Associated Press - December 11, 2008
Maria Cheng

Research in the medical journal, The Lancet, said only half as many children were vaccinated than was claimed by countries taking part in special programs meant to reach kids in poor nations. The study, which was paid for by the Bill & Melinda Gates Foundation, raises serious issues about vaccination programs - and whether money earmarked for children is actually reaching their intended recipients.

"With the unprecedented billions given by the international community, there is no excuse for these poor coverage rates," said Philip Stevens, of the International Policy Network, a London-based think-tank. "One has to wonder where the money has gone - hopefully not into Swiss bank accounts."

American researchers analyzed records of children supposedly vaccinated by initiatives led by the United Nations and related groups like the Global Alliance for Vaccines and Immunization, or GAVI.

The scientists examined reports the countries gave to the United Nations on how many children were immunized. They then compared those figures to independent surveys on vaccination conducted by non-governmental groups and other outside researchers.

The report did not focus on the tens of millions of children immunized globally each year. Instead, the researchers studied programs meant to increase the availability of vaccinations in poorer countries - vaccinations designed to reach kids who would not be covered otherwise.

From 1986 to 2006, the United Nations reported that 14 million children received immunizations in the programs. But the reports from the independent surveys put that number at just over 7 million.

"The magnitude of the gap is surprising," said Christopher Murray, director of the Institute for Health Metrics at the University of Washington and the study's lead author.

Murray and colleagues found about half of 51 countries taking part in the U.N.-backed programs over-reported how many children were protected against diphtheria, tetanus and whooping cough.

Experts suggest that inflating the numbers is part of a larger problem in attracting limited resources.

"That's how you get money," said Ken Hill, a public health professor at Harvard University who was not linked to the study. "You exaggerate the number of people who die or who you save to get visibility. Somehow, numbers always end up bigger than they would be otherwise."

The global alliance pays developing countries $20 per extra vaccinated child - a payment that relies exclusively on reports from the countries.

Murray and colleagues estimated that the alliance should have paid countries $150 million. Instead, it paid them $290 million.

Some countries, including Liberia, Pakistan and Zambia, reported vaccination numbers more than four times higher than surveys showed.

Experts said the study raised questions about the credibility of other health data from the United Nations and countries.

Julian Lob-Levyt, the chief executive officer of the global vaccines alliance, said it would hold off on all payments until affected countries can clarify what is happening in their programs.

He also stressed that there was no evidence of corruption in any of the countries that had received money from the alliance.

Some experts worry that the Lancet study overstated the problem and that immunization programs would be unfairly overhauled.

The United Nations has been criticized for its fluctuating figures in the past. In 2007, it dramatically slashed its HIV figures, citing new surveillance methods.

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