Once a poster child for immunization coverage, Guyana is flirting with a public health crisis from common preventable illnesses. The percentage of people who received mostly the second and third regimens of vaccines that protect against tuberculosis (TB), polio, pneumococcal disease, and fatal bacterial infections have declined in 2016 (the latest year for which data is available) compared to 2014, according to data by the World Health Organization (WHO) and UNICEF. Of note, vaccination rates in 2016 compared to 2014 for:
- PcV3, which protects against pneumococcal disease declined by 5 percentage points. Pneumococcal disease is the world’s number 1 vaccine-preventable cause of death among infants and children younger than 5 years old.
- BCG, which protects against TB declined by 4 percentage points. This is especially troubling since this vaccine is administered in one dose and is required only once at birth. TB is an infectious disease that mainly affects the lungs and is characterized by coughing up blood.
- DPT1, which protects against diphtheria, pertussis, and tetanus, – which are all potentially fatal bacterial infections, – declined by 3 percentage points.
- Pol3, which protects against polio, a disease marked by paralysis and sometimes death, declined by 3 percentage points.
The decline in these rates are significant and should be a cause of serious concern to public health professionals and lawmakers. The drop in these rates are not isolated events, they are consistent with reports of poor quality care and widespread shortages of basic medicines and other medical supplies across the country over the same period and the high rates of mother and child deaths (see report). Thus, they are indicative of poor public health management and the delivery of healthcare. More importantly, they are early warning signs of a looming public health crisis for which the social and economic consequences can be devastating to communities in terms of lives lost, public health deterioration, and cost to taxpayers. Research shows that a 5 percent decline in coverage of similar vaccines resulted in a 3-fold increase in annual illness cases, costing taxpayers an additional US$2.1 million to take control of the problem.
The decline in these vaccination rates are not only striking but a surprise given that from 2014 public health expenditures grew by 29% or almost $6 billion, reaching a total of $26.2 billion in 2016. This was more than the combined birth rate and inflation rate over the over the same period, suggesting that there were enough funds to pay for vaccines at the level of public needs. Whether these funds were used in an efficient and fiscally responsible manner and for their intended purposes in unclear and requires access to data not publicly available. Other factors that could cause these rates to fall include declining access to health facilities, shortage of medical supplies, shortage of medical professionals, etc. The exact reason/s for these decline is critical if we are to reverse these trends and avert a public health crisis.
Lawmakers and public health professionals, alike, must take these findings seriously, take immediate actions to investigate the causes, and corrective measures to ensure that every child gets vaccinated on time. This is not just important for preventing a public health crisis but to ensure that every Guyanese, children and adults, get access to quality health care to lead healthy and productive lives.
* Ryan Ramphul. MS. is the Program Manager and Analyst for Public Health at the Guyana Budget & Policy Institute.