Last update - 00:00 08/02/2008
Flawed school vaccine plan feared unable to stem outbreaks
By Ran Reznick, Haaretz Correspondent
The shortcomings of the school vaccination program could lead to new outbreaks of contagious diseases like those recently of whooping cough and measles, senior doctors who asked not to to be named told Haaretz.
Curtailed vaccinations in schools, and the failures in administering the shots, have exposed children to the threat of these diseases, say the doctors and Health Ministry reports.
A Health Ministry spokesman said the government's outsourcing of the inoculation service in schools to a private company has led to a reduction in vaccinations. By the end of this school year the number of vaccinations will return to its former level, he said.
Children's inoculations against severe contagious diseases are considered a cornerstone of public health and help prove that a country has an advanced health system.
According to Health Ministry figures, vaccinations in schools have dropped consistently in the past four years. In 2004, 96 percent of second grade pupils were inoculated compared with 74 percent in 2007.
In addition, the number of parents who refuse to inoculate their children has risen. Most of these parents are ultra-Orthodox people who refuse inoculation for religious reasons or because they refuse to cooperate with the state. Some of them fear that the inoculation involves risks.
Senior health officials blame the slashing of public health budgets in recent years for the deterioration. The cuts are reflected in a lower number of school nurses who administer the inoculations. At the same time, the Health Ministry privatized the school health services and transferred them to the Public Health Association.
Health Ministry figures show that in 2007, 2,616 children contracted whooping cough compared with hundreds of cases in every previous year and 429 cases of measles compared with a handful of cases in previous years.
The doctors also warn that children's health is being neglected, especially in the poor neighborhoods and periphery of the country.
Health Ministry surveys conducted in dozens of schools nationwide state that "the inoculation process is defective in all its stages, including deficiencies in injecting [the vaccine]."
Some of the vaccines in the schools are administered by nurses who have no training in schoolchildren's health and in performing resuscitation, the ministry's internal reports say.
The reports find that used syringes and needles are not handled safely and vaccinations are not always administered in clean and sterile conditions.
The reports also find that mistakes have been made in identifying the children who are to be vaccinated and that mistakes in giving the vaccinations have been covered up and concealed from the parents. In some cases the vaccinations have been administered by nurses who said they were subjected to an "intolerable work load," as their private employer pressured them to complete vaccination quotas regardless of the treatment's quality.
The doctors say some of the system's malfunctions led to this week's incident at Givatayim's Borochov elementary school, where two registered nurses erroneously injected 70 pupils with sterile water instead of a vaccination for measles, rubella and mumps. The nurses continued to administer the shots even when they noticed that the pupils were crying excessively. The mistake was discovered later at the Public Association's logistic center in Tel Aviv, after the injecting process had been completed.
Haaretz has learned that in recent months senior Health Ministry officials have warned about the schools' inoculation system and of the severe risks in privatizing such a basic medical service. The doctors said the Health Ministry had failed to supervise the inoculation system.
"It is hard to obtain an orderly work plan from the Public Health Association," wrote Dr. Itamar Grotto, National Director of Public Health, to Health Ministry director general Avi Yisraeli. Grotto is responsible for all the pupils' health services in Israel.
"We have no information about the extent of inoculations in schools," Dr. Shimon Sharf, director of the Health Ministry's Ashkelon district, warned Yisraeli in December. He said the private association was not cooperating with him to enable the supervision of administering vaccines.
In November and last month a senior nurse in the Health Ministry's central district, Miriam Payis, warned that the deficiencies in administering the vaccines "indicate crossing a red line both professionally and ethically."
Yael Arbeli, a supervising nurse in the Ashkelon district, warned in November that the report on the inoculations' side effects among schoolchildren were "extremely deficient" and that the nurses are receiving "unprofessional advice." She said much of the the vaccination process in the schools was kept secret.
Only eight nurses are supervising the privatized inoculations this school year, although the Health Ministry warned in April last year that supervising the inoculations with so few nurses was "an impossible mission."