In Latin America, there are almost 7 million children who, due to the pandemic, did not receive vaccines to control preventable diseases such as measles or polio. The figures for 2022 show that although some countries such as Brazil or Mexico have overcome the "hangover" caused by Covid, in others large niches of health risk are still active, with children who have not received any vaccine in their entire lives: the so-called zero-dose children. In Argentina there are more than 112,000.
The figure comes from a UNICEF report from July, which takes data from 2021. But the whole issue can be updated by looking at the "III Report on National Vaccination Coverage", issued by the Ministry of Health at the beginning of November, although due to the electoral turmoil it went almost unnoticed. The document, however, stands out now, when the imminent change of presidential administration could represent – more than one believes – a shift in the historical conception of the importance of vaccinating (more clarifications, at the end of these lines).
Amid uncertainty over the new definitions, the latest pediatric vaccination figures in Argentina are tepid. There's some bad news and, also, some semi-good news to share.
The bad ones are the guys zero dose. In 2021, UNICEF reports, 112,376, or 18% of babies under one year of age, did not receive any injections of any of the mandatory vaccines. In addition, more than 37,000 (6% of children under one year of age) were undervaccinated or incompletely vaccinated.
Apart from the fact that it is impossible to know if anyone went to look for those more than 150,000 babies that the State simply "passed by" due to Covid, the zero-dose children are part of a persistent trend since 2015, when Argentina lost its nickname as an "impeccable" country in vaccination. The historic 90% of the vaccinated population dropped, in several of the most important doses, to 80% and even 70%.
The semi-good news is in the local health report for November. Ricardo Rüttimann, an infectious disease specialist at the Center for Infectious Disease Studies Foundation (Funcei) and a member of the National Commission on Immunizations (CoNaIn), summed it up cautiously: "We see some recovery since the drop in pediatric vaccination in the pandemic, but the data are far from ideal."
Accumulation of susceptibility due to lack of vaccination
Both for the doses that newborns should receive (BCG and hepatitis B) and for those that are due to infants, the report of the ministry still led by Carla Vizzotti recognizes coverage with "suboptimal values". Of course, there is a recovery in 2022 compared to the pre-pandemic, and an improvement of between one and five percentage points, compared to 2021.
But it is worth insisting with half an empty glass because, Rüttimann explained, "we always had more than 90% coverage and a drop of five percentage points every year is no small thing. Accumulated over several years, they end up adding up to 10%, 15% or 20% of susceptible people. There are hundreds of thousands of people who are unprotected against easily contagious diseases."
Returning to babies, BCG, in 2022, did not reach 80% coverage. Hepatitis B barely passed it, with 80.9%.
Although those that affect infants were close to 84%, those that are of concern are some of the vaccines that are due at one year of age: hepatitis A, the first dose of the MMR vaccine (measles, rubella and mumps) and a booster of the pneumococcal vaccine.
The first two were at 86.9% and 84.6%, percentages that seem more or less good, but represent a drop from the previous year.
In hepatitis A, the drop is only one tenth, but the MMR, which includes the sensitive issue of measles (a disease of which experts warn of a real risk of reintroduction in the country) fell almost two percentage points.
As for the pneumococcal vaccine, it didn't go very well either. With a coverage of 78.9%, it showed no improvement compared to the previous year.
Polio, meningitis and the quintuple in low
Between 15 months and a year and a half of life, the dose against chickenpox is indicated (it goes without saying that it is of great importance in the prevention of shingles in adults) and the first booster of the quintuple, a vaccine of major importance, since it fights five complicated pathogens.
One is the cause of poliomyelitis, a subject about which Rüttimann was emphatic: "The UNICEF uniform on Argentina warns that in polio we are in a critical area, with a real risk of re-emergence."
In addition, this injection includes the combo diphtheria, pertussis (or whooping cough, or whooping cough), hepatitis B and a microbe that is rarely mentioned but should be taken into account: Haemophilos influenziae type B, one of the causes of pneumonia but also of bacterial meninigitis.
That booster, with just 74.2% coverage, fell more than a percentage point from 2021.
Roberto Debbag is president of the Latin American Society of Pediatric Infectious Diseases, an organization that has just published a paper with recommendations for the prevention of infections in the first 1,000 days of life. Consulted by Clarín, he spoke with concern about meningitis, but not only bacterial but also viral, both preventable by vaccination.
"We had not seen children with meningitis for 20 years and in the last year we have been able to see the severity of this disease, which produces mortality in 10% to 20% of cases, not to mention that it can leave cognitive sequelae in 60%," he said.
Immunizations in primary and secondary schools
From the nearly 95% coverage surveyed for vaccines applied in preschool, something basic emerges: the school's indication to take children to be vaccinated as a mandatory requirement to enter first grade is a filter with its own weight.
None of that happens with HPV doses, which are prescribed at puberty and which no one controls in high school. In particular, the booster dose, which is what allows us to achieve real coverage against the human papillomavirus.
In 2022, 82.7% of girls completed the first dose, but in boys the figure dropped to 75.6%. As for the reinforcements, the figures are horrific: women, 54.3%; men 47.6%.
"This is the first time that Argentina has had the concept of zero-dose children. The vast majority of them are children living in poverty, who are unable to access health care. Children of mothers who don't think about vaccinating but about feeding them. We're talking about vaccines that are waiting in the refrigerators," Debbag reflected.
It would be good to find them and vaccinate them, but "Argentina doesn't have the technology that is needed. This administration, which knew a lot about vaccines, did not generate a technification with a tracing system. It's all in rudimentary excel spreadsheets," he said.
Advice and doubts about the new Health policy
To the economic malaria to come, no one would want to add a sanitary one. By law, official vaccinations are mandatory and free of charge in all provinces. When in doubt, it is worth taking a look at the nearest paediatrician or vaccination centre, vaccination card and children's ID card in hand.
Could the right to be vaccinated change under the new government? Rüttimann reassured: "There is a regulated vaccine law and that gives solidity to what is happening here. Getting vaccinated is a right. It is an aspect that those of us who support public health and the protection provided by vaccines should leave us reassured"
In terms of public spending, there should be no doubts either. Vaccinating prevents health care costs, the UNICEF report summarizes. And it's clear: "For every dollar spent on vaccination, there is a return on investment of $26."