More than a year ago, I was sitting with my grandparents on the morning of the New Year eating a champurrada and reading the Guatemalan newspaper Prensa Libre. We had celebrated the previous night at a nice restaurant in the colonial city of Antigua where we watched the sky light up with fireworks at midnight. I was reading the newspaper with the intention of practicing my reading comprehension skills in Spanish, as I had not taken a formal class in years, when I stumbled upon an emergency that has largely been ignored in the Western press.
In August 2015, almost 400,000 children under the age of one did not receive vaccination against measles, a disease that was eradicated from Guatemala 20 years ago. There are 328 health posts in the country, however 26 of those are closed, and the rest of them are understaffed and under-resourced at epidemic proportions. I heard about this first-hand from the Guatemalan women who I interviewed for my research project on diabetes this past summer, as they described stories of arriving at the health post at 3 AM and waiting in line to receive medicine that would run out by the time it was their turn. The health post catered to the growing population of diabetics, but only on one day of each month.
Shortly after that article was published, Prensa Libre published another article describing how 602,357 vaccinations were lost in the transition between the Ministry of Health and the health posts due to robbery, improper refrigeration and lack of coordination in 2014. This resulted in a loss of almost a million dollars, but more than anything, it created a growing risk for thousands of infants now vulnerable to dying of preventable diseases in the near future. The incoming Director of the Ministry of Health, Luis Monterroso, said that 45% of children in Guatemala were not vaccinated in 2014. Data shows that the most rural and impoverished regions of Guatemala did not receive any vaccinations for the entire year.
Fast forward to April 2016. It is now one year after the former President of Guatemala, Otto Perez Molina, was impeached and arrested for insurmountable charges of stealing money from the health system, several months after the national hospital ran out of food for their patients, the same month in which six newborns died at the National Hospital of Sololá due to lack of medical attention, and the same month when the recently elected president, Jimmy Morales, failed his promise to fix the health system crisis within 100 days of being in office. In Guatemala today, 800,000 planned vaccinations were not completed in 2014 and 2015. According to the Alliance for Nutrition (Alianza por la Nutricion), 81.5% of children under two years old do not have the recommended vaccinations. On top of everything, the Guatemalan government owes millions of dollars to the Pan-American Health Organization – a sum that rivals what is needed to immunize the thousands of children lacking vaccinations in Guatemala today.
While local actors are combating this national emergency, I could not find any information about this crisis in an English-speaking source. In fact, this emergency has only received attention from Prensa Libre, the Guatemalan newspaper that I happened to read on a dining room table in Guatemala two years ago. Both UNICEF and WHO had data on vaccination coverage for Guatemala. The percentage of coverage was in the 90’s for most of the immunizations on UNICEF’s profile of Guatemala. Looking closer, I noticed that the data on the home page was from 2013, and more recent data showed vaccinations had fallen by 10% across the board. Going back to the Guatemalan newspapers and a report published by the Ministry of Health, Hepatitis B and Pneumococcal vaccine were administered to 21.86%, and 59.87% of children in 2014, respectively. Statistics from the WHO matched these results. Rotavirus vaccine, which prevents vomiting and severe diarrhea in infants, had percentages of immunization coverage varying from 81% in 2013 (UNICEF) to 54.27% in 2014 (Prensa Libre and WHO). The international standard for all vaccinations is 95% – so no matter, Guatemala is very much below the standard, and with each passing year this problem becomes more dangerous.
This past summer, I saw two cases of Hepatitis B – one in a private pediatric clinic in Guatemala City, and the other in an NGO-funded health clinic open once a week in rural San Martin Jilotepeque. They were both boys no older than five with scared brown eyes and thin limbs. The boy from the urban private clinic had just returned from Disney World and was accompanied by his two parents, both dressed in American brands, while the boy from the rural public clinic was accompanied by his mother, dressed in a Mayan huipil with his younger baby sister strapped to her back. Looking back, I found it a strange coincidence that I had seen two Hepatitis B cases in boys of nearly the same age but from vastly different worlds. And yet, how much of a coincidence was it in a country where only 22% of children were vaccinated against Hepatitis B in 2014? Hepatitis B has a higher likelihood of resolving itself in children above the age of 5, but for younger children and infants there is a 50/50 chance of chronic life-long infection of the liver. For a family living in poverty, this is devastatingly costly condition in a young child. Thus, like most health problems in the world, the vaccination crisis in Guatemala falls most heavily on the most vulnerable in society – children, and the poor.
In a crumbling health system in crisis, 80% of children under the age of two cannot afford to be without all the necessary vaccinations. Amid debate on national sovereignty and governmental requirements from international bodies, what is to be done about this national emergency, and by whom? While some parents in the US benefit from the luxury of “herd immunity” and do not vaccinate their children, Guatemalan parents have neither the choice to vaccinate their children nor are able to prevent their children from dying of preventable causes. What can be done against the systematic invisibility of long-term global health emergencies in Western media? Without proper attention to this public health emergency, nothing will be done in the near future.