The Venezuela Health Crisis: A reemergence of infectious and vaccine-preventable diseases

As the economic and political crisis in Venezuela continues, many doctors are leaving the country and there is a dire shortage of medicine and medical supplies. Conditions are favorable for the reemergence of rare, infectious diseases such as malaria, tuberculosis, Chagas, and chikungunya, and vaccine-preventable diseases such as diphtheria and measles (Phillips, 2019). At one time, Venezuela served as a successful model for its comprehensive primary healthcare system. Hugo Chávez, who was President from 1999 until his death in 2013, used the high oil profits from the mid-2000s to create a strong healthcare system with an emphasis on primary health care and funded social welfare programs in relation to food, housing and education from 2003 to 2007 (Finnegan, 2016). The most prominent program was the Misión Barrio Adentro program (MBA) which focused on building 8,500 health centers to provide primary care to all citizens, a form of universal health care (Briggs and Mantini-Briggs, 2009). However, when oil prices plummeted in 2015, the government did not have the money to support these programs and cut their spending which effectively unraveled the healthcare system (Carrillo Roa, 2018). Today hospitals lack the resources to provide even the most basic supplies, such as soap to ensure hygienic standards, and face a chronic shortage of antibiotics and vaccinations. This is an especially dangerous situation as many citizens are severely malnourished and thus their weakened bodies are at an increased risk of developing infections (Phillips, 2016).

Vector-borne disease such as malaria, Zika and dengue are on the rise with an increase in incidences up 400 percent in the last decade (Daley, 2019). In 1961, the WHO deemed Venezuela to be the first country in South America to eliminate malaria from the majority of its territory and most other vector-borne diseases were practically eradicated. At one time, the country had a robust epidemiological surveillance department and a weekly bulletin was published with statistics (Daley, 2019). However, since Nicolás Maduro came to power in 2014 this progress has been erased. In 2017, he fired Antonieta Caporale, the Health Minister, after the department published a bulletin that showed rising infant and maternal mortality rates as well as an increase in vector-borne diseases (Grillet, 2019). There is no antimalarial surveillance, treatment, or control to limit the spread of these vector-borne diseases due to funding cuts. Scientists fear for their freedom by continuing to work on exposing incidences of vector-borne diseases, the government regularly destroys and confiscates data and research on this subject, and thus information is not widely available (Grillet, 2019).

While the government announced 600,000 cases of malaria in 2018, many scientists believe that there could be upwards of 1.2 million cases (Daley, 2019). This number is especially jarring when compared to the fewer than 50,000 cases in 2010 (Daley, 2019). Further adding to the resurgence of malaria is the fact that many Venezuelans, lacking income or a job, are traveling to illegal mining camps near the Brazilian border where malaria has not yet been eliminated. At the mines, conditions are unsanitary and there are stagnant pools of water, the perfect breeding ground for the Anopheles darlingi mosquitoes (Boseley and Graham-Harrison, 2019). The declining health care infrastructure, departure of doctors, and lack of public health surveillance and prevention programs have led to a resurgence in vector-borne diseases.

Coinciding with this increase in vector-borne diseases, is a rise in incidences of tuberculosis. The disease was once seen to be a disease of the poor and well contained in the country but today it is returning in aggressive drug-resistant strains and affecting many middle-class people. With the scarcity of doctors, medicine and unhygienic environments the rate of transmission has increased and individuals, weakened by malnutrition, are more susceptible (Semple, 2018). The government’s tuberculosis prevention and control program was at one time one of the best and there were low rates of infection (PAHO, 2019). In the last year, the rate of patients testing positive has increased by 40 percent. Hospitals are unable to provide testing or medication to treat the disease and thus the disease continues to spread (PAHO, 2018a). As the crisis continues there are not enough doctors, supplies or medication to cure those with tuberculosis further accelerating the disease among already vulnerable individuals.

In recent years there has been a drastic increase in the rates of vaccine-preventable diseases, in particular diphtheria and measles. Between 2016 and October of 2018, over 2,000 cases of diphtheria were reported, which was especially stunning considering that previously it had not been detected in the country in 24 years (Paniz-Mondolfi, 2019). In 2017 and 2018, over 9,000 cases of measles were reported and only half the population had received the second dose of the measles vaccine which is critical to ending transmission (PAHO, 2019). The country-wide vaccine campaigns which had begun in 2007 were unable to continue as the country lacked the funds for both promotion and the vaccines (Snyder, 2009). The healthcare shortages leading to a lack of vaccines have caused a re-emergence of once eradicated and deadly diseases notably measles and diphtheria. Among the most vulnerable to these diseases are children, many of whom who suffer from malnutrition.

In addition to the effects that these diseases have in Venezuela they also have the potential to spread to nearby countries. Over three million refugees have left the country primarily to nearby countries such as Brazil, Colombia, and Peru. There is evidence that migration patterns can be traced to the emergence of measles, diphtheria, malaria and HIV in other locations (Tuite, 2018). In Brazil in 2018, 10,000 cases of measles were detected, determined to have come from the outbreak in Venezuela (PAHO, 2018b). When these migrants enter into new countries, they frequently spend months or years in refugee camps or other forms of poor housing, further increasing their risk and vulnerability to infection and disease. Even in new countries, migrants often cannot obtain treatment. In Brazilian and Colombian border towns, the hospitals are so overwhelmed they are unable to accommodate healthcare needs of the refugees further adding to health crisis (Tuite, 2019). The Pan American Health Organization has set up field missions in Colombia and Brazil in an attempt to provide vaccines and healthcare services (PAHO, 2018b).

At one time, Venezuela served as a model for a robust state-run healthcare system that provided access to vaccinations, epidemiological surveillance, and HIV/AIDS treatment. Today due to the economic and political collapse, the healthcare system is in a state of duress. Healthcare, medicine and medical supplies are practically unavailable and there has been a reemergence of vector-borne and vaccine preventable diseases. As out migration continues at an exponential rate there is evidence that these diseases too are spreading beyond the borders of Venezuela making them difficult to control and eradicate. The breakdown of Venezuela’s health care system serves as an example of the crisis the country is facing in regards to a socioeconomic breakdown. These epidemiological factors are an indicator of this broader breakdown within the country and it is important to consider and understand them as a way to asses the broader political, social and economic climate of a place.

Related Articles

• Healthcare in Times of Crisis
• The Zika Epidemic in Latin America
• Malaria
• Tuberculosis

Additional Resources

Briggs, C. L., & Mantini-Briggs, C. (2007). Misión Barrio Adentro: Medicina Social, Movimientos Sociales de los Pobres y Nuevas Coaliciones en Venezuela, Salud Colectiva, 3(2): 159-176.

Gladstone, R. (2016, May 27). How Venezuela Fell Into Crisis, and What Could Happen Next, The New York Times. Retrieved From https://www.nytimes.com/2016/05/28/world/americas/venezuela-crisis-what-next.html

Hotez, P., Basáñez, M., Acosta-Serrano, A., & Grillet, M. (2017). Venezuela and its rising vector-borne neglected diseases, Plos Neglected Tropical Diseases, 11(6): 1-7.

References

Boseley, S., & Graham-Harrison, S. (2019). Venezuela crisis threatens disease epidemic across continent, The Guardian. Retrieved From https://www.theguardian.com/global- development/2019/feb/21/venezuela-crisis-threatens-disease-epidemic-across-continent-experts

Briggs, C. L., & Mantini-Briggs, C. (2009). Confronting health disparities: Latin American social medicine in Venezuela, American Journal of Public Health, 99(3): 549-555.

Carrillo Roa, S. (2018). Sistema de salud en Venezuela: ¿un paciente sin remedio?, Cadernos de Saúde Pública, 34(3): 1-17.

Daley, J. (2019). Infectious Diseases Spike amid Venezuela’s Political Turmoil, Scientific America. Retrieved From https://www.scientificamerican.com/article/infectious- diseases- spike-amid-venezuelas-political-turmoil/

Finnegan, W. (2016, November). Venezuela, A Failing State, The New Yorker. Retrieved From https://www.newyorker.com/magazine/2016/11/14/venezuela-a-failing-state

Grillet, M. (2019). Venezuela’s humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region, The Lancet Infectious Diseases, 19(4).

Pan American Health Organization. (2018). Plan Maestro para el fortalecimiento de la respuesta al VIH, la tuberculosis y la malaria en la República Bolivariana de Venezuela desde una perspectiva de salud pública, Health in the Americas.

Pan American Health Organization. (2018). Epidemiological Update Measles, Health in the Americas.

Pan American Health Organization. (2019). Number of Vaccine Preventable Disease cases in the Americas.

Paniz-Mondolfi, A (2019). Resurgence of Vaccine-Preventable Diseases in Venezuela as a Regional Public Health Threat in the Americas, Emerging Infections Diseases, 25(4): 625-632.

Phillips, T. (2019, January 06). Venezuela crisis takes deadly toll on buckling health system, The Guardian. Retrieved from https://www.theguardian.com/world/2019/jan/06/venezuela-health-system-crisis-nicolas- maduro

Semple, K. (2018). ‘We’re Losing the Fight’: Tuberculosis Batters a Venezuela in Crisis, The New York Times. Retrieved From https://www.nytimes.com/2018/03/20/world/americas/venezuela-tuberculosis.html

Snyder, M. (2019). The Venezuela Crisis and Infectious Disease Spread, Outbreak Observatory. Retrieved From https://www.outbreakobservatory.org/outbreakthursday- 1/2/28/2019/the-venezuela-crisis-and-infectious-disease-spread

Tuite, A. (2018). Infectious disease implications of large-scale migration of Venezuelan nationals, Journal of Travel Medicine, 25(1): 1-8.