Dispatch from Haiti: We can do better on childhood vaccination coverage

Xinshu She Haiti nurses rounding childhood vaccination

I will never forget the first time I saw a child die of a vaccine-preventable disease. I walked into a room in a busy Haitian hospital (where I spend 6 months each year working as a fellow with Boston Children’s Global Health Program) to find an 8-year-old boy gasping for air. A thick, greyish white coating covered his mouth and throat, and his body burned like it was on fire. I had seen it only in textbooks before—a classic late presentation of a diphtheria infection.

A few hours later, despite our best efforts and timely antibiotics, the child died of acute respiratory failure. I remember sitting in the doctor’s room, staring into the space and overwhelmed by an intense wave of sadness. This child could have lived, if he had been vaccinated. This should never have happened.

Coming back to work in Boston usually reminds me of how fortunate we are in the U.S. Relative to most countries, we have an abundance of resources, trained providers and infrastructures aimed at both preventing and treating disease. However, this summer’s Center for Disease Control (CDC) annual report on vaccination coverage among children in kindergarten shocked me. Thirty-two states and the District of Columbia haven’t met the Healthy People 2020 target of 95 percent measles vaccine coverage. In seven states, coverage for the full 2-dose measles, mumps, and rubella (MMR) schedule is less than 90 percent. In 2015 alone, measles outbreaks affected 68 unvaccinated U.S. residents, 43 percent of whom did not get vaccination because of philosophical or religious objections.

Haiti childhood vaccinations global health
Haiti (United Nations/Wikimedia Commons)

While you might say that national vaccination coverage of 93-94 percent doesn’t sound so bad, look at a small country in Africa that is taking vaccination very seriously—Rwanda. The Minister of Health, Agnes Binagwaho, is a proud pediatrician who studied public health at the Harvard School of Public Health. She gave a fantastic talk this month about the progress her country has made in health care quality. For example, Rwanda’s measles vaccination rate was an impressive average of 98 percent in 2014, compared to the U.S.’s embarrassing 91 percent.

The U.S. physician-to-patient ratio is 24 times that of Rwanda; its GDP per capita is 90 times higher. There is no excuse for our country’s vaccination rates to be lower.

My experiences in global health have taught me that we can never take for granted life-saving interventions that prevent diseases still killing millions in the world. In addition to helping less-resourced countries improve their health care, we need to be an example of a system that truly makes good use of the resources that we have—including clean water, flushing toilets, access to health care and VACCINES.

We as pediatricians need to be more vocal about the potentially disastrous consequences of declining coverage, and advocate for and support policies that can improve disease prevention. Some states have already taken action. For example, California and Vermont both removed religious exemptions for vaccination for all children attending public and private schools in 2015. California has gone even further, removing philosophical exemptions as well.

Now, let’s all join the movement in whatever capacity we can, as pediatricians and as families, neighbors and friends of all children who deserve to live their lives free of vaccine-preventable diseases. My wish is to never have to witness another death from a vaccine-preventable disease. Let’s start with the U.S.

Xinshu She global health childhood vaccinationXinshu She, MD, MPH, is a fellow in the Global Health Program at Boston Children’s Hospital. She spends 6 months each year in Saint-Marc, Haiti, working with Partners In Health. There, she works side-by-side with local pediatricians and nurses; teaches residents and medical students; and carries out quality improvement projects. Before joining Boston Children’s, she worked with global health projects in China, Mexico, Congo and Guatemala.