A vaccine-related tragedy in Mexico

Recently there was a news report from the region of Chiapas, Mexico, where two infants died and (according to the official report) 29 are still hospitalized with 6 in critical condition. The deaths and illness followed vaccination with BCG, Hep B, and rotavirus vaccines by Mexican health workers. According to Latin Post, the parents received the vaccinations voluntarily.

The vaccinations were offered on Friday when officials came to La Pimienta, where access to medical care is difficult to come by; they announced over loudspeakers that the shots would be given to newborns, local residents told CNN MĂ©xico.

There are no hospitals or clinics in the area, and residents flock to a small cinder-block health center with a tin roof whenever a doctor passes through the community.

“A small selection of paracetamol and other pills sits on dusty shelves inside,” CNN said of the health centers.

Vaccination campaigns have been suspended only in the region where this occurred, as the Mexican government does not see any risk to children outside of the region. The government is paying for the care of the children and their parents while they recover.

—update–

The latest update indicates bacterial infections were the cause of injury, and the government has stated that the contamination was not in the vaccines but apparently from the environment. There have not been reports of anyone else in the community being ill, only the vaccinated infants, but 21 infants who were vaccinated the same day did not fall ill or have any adverse effect.

The contamination risks that are posed in isolated, rural villages or densely populated refugee camps in unstable regions are not the same risks that people in wealthier nations face when getting vaccinated. The risk does not translate to children in urban and suburban California. The problems are in the circumstances, not the vaccines.

This type of situation gets used repeatedly by people in other parts of the world (like here in the US) eager to point out the dangers of vaccines. There is this similar report several years ago where 5 infants died from an unknown bacterial infection in a remote village of Chiapas, not associated with a vaccination program. It may be that healthcare worker’s visit and the children’s illnesses coincided– they happened at the same time. An hopeful speculation could be that the health care workers visited the remote region, and perhaps that is why the illnesses were observed in the first place, and the majority of the children were able to receive prompt care. That is called coincidence, and coincidence is both random and very common. As I said, though, it’s only speculation at this point.

In a case where the process truly was at fault, in Syria, vaccines were reconstituted with a muscle relaxant that killed over a dozen children (reports varied widely on the actual number). An overdose of atracurium was the cause of death, and it was a mixup that could have been made with any injectable drug. The error was compounded by the fact that by necessity the small clinic stored preventive vaccines alongside dangerous, but lifesaving emergency drugs.

So what is the point of distinguishing the vaccines- a medical product- from the process of vaccination delivery and administration? Is it just to absolve vaccines, and say they never do any harm? I’ll answer my own rhetorical question– that no, vaccine injuries are not denied for the pure joy of saying “it wasn’t the vaccine.” These injuries are most often denied because it actually wasn’t the vaccine.

First, you make the distinction simply to know how to respond. If the vaccination is inherently dangerous, then it is unethical to use it or to advocate its use. We’ve seen over and over again that vaccination is not inherently dangerous, although there are specific risks that are inherent in the vaccine. These inherent risks need to be considered independently when advocating for, or recommending the use of vaccines. This is where the term “unavoidably unsafe” is used, because of the specific risks that the vaccine itself poses, which can not be ameliorated without negating the entire purpose of vaccination. In other words, vaccines stimulate the immune system to develop immunity, and there is always small risk to that– a risk much reduced compared to immunity provoked by the disease itself.

So again, a safe product that is delivered with negligence, sabotage or with accidental carelessness is still a safe product. Yet, it might be inappropriate to administer the safe product under circumstances where associated dangers can not be remedied.

Can contamination, drug mixups and other errors be avoided? Yes, they can. Vaccines and vaccine programs both remain safe and lifesaving, even when rare (but often highly publicized) tragedies do occur.

If the error occurs during vaccine administration, such as a mixup or post-manufacturing contamination due to improper storage, then that needs to be addressed. Often, situations like that can be controlled and prevented with standardized storage and administration protocol. Reuse of needles is a dangerous practice that can occur with injections, and has occurred with vaccines, injected vitamins and other injected drugs. The problem– needle reuse– can be addressed without pointing the finger at the vaccine campaign, because vaccines can be safely administered without reusing needles. Hygeine during administration is also important, and may have been an issue in the situation in Mexico, as the government has stated that contamination was found outside of the vaccine– presumably meaning the vaccine vial. In that case, it sounds like someone didn’t wash his hands and subsequently handled the child and/or the vaccine. Again, speculation.

The crux of the issue is whether or not the problem is inherent in vaccines– do 60-80% of children who are vaccinated have to worry about severe reactions such as these? No, absolutely not. Rare, isolated clusters of error, improper administration and contamination are not applicable to the entire pediatric population.

Each regions its own risks, and in the US and other developed nations, storage procedures are such that the risks are mostly 1) the wrong vaccine is given, which uncommonly causes any problems at all and 2) the vaccine is ineffective due to improper storage, which is a serious problem because people will not be immune and may not realize it, but it is not a vaccine safety problem in the sense that the vaccine itself does not cause harm in that instance.

By discussing the real problems here, it doesn’t mean that those tragedies don’t matter, but that they have to be resolved honestly and not by indefinitely halting vaccination or placing the blame on unrelated issues, such as vaccine science or manufacture, or advocacy for aid in the form of preventive vaccines, when those are not the problems.

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