Development & Aid, Headlines, Health, Latin America & the Caribbean

ARGENTINA: Provincial Officials Lied About Polio Vaccination Coverage

Marcela Valente

BUENOS AIRES, Apr 19 2004 (IPS) - Since Argentina’s federal government directly took over the administration of the northern province of Santiago del Estero this month, an appalling scenario has been revealed: local officials regularly over-reported vaccination coverage, and less than 60 percent of children have been immunised against polio.

Dr. Donato Spaccavento, the federal government-appointed head of the provincial health system in Santiago del Estero since Apr. 1, told IPS that children in the province are actually at risk of contracting poliomyelitis, an acute infectious viral disease that damages the spinal cord and often leads to permanent disability and paralysis.

Although the director of the national Health Ministry’s immunisation programme, Dr. José Urrusuno, pointed out in a conversation with IPS that ”there have been no cases of polio in Argentina for 20 years”, he underlined that ”there is no room for complacency,” because there are still pockets of the disease in India and several countries in Africa.

Spaccavento, meanwhile, said that according to statistics from the provincial health ministry, ”more than 40 percent” of children under six have not received the complete mandatory immunisation coverage, including the Sabin oral polio vaccine.

Before the federal government took over the three branches of the provincial government this month, local authorities in Santiago del Estero regularly altered the reports they sent the national Health Ministry to conceal the low immunisation levels.

That was done despite the fact that the Health Ministry methodically and promptly sent the necessary immunisation materials, said Spaccavento.

Dr. Enrique Smith at the Santiago del Estero Children’s Hospital told IPS that he did not have the official figures, but that the hospital’s records show that ”between 30 and 40 percent” of the children treated there had not received full vaccination coverage.

”The percentages of immunisation in Santiago (del Estero) are far below the minimum required by the World Health Organisation (WHO) for declaring the disease eradicated” in a given area, said Smith, who also works as a pediatrician in the province’s Centro Médico del Niño (Children’s Medical Centre).

The government of centre-left President Néstor Kirchner seized control of Santiago del Estero on Apr. 1 after Congress approved direct rule of the province for six months.

The caretaker governor, Justice Minister Pablo Lanusse, is attempting to dismantle the local power structure in the impoverished province, which has been ruled for 50 years by a family accused of corruption, brutal persecution of opponents, and human rights violations.

Governor Mercedes Aragonés and her husband, former governor Carlos Juárez, were suspended and arrested on Apr. 1.

For decades, Juárez, Aragonés and their cronies in the governing Justicialista (Peronist) Party won elections by handing out favours, especially public sector jobs and housing. In fact, half of the provincial population of 800,000 depends on jobs in the public administration or on government assistance.

Lanusse said Friday that he was ”disgusted and ashamed” by the fact that provincial authorities had provided false records on child malnutrition, vaccination coverage, and infant and maternal mortality in Santiago del Estero.

Juárez and Aragonés instructed doctors and health officials to under-report the level of malnutrition which, as the newly appointed authorities have now found, affected 40 percent of hospitalised children. They also discovered that infant mortality stands at 24 per 1,000 live births, rather than 12.4 per 1,000 as reported by the provincial officials who have now been removed.

According to WHO and the United Nations children’s fund (UNICEF), 91 percent of children in Argentina have been vaccinated against polio.

The Health Ministry’s Urrusuno said the latest records show ”around 90 percent coverage.”

But, he said, there are differences between provinces that can be hidden in that average, so authorities have set ”the goal of reaching 90 percent in every district,” rather than aiming at a certain average.

WHO and UNICEF, which report that polio could be the first disease of the 21st century to be eradicated worldwide, say polio vaccination averages 90 percent in the Americas, compared to just 56 percent in Africa.

The new information that has emerged indicates that polio vaccination levels in Santiago del Estero are closer to those of Africa than to the averages in Latin America or Argentina as a whole.

Urrusuno explained that the Health Ministry sends vaccination materials to all of the provinces, which are in charge of carrying out the immunisation campaigns.

WHO oversees the vaccination programmes, and recommends that national authorities supervise and verify that the vaccines effectively reach the children.

”The Health Ministry has mechanisms for supervision, but changes among the officials in charge of immunisation (arising from political decisions) mean there is no stability, and lead to a discontinuity in oversight efforts,” acknowledged Urrusuno.

As to the reasons given for the serious undercoverage by the vaccination campaign in Santiago del Estero, local health officials gave excuses like ”they did not receive the order” to immunise or ”they couldn’t speak out” about what was happening, said Spaccavento.

”There is a generalised under-reporting of cases of (the deadly) Chagas disease, hepatitis, and vaccines. We don’t know if the data was concealed on Juárez’s orders, or if they were so afraid of him that they did not dare tell him the truth,” which stood in sharp contrast to the rosier statistics of which the provincial government boasted, Spaccavento explained.

”The authorities here (in Santiago del Estero) systematically lied over the past 50 years, but I think it was even worse in the last 10 years, due to the aging of Juárez (now 87) and the increasing participation in running the province by his wife (Aragonés),” said Smith.

”In that period, the deterioration has been so great that it ended up sealing their fate.”

For an immunisation campaign, ”the worst thing that can be done is to turn away a child who has shown up for vaccination.

”If the person in charge of giving the vaccines does not have the information needed to know who needs to be vaccinated and who doesn’t, there is a deleterious effect on immunisation coverage,” he added.

WHO recommends, above all, close oversight and control of the personnel in charge of storage and maintenance of vaccines. ”Children in Santiago were probably turned away out of ignorance,” said Smith.

”It would take a sociologist or social psychologist to explain the blindness, ignorance and lack of culture of the people in the women’s branch of the Justicialista Party, who supported Aragonés (up to the very end) while ignoring the enormous risks to which children,” including their own, were exposed, he added.

The authorities appointed to clean up the provincial health system ”can’t even imagine the surprises that are still awaiting them,” said Smith, without providing further details.

All children in the province under the age of six without a certificate showing they were immunised will be vaccinated starting on Apr. 23, Spaccavento announced.

They will also undergo weight and height controls to detect whether they are undernourished, and a programme to combat malnourishment will be launched.

Meanwhile, Juárez and Aragonés, once proclaimed by the provincial parliament ”illustrious protectors of the province in recognition of their copious work for the sake of the common good,” are under arrest on charges of murder and fraud, and are being investigated for corruption, clientilism, and persecution of opponents.