Three Dead Kids and a Vaccine That Exists

Y mientras tanto, nacían niños cada día que no recibían sus vacunas.

And in the meantime, children were being born every day who weren't receiving their vaccines.

UNICEF put a number on that.

Around 67 million children globally missed routine vaccinations during that two-year window.

That's a generation-sized gap in coverage.

Y esos niños no desaparecieron.

And those children didn't disappear.

Siguen ahí, con edades comprendidas entre los cuatro y los seis años ahora mismo, formando una bolsa de población susceptible que es, desde el punto de vista epidemiológico, un regalo para el sarampión.

They're still there, between four and six years old right now, forming a pool of susceptible people that is, from an epidemiological standpoint, a gift to measles.

No podemos permitirnos el lujo de pensar que esto ya pasó.

We can't afford the luxury of thinking this is already behind us.

And Bangladesh got hit by something else on top of that, didn't it?

There were flooding events, the displacement from Rohingya communities.

The structural problems were compounding.

Completamente.

Completely.

Los campos de refugiados rohinyás en Cox's Bazar son uno de los entornos más difíciles del mundo para la salud pública.

The Rohingya refugee camps in Cox's Bazar are one of the most difficult environments in the world for public health.

Alta densidad, saneamiento deficiente, acceso limitado a servicios médicos y una población que, por razones completamente comprensibles dada su historia, desconfía profundamente de las autoridades gubernamentales.

High density, poor sanitation, limited access to medical services, and a population that, for completely understandable reasons given their history, deeply distrusts government authorities.

Vacunar a esa población es enormemente complicado.

Vaccinating that population is enormously complicated.

I covered displacement camps in Indonesia, in Lebanon.

And the thing that strikes you on the ground is how rational the distrust is.

These are people who have been persecuted by governments.

Why would you line up to take something a government is offering you?

Y ahí está el gran problema que los programas de salud pública no saben resolver bien: la confianza no se establece repartiendo folletos.

And there lies the great problem that public health programs don't know how to solve well: trust isn't built by handing out leaflets.

Se construye con presencia constante, con trabajadores comunitarios que hablan el mismo idioma, que conocen a las familias, que llevan años en el terreno.

It's built with constant presence, with community workers who speak the same language, who know the families, who've been on the ground for years.

Eso requiere dinero, tiempo y voluntad política sostenida.

That requires money, time, and sustained political will.

Las tres cosas que suelen faltar.

The three things that are usually missing.

Now, Bangladesh in 2026.

Let's think about the political context there too, because it matters.

The country went through significant upheaval in 2024, the fall of the Hasina government, the interim government.

That kind of political transition has consequences for every ministry, including health.

Es un punto crucial.

That's a crucial point.

Cuando cambia un gobierno de manera abrupta, los programas que dependían de relaciones institucionales específicas, de cadenas de suministro concretas, de funcionarios que conocían el sistema por dentro, de repente quedan en el aire.

When a government changes abruptly, programs that depended on specific institutional relationships, on particular supply chains, on officials who knew the system from the inside, suddenly hang in limbo.

La continuidad burocrática en salud pública no es un lujo administrativo: es literalmente una cuestión de vida o muerte.

Bureaucratic continuity in public health isn't an administrative luxury: it's literally a matter of life or death.

Let me bring in the global picture here, because Bangladesh is not alone.

The WHO put out data not long ago showing measles cases surged globally in 2023 and 2024.

Europe had outbreaks, Central Asia had outbreaks, parts of Africa.

This is a worldwide backslide.

Europa, sí.

Europe, yes.

En 2023, los casos de sarampión en Europa se multiplicaron por cuarenta y cinco respecto al año anterior.

In 2023, measles cases in Europe multiplied by forty-five compared to the previous year.

Por cuarenta y cinco.

By forty-five.

Y muchos de esos casos ocurrieron en países que se supone tienen sistemas sanitarios robustos y cobertura de vacunación alta.

And many of those cases occurred in countries that are supposed to have robust health systems and high vaccination coverage.

Rumanía, Kazajistán, Kirguistán.

Romania, Kazakhstan, Kyrgyzstan.

Pero también hubo casos en Italia, en Austria.

But there were also cases in Italy, in Austria.

That number is staggering.

Forty-five times.

And that doesn't happen in a vacuum.

There's a political force accelerating this, and I think we have to say the word out loud: anti-vaccine movements.

Hay que decirlo con claridad y sin rodeos: el movimiento antivacunas moderno se alimentó de la desinformación que creció durante el COVID, pero tiene raíces más antiguas.

It has to be said clearly and without hedging: the modern anti-vaccine movement fed off the misinformation that grew during COVID, but it has older roots.

El fraude de Wakefield en 1998 afirmaba que la vacuna triple vírica causaba autismo.

The Wakefield fraud in 1998 claimed the MMR vaccine caused autism.

Ese estudio fue retractado, el médico perdió su licencia, la ciencia lo refutó mil veces.

That study was retracted, the doctor lost his license, science refuted it a thousand times.

Y sin embargo, el daño que causó sigue matando niños en 2026.

And yet the damage it caused is still killing children in 2026.

Wakefield.

A man who fabricated data, got paid by lawyers who wanted to sue vaccine manufacturers, and then got to spend years on talk shows.

The asymmetry of damage and accountability in that story is something I find genuinely enraging.

Y lo que hace tan difícil combatir la desinformación en este campo es que opera con una asimetría comunicativa brutal.

And what makes disinformation in this field so hard to fight is that it operates with a brutal communicative asymmetry.

Un titular que dice 'vacuna causa autismo' entra directamente en el miedo parental más profundo.

A headline saying 'vaccine causes autism' goes straight to the deepest parental fear.

Un estudio de treinta páginas en The Lancet que lo desmiente no llega a esos mismos padres.

A thirty-page study in The Lancet that debunks it doesn't reach those same parents.

El miedo viaja más rápido que la evidencia, siempre.

Fear travels faster than evidence, always.

And social media industrialized that asymmetry.

What used to be pamphlets at health food stores is now algorithmic reach to millions of people in forty-eight hours.

Aunque también quiero matizar algo, porque me parece importante no simplificar demasiado.

Though I also want to nuance something, because I think it's important not to oversimplify.

En Bangladesh, el problema no es principalmente el antivacunismo ideológico al estilo occidental.

In Bangladesh, the problem isn't primarily ideological anti-vaccine sentiment in the Western sense.

El problema tiene más que ver con el acceso.

The problem has more to do with access.

Con madres que quieren vacunar a sus hijos pero que viven a horas de un centro de salud, que no tienen dinero para el transporte, que trabajan en jornadas que no les permiten ausentarse.

With mothers who want to vaccinate their children but who live hours from a health center, who don't have money for transport, who work hours that don't allow them to be absent.

La desconfianza y la pobreza se parecen mucho desde fuera.

Distrust and poverty look a lot alike from the outside.

That's a distinction worth making.

Vaccine hesitancy in a suburb of Paris is a different phenomenon than vaccine inaccessibility in a rural district in Sylhet.

Treating them as the same problem leads to the wrong solutions.

Exacto.

Exactly.

Y sin embargo, la respuesta política internacional tiende a homogeneizar.

And yet the international policy response tends to homogenize.

Se financian campañas de comunicación cuando lo que hace falta son motos para que los agentes de salud lleguen a las aldeas remotas.

Communication campaigns get funded when what's needed are motorcycles so health workers can reach remote villages.

Se invierten millones en mensajería digital dirigida a personas que no tienen acceso estable a internet.

Millions get spent on digital messaging aimed at people who don't have stable internet access.

Hay una brecha enorme entre lo que los donantes quieren financiar y lo que realmente se necesita.

There's a huge gap between what donors want to fund and what's actually needed.

Let me ask you something that's been nagging at me.

The WHO has had measles elimination targets for years and kept pushing them back.

At what point does that become a credibility problem?

Ya es un problema de credibilidad.

It already is a credibility problem.

El objetivo original era eliminar el sarampión en cinco de las seis regiones de la OMS para 2020.

The original goal was to eliminate measles in five of the WHO's six regions by 2020.

Luego se aplazó a 2030.

Then it was pushed to 2030.

Yo apostaría a que también se aplazará.

I'd wager it'll be pushed again.

Y el peligro de aplazar repetidamente es que las instituciones empiezan a ser percibidas como organismos que producen metas en lugar de resultados.

And the danger of repeatedly delaying is that institutions start to be perceived as bodies that produce targets instead of results.

Eso erosiona la confianza, y la confianza, como ya hemos dicho, es el recurso más escaso en salud pública.

That erodes trust, and trust, as we've already said, is the scarcest resource in public health.

And the children who die in the gap between the target and the reality don't get mentioned at the press conference where the new target is announced.

No.

No.

Nunca.

Never.

Lo cual nos lleva a una pregunta más incómoda aún: ¿qué pasaría si el mundo gastara en vacunación infantil de base una fracción de lo que gastó en desarrollar vacunas de COVID en tiempo récord?

Which brings us to an even more uncomfortable question: what would happen if the world spent on basic childhood vaccination a fraction of what it spent developing COVID vaccines in record time?

No es una pregunta retórica.

That's not a rhetorical question.

Es una pregunta sobre prioridades políticas y económicas disfrazada de pregunta técnica.

It's a question about political and economic priorities disguised as a technical question.

The COVID vaccine development was extraordinary.

Genuinely extraordinary.

But it also showed that when rich countries feel threatened, the money and the political will appear almost instantly.

And measles has never threatened a hedge fund manager in Connecticut.

Eso es decirlo de una manera muy directa, pero no es inexacto.

That's a very blunt way of putting it, but it's not inaccurate.

Hay una arquitectura de la atención global que favorece a las enfermedades que cruzan fronteras en avión de clase business y desfavorece a las que se quedan en los márgenes.

There's an architecture of global attention that favors diseases that cross borders in business class and disfavors those that stay on the margins.

El sarampión mata principalmente a menores de cinco años en países de ingresos bajos y medios.

Measles kills primarily children under five in low and middle-income countries.

Eso lo hace invisible a efectos prácticos para los que toman decisiones presupuestarias en Ginebra o en Washington.

That makes it practically invisible to those making budgetary decisions in Geneva or Washington.

Three children.

In a single day.

And we know their names exist, even if we don't know their names.

That's what the number means.

Y no son estadísticas abstractas para sus familias.

And they're not abstract statistics to their families.

Aunque para el resto del mundo lo sean.

Even though they are to the rest of the world.

Eso es el verdadero fracaso: no que la medicina no tenga solución, sino que la solución existe y el mundo ha decidido, de manera implícita pero muy real, que no vale la pena el esfuerzo de aplicarla de manera consistente.

That's the real failure: not that medicine has no solution, but that the solution exists and the world has decided, implicitly but very really, that it's not worth the effort to apply it consistently.

Let me ask a harder question.

Is there any version of this that gets better?

Or are we just going to be having this conversation again in five years?

Podría mejorar.

It could improve.

Las herramientas existen: vacunas de dos dosis baratas y eficaces, trabajadores comunitarios de salud bien formados y bien pagados, cadenas de frío que funcionen, sistemas de vigilancia epidemiológica que detecten brotes antes de que se desborden.

The tools exist: cheap and effective two-dose vaccines, well-trained and well-paid community health workers, functioning cold chains, epidemiological surveillance systems that detect outbreaks before they spiral.

Nada de eso es tecnológicamente complicado.

None of that is technologically complicated.

Lo que es complicado es sostenerlo políticamente durante décadas sin que el interés decaiga.

What's complicated is sustaining it politically for decades without interest fading.

And therein lies the whole thing.

The boring, incremental, unglamorous work of maintaining systems.

It doesn't generate headlines.

It doesn't win elections.

Exactamente.

Exactly.

Y fíjate en la paradoja: cuando los sistemas funcionan bien, el sarampión desaparece, nadie lo ve, nadie se preocupa por él, y los políticos recortan los presupuestos de salud pública porque 'no hay ninguna crisis'.

And notice the paradox: when systems work well, measles disappears, no one sees it, no one worries about it, and politicians cut public health budgets because 'there's no crisis'.

Hasta que la hay.

Until there is one.

Before we wrap, something you said earlier caught my ear.

You used the phrase 'no podemos permitirnos el lujo.' I know 'lujo' is luxury, but it felt like it carried more weight than just that.

Sí, es una construcción interesante.

Yes, it's an interesting construction.

'Permitirse el lujo de' significa literalmente 'permitirse el lujo de' hacer algo, pero en español se usa con mucha frecuencia de manera irónica o negativa.

'Permitirse el lujo de' literally means 'to allow oneself the luxury of' doing something, but in Spanish it's used very frequently in an ironic or negative way.

'No nos podemos permitir el lujo de esperar' no es que esperar sea un placer lujoso, sino que esperar tiene un coste que no podemos asumir.

'We can't afford the luxury of waiting' doesn't mean waiting is a lavish pleasure, but rather that waiting has a cost we can't bear.

So it works like the English 'we can't afford to.' Same structure, same ironic edge when you put 'luxury' in there.

Casi idéntico, sí.

Almost identical, yes.

Y lo interesante es que en español suena muy natural, no pretencioso en absoluto.

And what's interesting is that in Spanish it sounds completely natural, not pretentious at all.

'No me puedo permitir el lujo de equivocarme ahora mismo' es algo que diría cualquier persona en una conversación normal, no solo un personaje de novela del siglo XIX.

'I can't afford the luxury of making a mistake right now' is something anyone would say in a normal conversation, not just a character from a nineteenth-century novel.

I'm filing that one away.

Three children died of a preventable disease yesterday, and somehow I end the episode having learned a Spanish idiom.

There's something very Twilingua about that.

Así es como funciona, Fletcher.

That's how it works, Fletcher.

El mundo te da la noticia y el idioma te da las herramientas para entenderla.

The world gives you the news and the language gives you the tools to understand it.

Hasta la próxima.

Until next time.