MONTERREY, MEXICO – If parents here are late getting their child
inoculated, a public-health nurse will come to their home, pull down the
youngster's pants and give the vaccination right there in the living
room.
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If the parents are away at work, the nurse does not wait for them to
come home and give permission. Shots are given anyway, and the paperwork
is left with the baby sitter.
In Monterrey, like Houston, an industrial city of more than a million
with large pockets of underclass, the government divides its poor
neighborhoods into sections of about four square blocks each, then puts
a nurse in charge of supervising parents in each area to ensure all of
the children are vaccinated on time.
It is a paternalistic approach almost impossible to imagine in the
United States - where privacy rights and other freedoms are highly
valued and immunizations are increasingly feared - but it has proved
remarkably effective: Mexico has a 96 percent vaccination rate for
children ages 1 to 4, compared with an immunization rate of 79 percent
for 2-year-olds in the United States.
The disparity is even greater between Monterrey and Houston, which
has one of the most stubbornly low vaccination rates in the United
States. In Monterrey, 98 percent of the children ages 1 to 4 are fully
immunized, a higher percentage than reached by any U.S. city. In
Houston, barely 71 percent of 2-year-olds are caught up on their shots.
Mexico's immunization success is something Americans - particularly
Texans - can cheer. Epidemics of preventable disease used to go back and
forth between the two countries. That no longer happens, thanks mostly
to the remarkable but unheralded improvements in Mexico and other
countries in the region.
"One of the main reasons there is no longer measles in the United
States is because we no longer have measles in Latin America and the
Caribbean," said Dr. Ciro de Quadros, the recently retired director of
immunizations for the Pan American Health Organization. Mexico, he said,
has done a "remarkable" job of vaccinating its children in the past
decade.
Conventional wisdom says it is harder to develop a public-health
system in a poor country. But Quadros notes that a wealthy country like
the United States has problems of its own.
"In the United States, there are so many obstacles to vaccinations,"
said Quadros, a native of Brazil. "People have so many forms to fill
out, and there are so many more lobbies - anti-vaccine, anti-technology,
anti-everything."
The differences in culture and outlook between Mexico and the United
States make it difficult to compare the two systems of administering
vaccinations. But there are similarities, particularly between two
cities that share so much trade and human traffic.
Both Houston and Monterrey suffered from a terrible resurgence of
measles more than a decade ago, and leaders in both places promised to
respond by bolstering vaccine programs to ensure such an epidemic never
happened again. The goal - on both sides of the border - was a 100
percent vaccination rate.
But while Monterrey and Mexico as a whole have come close to keeping
that promise, the improvement in Houston's vaccination program has not
been so great. Vaccinations are clearly up from the winter of 1988-89,
when 10 children died from measles in Houston and organizers of the
Houston Livestock Show and Rodeo distributed letters warning that
participants may have been exposed to the disease and risked taking it
to other parts of the country.
Public and private groups responded by forming a number of programs,
such as mobile health clinics, which are designed to better reach the
most needy areas of Houston. But Houston still has no coordinated
vaccine registry, which officials say is necessary to reach the people
effectively.
And the effectiveness of the patchwork services now offered by so
many different organizations is hampered by a lack of any central vision
for running an immunization program, critics say.
"There's no real local leadership on the immunization issue," said
Barbara Best, with the Children's Defense Fund.
While no one predicts another measles resurgence, officials in
Houston and the rest of Texas have already started to worry about a
return of pertussis, also known as whooping cough.
Mexico, by contrast, has a sharply focused vision. After the measles
pandemic reached Mexico in 1990 and killed 5,899 babies, the Mexican
government established a central authority to oversee the national
vaccination campaign, known as the National Immunization Program.
Immunization campaigns are run three times a year, done with great
fanfare. In addition, uniformed brigades of nurses keep careful watch
over vaccination rates, neighborhood by neighborhood.
U.S. health officials, who have seen the unsparing force of a Mexican
immunization campaign, tend to remember it with both awe and dread.
The public-health nurses of Monterrey begin tracking babies before
they are born.
The nurse in charge of immunizations in a particular neighborhood
keeps a census of the area, including maps detailing where women of
child-bearing age live.
Babies are given their first immunizations - against polio and
tuberculosis - in the hospital right after birth. They also receive a
government-issued National Vaccination Record, on which the vaccines
they receive throughout their lives will be tallied. The vaccine record
must be presented in order to enter school, to get passports or other
identification papers and even to get some jobs and loans. Losing the
record is not usually a problem, because the same information is
recorded with the federal government and can be replaced.
