When it comes to third world medicine we almost invariably hear from the WHO about the successes of massive vaccination programs. If you look into the recent agenda for the World Health Assembly  you will find pandemic influenza vaccines at the top of the technical matters, and in the status section, the eradication of Poliomyelitis is at the top of that section. What is glaringly absent is a discussion of the pervasive double standards in research ethics, health-care safety and professional rigor that exist in the developing world. The WHO and its medical partners won’t talk about it publicly because when you look at the numbers, it is directly implicated in the suffering and ultimate death of millions of people in the developing world. That is what we’ll cover in this piece.
It is well known that needle re-use can be a major cause of virus transmission. In 2000, a WHO press release states:
Unsafe Injection practices have serious large-scale consequences…”unsafe injection practices throughout the world result in millions of infections which may lead to serious disease and death. Each year over-use of injections and re-use of dirty syringes and needles combine to cause an estimated 8 – 18 million hepatitis B virus infections, 2.3-4.7 million hepatitis C virus infections and 80,000 – 160,000 infections with HIV/AIDS worldwide. 
That same press release uses an epidemic of Hepatitis C that occurred from Schistosomiasis treatment in Egypt. Notably absent is any discussion of the massive immunization campaigns waged throughout the third world coincident with the massive epidemics of HIV and other infectious diseases. However, someone there must be aware of the potential problem because the press release states the following at the end:
In addition, to ensure the safety of immunization injections, WHO, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), and the International Federation of the Red Cross and Red Crescent Societies (IFRC) have recently called for the exclusive use of auto-disable (AD) syringes for immunization by the end of 2003.
We know quite reliably that the WHO knew years prior to this press release (2003) that medical practices in the developing world were problematic. As Gisselquist outlines in his 2009 article  the WHO was quietly giving UN employees the following advice in 1991.
take special precautions to avoid HIV transmission via blood . . . If you are not carrying your own needles and syringes, avoid having injections unless they are absolutely necessary . . . Avoid tattooing and ear-piercing. Avoid any procedures that pierce the skin, such as acupuncture and dental work, unless they are genuinely necessary. Before submitting to any treatment that may give an entry point to HIV, ask whether the instruments to be used have been properly sterilized.
“Being a carrier of MRSA has increased a lot, especially among school-aged kids,” said Lyn Finelli, chief of influenza surveillance at the CDC. “And being colonized may put them at risk for a severe staph aureus infection when they get the flu.”
This particular news story blames the problem on antibiotic overuse, and, of course, recommends the flu vaccine to save children from this dangerous situation. Read more
As a punishment from the gods, Sisyphus was compelled to roll a huge rock up a steep hill, but before he reached the top of the hill, the rock always escaped him and he had to begin again. The maddening nature of the punishment was reserved for Sisyphus due to the mortal’s hubristic belief that his cleverness surpassed that of Zeus.
In September, the AP reported that Prevnar…
“A vaccine that has dramatically curbed pneumonia and other serious illnesses in children is having an unfortunate effect: promoting new superbugs that cause ear infections.”
I always wonder who actually writes these science stories you see in the media.
Yes, the emerging serotypes cause ear infections and other mild illnesses, but they also cause various deadly forms of invasive disease. It’s a phenomenon called “serotype replacement” (or “replacement disease” in other circumstances) and so far all of the conjugate vaccines (Hib, Prevnar, Menactra) have done this in some form or fashion. The vaccines work extremely well against vaccine-included serotypes of streptococcus pneumoniae, but they work so well that they also prevent asymptomatic carriage of these normally commensal organisms.
And that is a problem.
For example, from The Lancet:
“FINDINGS: We noted no reduction of AOM episodes in the pneumococcal vaccine group compared with controls (intention-to-treat analysis: rate ratio 1.25, 95% CI 0.99-1.57). Although nasopharyngeal carriage of pneumococci of serotypes included in the conjugate-vaccine was greatly reduced after pneumococcal vaccinations, immediate and complete replacement by non-vaccine pneumococcal serotypes took place.”