GENETICA Y CIENCIA. The Dangerous Anti-Vaccine Rhetoric and Its Potential Impact on Countries with Weak Economies and Deficient Public Health Systems

César Paz-y-Miño. MD, Medical Geneticist and Master in Biology of Infectious Diseases. Universidad UTE.

A Political Decision Disguised as Public Health

The U.S. health administration has decided to significantly reduce the childhood vaccination schedule, eliminating the universal recommendation for hepatitis A and B, meningococcal disease, rotavirus, influenza, and COVID-19. This decision, presented as an “alignment with international consensus” based on the Danish model, represents one of the most dangerous setbacks in public health of the 21st century, not because of its domestic impact (which will be considerable), but because of the catastrophic influences it will export to weak economies and to countries such as Ecuador and others in the Global South.

The Comparison That Must Not Be Made: The Epidemiological Fallacy of “Copy-Paste”

The central argument of the new policy, that Denmark recommends fewer vaccines and maintains good health, is a scientific fallacy of historic proportions. Comparing health systems without considering social and structural determinants is like comparing the cold resistance of a polar bear with that of a Galápagos iguana simply because both are animals.

Denmark has 100% universal health coverage with immediate access to specialized care, real-time epidemiological surveillance systems, child malnutrition rates below 2%, basic sanitation coverage reaching 99% of the population, and a population density of 147 inhabitants/km², compared to Ecuador’s 71, though concentrated in urban areas with infrastructure, unlike rural zones.

Ecuador, meanwhile, reaches, at best, 82% coverage, with deep territorial disparities, 23% chronic child malnutrition rising to 45% in Indigenous communities, 65% of health centers lacking molecular diagnostic capacity, and 1.8 pediatric ICU beds per 100,000 children (half the recommended minimum).

What is reckless is ignoring that Denmark can afford certain flexibilities precisely because its population does not suffer the social determinants that multiply the lethality of infectious diseases. A case of hepatitis A in Copenhagen is detected within hours and efficiently isolated; in Morona Santiago, it could spread for weeks before being identified as an outbreak—or even within urban areas.

Imported Risk Calculation in Low Vaccination Coverage Scenarios

Mathematics does not lie, and epidemiological equations are particularly ruthless toward poor countries. Take the example of rotavirus: in the United States, under this decision, modeling based on pre-vaccination data estimates between 55,000 and 70,000 additional pediatric hospitalizations annually and 20 to 40 preventable child deaths each year.

But the truly sinister calculation occurs in the transfer of international risk. Using a simplified formula, Ecuador’s risk equals endemic risk plus imported cases locally over-amplified, combined with population vaccination coverage, population density, poor sanitation, and malnutrition, among other factors, models indicate a factor approximately 3.7 times higher than that of the U.S. This means that for every 100 cases the United States “saves” by cutting vaccination, Ecuador could import 10 to 15 cases, which would amplify to 37 to 55 secondary cases due to structural conditions.

The Three-Level Damage Mechanism

Level 1: Legitimation of Pseudoscience. When a hegemonic country adopts policies based on scientific denialism, questioned by PAHO, it grants global authority to local anti-vaccine movements. In Ecuador, where groups already question vaccination, this decision will become the main argument: “Even the United States does it.”

Level 2: Market and Price Collapse. Vaccines are produced according to global demand. A 30% reduction in U.S. demand (approximately 15 million doses annually of the now-optional vaccines) will trigger a 15–25% price increase for low-income countries, disincentivize research into new formulations, and possibly lead to shortages of combined vaccines.

Level 3: Saturation of Fragile Systems. Ecuador’s health system, with 2.1 pediatric ICU beds per 100,000 children, would be overwhelmed by a moderate meningococcal meningitis outbreak. A conservative estimate shows that of 200 imported/international cases annually, 20% would require ICU care, 40 beds. Ecuador has approximately 320 pediatric ICU beds nationwide, meaning 12.5% of national capacity would be consumed by a disease preventable with a simple vaccine.

The Paradox of Medical Autonomy

The policy is marketed as “respect for family autonomy” but ignores the autonomy of sovereign nations to protect their citizens. Ecuador, which reduced infant mortality from 25 to 13 per 1,000 live births between 2000 and 2020 (partly thanks to expanded vaccination), will see decades of progress placed at risk by a foreign decision, if it is mistakenly taken into account.

The true health dependency of the 21st century does not arrive through wars or conquests, but through regressive policies questioned by WHO/PAHO that export epidemiological risk to those least able to confront it.

Herd Immunity vs. Collective Egoism

Herd immunity is a fragile global public good. Vaccines operate on a principle of biological solidarity: I protect the vulnerable by protecting myself; the vaccinated protect the unvaccinated (herd effect). The U.S. decision represents the replacement of this principle with collective egoism: “my individual autonomy is worth more than your collective safety”, a libertarian argument in disguise.

For Ecuador and similar countries in the Global South, the response must be forceful: internal scientific strengthening to base vaccination schedules on local technical committees immune to international political trends; preparation for collateral damage through contingency plans for hepatitis, meningitis, and rotavirus outbreaks, including simulations that incorporate the factor of “imported cases from countries with regressive policies”; aggressive health diplomacy in international forums demanding that decisions by large, economically powerful countries consider their negative externalities, similar to environmental agreements on toxic emissions and transboundary pollution.

Additionally, there must be legal shielding of the national vaccination schedule against external pressures; prioritized investment in molecular epidemiological surveillance; active scientific communication against disinformation; Andean and Latin American regional coordination on immunization; and defense of health as a global public good.

History will judge this decision not by its declared intentions, but by its measurable consequences: children dying from imported meningitis, impoverished and already discriminated families witnessing the resurgence of hepatitis, and health systems collapsing under the weight of diseases that humanity collectively decided no longer deserved to exist.

The final fallacy is not only comparing countries without context, but believing that in an interconnected world, the health of a child in Quito is less valuable than the autonomy of one in Kentucky. Epidemiology, at least, does not make such distinctions: the virus only sees opportunities, and regressive policies are offering them on a silver platter.

La versión en español esta en EDICIÓN MÉDICA EC.