The silent decline of childhood vaccination in Latin America

Illustration made by Connectas. Used with permission.

This article was written by Grisha Vera for CONNECTAS and republished on Global Voices under a media agreement.

A decade ago, Latin America was one of the regions with the best coverage (93 percent) of childhood vaccinations in the world, exceeding the global average by nine points. But by 2022, the region's coverage was one of the worst, ranking five points below the global average, according to estimates from the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF).

These organizations estimate that 1.2 million children do not have the first dose of DTP3 (vaccine against diphtheria, tetanus and pertussis, a global indicator of vaccination coverage) and that nearly two million children in the region are at risk of contracting a vaccine-preventable disease.

Decrease in vaccination coverage with DTP3. Source: WHO and UNICEF

Twenty-three countries in Latin America and the Caribbean have decreased their DTP3 and measles vaccination coverage. The decline in seven countries is alarming: in Bolivia, El Salvador, Ecuador, Honduras, Paraguay, Peru, and Venezuela, coverage has decreased by 20 points or more in one of the two vaccines mentioned since 2012.

From a regional perspective, the reasons for the decrease in coverage respond to different reasons: the decrease in public campaigns to promote the importance and quality of vaccines, the worsening of health systems, anti-vaccine movements, the health crisis derived from the pandemic and less money allocated to buying vaccines.

According to figures on imports of vaccines for human use from the United Nations Comtrade, of the seven countries that registered the worst declines in their coverage, in two, Venezuela and Ecuador, spending decreased in the last decade. Field reporting in Bolivia, Ecuador, and Venezuela also showed that governments are not transparent about the vaccination situation and that there are failures when it comes to systematizing data, situations that further complicate addressing this problem.

In February 2023, the Pan American Health Organization (PAHO) issued an alert and urged countries in the Americas to update their response plans to prevent endemic transmission of measles again on the continent. In 2016, the region was declared free of this virus, but its circulation in places outside the subcontinent implied an increase in imported cases between 2017 and 2019.

Fragile systems

In the last decade, Peru has increased spending on the purchase of vaccines. Although the amount has fluctuated since 2019, the trend is upward: in 2023, the Peruvian government spent 108 percent more than it did in 2012. However, the increase in spending does not reflect better coverage of childhood vaccination. In the last 10 years, the trend has been downward: measles coverage decreased by 20 points in this period and DTP3 coverage decreased by 13 points.

The trend towards greater spending in this area, despite the decline in vaccination coverage, also occurs in El Salvador, Honduras, Bolivia, and Paraguay. Midy, the Unicef ​​advisor, warns that to guarantee the success of immunization programs, countries need to have enough health personnel, have a system capable of responding to the increase in demand for vaccination, raise awareness among the population, and have an adequate infrastructure to preserve vaccines.

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The Venezuelan case illustrates very well that access to vaccines is not enough to guarantee good coverage. Huniades Urbina, an intensive care pediatrician and vice president of the National Academy of Medicine of Venezuela, comments that in recent years the Venezuelan State has not purchased vaccines, due to a debt of $10 million USD that the country maintains with PAHO. The existing doses have arrived only through donations from international organizations.

Representatives of the Ministry of Popular Power for Health, Gavi, PAHO and Unicef ​​met in Caracas on November 14 / Photo taken from the web portal of the Ministry of Health of Venezuela.

Ignorance and exclusion

The lack of knowledge about the importance of vaccines has sparked a decrease in vaccination. Enrique Terán, a professor at the Universidad San Francisco de Quito and a Ph.D. in pharmacology, says that a decade ago, Ecuadorian governments continually encouraged families to vaccinate their children, but he says that for at least five years, the health system has been waiting for patients to reach health centers on their own.

In Ecuador, the migrant population is usually excluded from vaccination programs. “They are not excluded because they reject vaccination, but rather they have no way of being included. The bureaucracy leads them to a limbo in the health services and health policies rarely include the migrant population.” 

No data

Ecuador decreased DTP3 coverage by 17 points and measles vaccine coverage by 22 points between 2012 and 2022. Jácome, the Ecuadorian government authority, explained that, in September of this year, due to a special vaccination campaign that sought just increase this coverage, they realized that the estimates they had reported to PAHO were not correct.

Venezuela, for its part, has not reported vaccine purchase data to the United Nations since 2013, and since 2017 the budget for the execution of the National Immunization Scheme has been unknown. However, the data available in the National Budget Law and the accountability reports (2012-2017) show a decrease in the number of vaccines administered. For example, in 2014, there was a 58 percent reduction in doses applied. The following year this figure recovered the values ​​of 2013. But in 2016, there was another reduction in the doses applied, this time 12 percent. This reduction continued in 2017, the last year for which official figures are known.

Vaccine doses applied in Venezuela. Since 2017, the country has not reported the budget and scope of the National Immunization Scheme. Source: Memories and Accounts of the Ministry of Popular Power for Health

In 2020, DTP3 coverage decreased in 22 of the 33 countries in Latin America and the Caribbean and measles coverage decreased in 26 nations. By 2022, six of these countries still showed no signs of recovery in DTP3 coverage and 15 in measles coverage.

The lack of transparency in the countries analyzed leaves many questions unanswered, such as the reason that vaccination coverage has declined even though the purchase of vaccines in some countries in the region has doubled. 

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