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Saturday, January 19, 2013

Can We Catch Up With Belize?

My adventurous, smart and idealistic wife - also a pediatrician - is planning an international medicine experience this spring in Central America; her destination is Belize.  Since I'm the one more comfortable with literature searches than safaris, I've been checking out the healthcare system that she'll be working in.  According to the World Health Organization, Belize is a country of just 318,000 with a per capita GDP just 1/7th of the US.  This is not surprising, but here's what is.

In Belize, 98% of children receive measles vaccine, while 95% are immunized against whooping cough and hepatitis.  In the US, those rates are just 92, 92 and 93%.  Looked at another way, in the US four times as many children are un-immunized against measles than in a third world country, when adjusted for population.

Does it matter?  Immunization is one of the best markers we have for the quality of child healthcare.  Besides preventing a variety of infections that threaten life and health, immunization is a good proxy for overall contact with preventive healthcare and a measure of the extent to which a society provides for its children.  And look at the results: in the US, over 18,000 whooping cough cases were reported in 2011.  As well as 222 cases of measles.  In Belize, the number  And the previous year, also zero.  These data may not be perfect.  But they raise some very interesting questions.

But first, it is important to acknowledge that extreme poverty is not without consequence.  The children of Central America face serious issues about sanitation, clean water and access to advanced care.  Parasitic diseases are common. Educational opportunities are variable.  There are problems.

On the other hand, the Belizean people have decided that healthcare is a right.  All immunizations are paid for by the government.  Beyond this, the populace, being so very different than ours, have not fallen prey to the problem of "over thinking" their healthcare.  In the US, large numbers of children suffer from preventable infections because their parents became worried about rumored side-effects of individual vaccines, or just vaccines, period.  Perhaps the most pervasive involved a preservative, used for 70 years to prevent bacterial and fungal contamination of vaccine vials. More than a decade ago, this preservative, thimerasol, was removed from essentially all vaccines in our country.  This, despite the science which identified no relationship between the compound and any side effect, including that scourge, autism.  The anti-vaccine activists predicted that removing the preservative would result in a downturn in new autism cases, which would have been a wonderful and surprising thing.  What actually happened, sadly, was nothing.

(Well, not actually "nothing."  The incidence of autism continued to creep upward, while the cost of vaccine manufacture rose, creating yet another barrier to protecting our children.)

Alarmingly, a "coalition" of individuals opposed to thimerosal in vaccines is now seeking to extend the ban to developing countries.  Countries whose successful vaccination programs will falter and fail if these changes are enacted.  But I have faith that the WHO,  American Academy of Pediatrics and others will protect the Belizeans from well-meaning Americans.  If they can't, heaven help the children.

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