Strategic Advisory Group of Experts is categorical. It warns that the group remains “very concerned “ that “ progress toward the goals to eradicate polio, eliminate measles and rubella, and eliminate maternal and neonatal tetanus is too slow”. Global average immunisation coverage has increased by only 1% since 2010.
The causes, according to Médecins Sans Frontières
Médecins Sans Frontières list, in one of their reports, the reasons that, in their opinion, prevent basic standards in vaccination levels from being achieved. Firstly, the price – the basic package is now 68 times more expensive than in 2001, according to their figures. Moreover, the vaccines are not adapted to countries with limited resources. The majority of vaccines must be maintained at a constant temperature of between 1ºC and 8ºC, no mean feat in regions with poor transportation and electrical infrastructure, not to mention a shortage of healthcare professionals qualified to inject an infant. For this reason, Médecins Sans Frontières is calling for the development of thermostable vaccines, such as MenAfriVac, the vaccine developed to prevent Meningitis A in Sub-Saharan Africa, and other vaccine which do not require a syringe as they are orally administered (like the polio vaccine) or patch based. They are also calling for improvements so that the immunisation schedule no longer demands five visits to the doctor in the first year of a child’s life, quite a challenge for a family with no resources, transportation problems or living in a conflict zone. However, the uptake of vaccines is not purely a practical issue, there is a further underlying problem. According to the organisation, there are very few studies of strains that primarily affect developing countries, as research tends to be focused on epidemiology in developed countries.
Civio is a non-for-profit media, specialised in data and investigative journalism. Medicamentalia, our first investigation into health access, was awarded Investigation of the Year (small newsroom) in the Data Journalism Awards and the Gabriel García Márquez Journalism Prize (Innovation category).
It has been funded by the Journalism Grants programme of the European Journalism Centre and the Bill & Melinda Gates Foundation. None of these organisations had previous access to the content, nor influenced editorially by any means.
Photo credit: EC/ECHO/Pierre Prakash via European Commission DG ECHO’s photostream on Flickr