Number of Children Immunized Has Been Inflated for Years

A boy gets a tetanus shot from a medic at a relief camp at Nagore, in the southern Indian state of Tamil Nadu.
A boy gets a tetanus shot from a medic at a relief camp at Nagore, in the southern Indian state of Tamil Nadu. (By Gurinder Osan -- Associated Press)
By David Brown
Washington Post Staff Writer
Friday, December 12, 2008

Many of the world's poorest countries have for decades routinely exaggerated the number of children being immunized against disease, apparently driven by political pressure and, more recently, financial incentives.

That is the finding of a huge analysis that has provoked heated discussion even before its publication in the Lancet, a European medical journal.

Since 1986, progress in childhood immunization in the developing world has been about half that officially reported by governments in the developing world. Not only are year-to-year improvements overstated, but the total percentage of children immunized is far lower than publicly acknowledged, the study found.

The two-decade trend masks extreme variations, with some countries overstating their gains four- and fivefold, and a few countries understating them.

The analysis -- which compares official immunization coverage with what was found in house-to-house surveys -- casts a shadow on the emerging strategy of "pay for performance" in global health assistance.

Specifically, it suggests that the pioneering Global Alliance for Vaccines and Immunizations (GAVI) may have paid out twice as much in performance rewards as it should have: $290 million instead of $150 million.

Of 51 countries that have received reward payments since 1999, six overestimated their immunization gains by a factor of four, 10 overestimated them by a factor of two, and 23 by less than two. Eight underestimated their progress.

GAVI has suspended reward payments to all countries, pending further review.

"By early next year, we will modify, drastically change, or possibly put in place a new system of incentive performance," Julian Lob-Levyt, the executive director, said yesterday from London after a two-day meeting with GAVI's partners to discuss the findings.

He noted that there was no suggestion any money has been diverted for personal gain.

GAVI was started with a $750 million "seed grant" from the Bill and Melinda Gates Foundation. Ironically, the new analysis, done by a group of researchers at the University of Washington led by Christopher J.L. Murray, was also funded by the Gates Foundation.

The study is an example of how health statistics can vary depending on their source -- and possibly also with the interests of the people generating them.

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