Venezuela's Resurgence of Vaccine-Preventable Diseases

As Americans fixate on the revival of measles cases and outbreaks and worry about the long-term consequences of anti-vaccine attitudes, there are serious infectious disease threats re-emerging in Venezuela. The country has been in a state of economic and political discontent for years and the recent presidential election has brought the nation even closer to a dangerous boiling point.

In recent years, an estimated 3 million Venezuelan citizens have fled the nation as hyperinflation, power cuts, and shortages of food and medicine have occurred as a result of the economic crisis. The disputed election of Nicolás Maduro has only fueled the discontent and chaos with hyperinflation rates exceeding 45,000% and the nation’s health system crumbling,

In the midst of the humanitarian crisis, vaccine-preventable diseases and arthropod-borne diseases are making a comeback. The resurgence of these diseases is only made worse by a collapsing health care system and a public health infrastructure that is woefully inadequate.

Now, investigators from around the world, including Venezuela, are attempting to draw attention to the public health crisis in the wake of a collapse of the country’s infrastructure under authoritarian rule via a report in US Centers for Disease Control and Prevention’s Emerging Infectious Diseases journal.

With 66% of the population living in extreme poverty, more than 280,000 children are already at risk for death due to severe malnutrition. Furthermore, infant and maternal mortality have risen by 30% and 65%, respectively, since 2016. As public hospitals struggle with limited staff and resources, it is estimated that the institutions are only equipped with 30% of the basic medication to treat infectious diseases. Additionally, immunization programs are struggling and surveillance programs are no longer a priority.

The crisis within the country has resulted in a return of measles, which has already bubbled beyond its borders with 25 cases brought into Colombia from Venezuelan migrants. The resurgence of measles arrived after the Venezuelan immunization program began to crumble in 2010. The most recent reports reveal that only 52% of the nation has received their second dose of the MMR vaccine.

Despite diphtheria not being reported in Venezuela in 24 years, the vaccine-preventable disease began popping up again in 2016. More than 2170 cases have been reported since 2016 and several cases were spread from Venezuela to Colombia. Similarly, national coverage is below herd immunity requirement rates with an estimated 60% of the population having received all 4 doses of the diphtheria-tetanus-pertussis vaccine.

Polio, which was eliminated from the Americas in 1971, could also re-emerge now that collapsing health care and public health infrastructure has put Venezuela in a perilous state of vulnerability, with immunization coverage rates below recommended levels. The investigators on the Emerging Infectious Diseases report note that “during the past decade, crises in Africa and the Middle East have provided numerous examples of the consequences for failure of the control of vaccine-preventable diseases when health care delivery is disrupted by political turmoil; these areas have also provided paradigms of successful intervention measures.”

Syria has given us a prime example of infectious diseases resurging in a weakened health care system and a population under duress. Given Venezuela’s increasingly precarious situation, there is a desperate need to provide public health and health care intervention. As air travel has increased the ease of disease transmission, it is likely that Venezuela could be a hot spot for emerging infectious and vaccine-preventable diseases.