The great yellow fever shot controversy

On the afternoon of October 16, the Ministry of Health issued a long and defensive communique, the operative paragraph of which provided that:

That the application of the vaccine against yellow fever, beginning November 1, 2008, will be a RECOMMENDATION and not a requirement for travelers coming from or with a destination of countries with a risk of transmission of this illness.

(Que la aplicación de la vacuna contra la Fiebre Amarilla, a partir del 1 de noviembre de 2008 será una RECOMENDACIÓN y no una exigencia para los viajeros procedentes o con destino a países con riesgo de transmisión de esta enfermedad.)

Thus ended a day when The Panama News was informed that uninformed or corrupt officials at Tocumen Airport had been demanding proof of yellow fever vaccinations of departing passengers.

(The insistence upon application of a non-existent rule, or misapplication of an existing one, or enforcement of one that’s never enforced, such that it causes great inconvenience to a person who can be expected to be carrying cash and would be tempted to offer a bribe to resolve the problem, is an ancient technique in the lower ranks of the Panamanian bureaucracy, particularly by political appointees as an election looms and uncertainty about their future employment increases.)

Thus ended, so it would seem, one of the more comical demonstrations of the Torrijos administration’s ineptitude at health policy.

(There was nothing comical about the most outrageous demonstration of this, the mass poisoning of public health care system patients with tainted cough syrup, the concealment of information about this problem which multiplied the death toll and the denial of funds to do timely toxicology tests so as to deny benefits to most of the victims.)

So do teenagers in Shanghai refer to this sort of bureaucratic display as a “Panamanian fire drill?”

And do Panamanians need any more proof that, notwithstanding the “sí se puede” campaign slogan, the minions of the Torrijos administration still play the old “no se puede” game?

Panic, confusion and the government's PR
by Eric Jackson

Nearly two years ago, The Panama News reported on a World Health Organization agreement on innoculation standards for international travelers. The main concern then, and now, was and is a global pandemic of a particularly virulent strain of influenza. But that's not the only concern. Climate change, rapid urbanization in the Third World, and people developing and moving into former wild areas add up to geographical shifts in disease vectors and more frequent human exposures to pathogens that can but usually don't infect people. That's largely what the "emerging diseases" phenomenon is all about, and also behind the reappearance of certain diseases to places where they had been absent for some time.

There was this hysterical misinterpretation of the agreement in some quarters when Panama formally adopted the WHO scheme, but that measure would not go into effect before the Ministry of Health issued its regulations. More than one year ago in these pages tourism minister Rubén Blades downplayed the fears but advised that international travelers would soon have to get used to carrying immunization cards along with their passports.

Finally, this past August, the Ministry of Health started to issue regulations pursuant to the agreement. Its decree provided that people traveling between Panama and places on the WHO list of countries with a risk of contracting yellow fever --- in either direction --- would have to be immunized against yellow fever at least 10 days before traveling. But despite all of the millions of dollars that the Torrijos administration spends on advertising, the ministry spent not one dime informing international travelers, either here or abroad.

The ministry did sent a note to airlines serving effective routes, which in its simple inelegance served to confuse matters. Issued in late September, it stated that a new travel policy would go into effect on October 1. It didn't get into the particulars about how travel to and from some countries is affected while people can still come and go unimmunized with vast regions of the world, including North America and Europe. It didn't get into the medical issues of how pregnant women, infants, people with certain allergies and senior citizens in frail health probably should not take the small risks inherent in getting a yellow fever shot.

Then, the most sensationalistic, simplistic and anti-scientific publications in Panama got the story from underinformed travel agencies who had received it from underinformed airlines, embellished it with a few scary phrases and published it far and wide. Readers of Don Winner's disreputable website suddenly "knew" that they needed a yellow fever shot to travel to and from the United States. Worse yet, people from whom one would expect better information like the British Embassy began to pass on the misinformation.

And how did the Ministry of Health prepare for the hordes of panicky travelers, now that they had tickets to fly in less than 10 days and were told that they needed to have had their yellow fever shots 10 days in advance? Preparation? What preparation? Didn't the poisoned cough syrup affair tell you that the health authorities here --- not the rank-and-file, but the people who run things --- are political operatives who are there to strut around and pick up fat paychecks and don't consider actually doing their jobs as part of their jobs? The Ministry of Health, having caused great confusion and having ordered a policy affecting nearly half of the people who come and go through Tocumen Airport every day --- most notably those from northern South America, including Colombia, Venezuela, Ecuador and Peru --- didn't prepare for the increase in demand for yellow fever shots, let alone for the demand by people who didn't need the shots but thought that they did. People waited in long lines at the ministry's Los Rios facility, the only place where shots were available, and some of them went home unvaccinated after an all-day wait because sufficient staff had not been assigned to deal with the demand.

So, did our illustrious health minister go before the press and public and clarify matters? Well, no. Actually, the Tourism Authority and the Foreign Ministry were beseiged by urgent requests for clarification, mainly from people in the tourism industry and the Colon Free Zone who feared that they would be negatively affected, and by would-be business travelers, some of whom on the face of the policy as presented to the public would be prevented from traveling to Panama to meet with Panamanian public officials about public business on the basis of a catch-22 order from another Panamanian governmental ministry. The information that the policy's implementation would be delayed from October 1 to November 1 came from the Minstry of Foreign Relations.

Clarifications began to be made, people made their plans and confusion began to subside.

However, the private sector intervened to stoke the confusion just a little. COPA Airlines announced a policy by which travelers to and from Panama, whatever the place of departure or destination, would have to have had yellow fever shots 10 days in advance. We should expect, however, that unless its competitors on the US-Panama routes follow suit COPA is going to get hammered in the marketplace and will have to back down.

Having Panama as a hub, however, does complicate things for COPA. We are, after all, one of those countries listed by the WHO as having a risk of yellow fever transmission.

How can that be? The last yellow fever death recorded in Panama was in 1905. It has been decades since we had a confirmed case and the last outbreak we had came during World War II, arriving with US military personnel who had contracted it elsewhere.

But scientists believe that the yellow fever virus, or at least a variant of it, has never left the isthmus. Wild monkeys have tested positive for it and it is suspect that out in the jungle there may be other animal reservoirs as well. It's entirely possible that in remote areas there have been human yellow fever cases about which the national health authorities were never advised. It is thus said that in the eastern part of Panama province --- Chepo district and points east --- and in Kuna Yala and the Darien, there is a small but present possibility of getting yellow fever and it would be wise for people going to those places to be vaccinated.

And heaven help us if we get a few yellow fever cases in the metro area, coming in either from remote parts of eastern Panama or from Brazil or other parts of South America that have seen outbreaks in recent years. Panama's embrace of the slovenly throw-away culture has given us plenty of dengue fever --- in every beer or soda can by the side of the road, in every old tire tossed away where the rain can get into it, in every piece of plastic thrown into a storm drain and washed up on the beach, in every junkyard or trash heap, you will find a place where the Aedes Egypti mosquito that spreads dengue will breed. This insect species also happens to be the vector that spreads yellow fever among humans.

On the basis of these small but very real risk factors, the World Health Organization has listed Panama as a country where there is a risk of transmission of yellow fever and a number of countries that don't have this risk --- not including the North American countries, Costa Rica, or the nations of the European Union --- do require yellow fever shots for people coming from or going to Panama. The WHO list of countries with risk of yellow fever transmission and those with yellow fever immunization requirements is found online at http://www.who.int/yellowfever.pdf.

Health Minister Rosario Turner told El Panama America that the immunizations will be required until the WHO removes Panama from the list of countries with a risk of yellow fever transmission. However, unless the public health care system she serves --- which can't even maintain adequate supplies of medicines that patients with life-threatening chronic diseases need on a daily basis --- intends to vaccinate the entire population of Panama against the reservoirs of yellow fever virus lurking out in the jungle or in neighboring countries, it's probably unrealistic to expect Panama to be taken off of that list. Panama has, however, appealed to the WHO to remove it from the list.

Meanwhile, the Ministry of Health has belatedly moved to meet the demand for yellow fever vaccinations. People planning to travel to countries where it is required by the Panamanian or destination country's government will no longer find impossible lines. The same applies to those who don't particularly plan to travel abroad but due to where they go in Panama or for some other reason feel that it would be safer to be vaccinated; and also those who plan to travel by COPA Airlines to and from places where the shots are not legally required but will nevertheless be required to meet COPA's more stringent special corporate immunization policy.

You now get the shots at the Ministry of Health's vaccination center in Corozal. The shots cost $5. The vaccine takes 10 days to become effective and remains effective for 10 years.

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