The Silent Spread of Diphtheria

According to the death certificate of Abismael Espinoza, the child died as a result of diphtheric cardiomyopathy. Like his, the death certificates of three other children from Bolívar - Sara Bastardo, Jhoangely Alexandra Ochoa, and Dariervys Brazón -, issued between September 24 and October 10, and obtained by Armando.info, indicated diphtheria as the cause the deaths. For physicians in the health centers of Bolívar, witnesses of the resurgence of diphtheria, an epidemic is hidden. "The confirmation of cases is usually delayed, because almost all of the evidence is sent to Caracas. However, we already have several patients, dozens, and they do not know each other. There are more than 20 deaths from this disease. Even the pediatric ward of the hospital (Raúl Leoni) has been enabled to attend only potential patients of diphtheria," says a doctor at this hospital.

Diphtheria is a preventable disease. The expedited way to avoid an outbreak in the population is vaccination. In Venezuela, immunization depends on health programs run by the State. According to recommendations of the World Health Organization (WHO), countries should immunize 90 percent of the population, in this case with the vaccine known as DPT3, to prevent the re-emergence of this disease. However, this guideline has not been complied with in Bolívar state in the last decade.

The parents of the four children whose death certificates indicate that they died of diphtheria admitted that they did not completed the required doses of the vaccines. "I always wanted to vaccinate my baby, but when I went to the outpatient clinic or the hospital, they told me that the vaccine had run out. At some point, I threw in the towel and did not keep going," says Melville.

Diphtheria vaccines depend on an agreement signed between Cuba and Venezuela, through the Socialist Company for the Production of Biological Medicines, Espromed Bio C.A., created on June 12, 2014 by a decree of President Nicolás Maduro.

However, Espromed Bio was not an invention of the Government. The vaccine plant, in Universidad central de Venezuela, already existed since 2000 and depended on the Rafael Rangel National Hygiene Institute. The Government only decided to transfer the administration directly to the Ministry of Health to reinforce its operation. The company was expected to meet the country's demand, since it is made up of three independent laboratories for the industrial fermentation process with the capacity to produce 160 million doses of diphtheria toxoid, anti-Pertussis vaccine and tetanus toxoid per year, and with a plant of formulation, filling and final processing, with an installed capacity of 120 million doses per year.

The emerging promise has not escaped from the Venezuelan decline though. Last year, Espromed Bio only produced the packaging and labeling of 21,718,906 doses of biological products and essential medicines to prevent diseases caused by viruses, bacteria, toxins, among other agents. Only 5,104,842 out of this amount —almost all the doses acquired from the agreement between Cuba and Venezuela—were distributed in the country. According to the 2015 Annual Report of the Ministry of Health, the company was victim of delays in the allocation of foreign currency to import spare parts and supplies for production, among other administrative obstacles.

The reappearance of diphtheria has coincided with the worst health crisis faced in Venezuela. The country, dependent on oil and subject to strict foreign exchange control, has fallen into a financial meltdown that causes a drop in imports. This situation has affected hospitals, pharmacies and laboratories that, in most cases, are supplied with inputs acquired abroad. It is estimated that there is almost a deficit of 85 percent of drugs -according to the Venezuelan Pharmaceutical Federation- and a growing deterioration of medical centers. But the Government of Maduro has coined the term of "economic war" to hold it responsible for all ills.

In the Christian church of the Buen Retiro neighborhood of San Felix, in the heart of Bolívar state, they have said a prayer for the soul of Saraí Bastardo. The inhabitants of this walled village still cannot find explanations for the sudden death of the girl. Solmaira Melville, the mother of Saraí, resents not having noticed in time the signs of faintness of the daughter: "Dyspnea, sore throat, stifling sensation in the chest. Since she was asthmatic, we thought that was what she had, and that she would improve with medication. But it was not that, it was diphtheria."

The outbreak of diphtheria has unleashed fear in Bolívar. Melville denounces that one of his three children has been isolated at school. "A teacher began to say that the child could not be with the other children; that he had to be subject to medical exams before rejoining. After the death of my baby, we have all been vaccinated. Already, after several complaints, the principal is aware of this and allowed the child to attend school," she says.

In the neighborhood of the Espinoza Rodriguez family, the mourners of Abismael, is already aware of the diphtheria due to the death of the child. "Ask about the mother of the child who died of diphtheria! Anyone can tell you where my home is," says Gregoria Rodríguez, when scheduling a journalistic interview.