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  1. David Brown
  2. Service delivery
  3. Tuesday, 08 January 2019

Recent reports [1] of counterfeit yellow fever vaccination certificates in Zambia follow reports of falsified proof of vaccination documents being used in other countries, including Ethiopia [2], India [3], Nigeria [4], Pakistan [5], Sudan [6], Uganda [7], Tanzania [8] and Zimbabwe [9]. While the World Health Organization (WHO) published guidelines in 1999 [10] to support countries in developing measures to combat counterfeit pharmaceutical products and issued a report in 2017 [11] highlighting the public health and socioeconomic impacts of falsified medical products, neither publication discussed the current problem of false or fraudulently obtained proof of vaccination documentation. Counterfeit proof of vaccination in home-based records (HBRs), particularly those issued to provide documented proof of vaccination against yellow fever virus or polio virus [12], presents a threat to the health and security of countries and their citizens and warrants further discussion and action.

Given the imperative of preventing the spread of vaccine-preventable diseases at a time when increased air travel and globalization link communities worldwide as never before [13], efforts seem warranted to (1) understand the magnitude and impact of counterfeit proof of vaccination and (2) work with national health authorities to develop practical counterfeit-deterrent strategies as part of the Eliminate Yellow fever Epidemics (EYE) global strategy (2017–2026) [14] as well as ongoing WHO activity around protection of essential medicines and health products [15]. Efforts to combat counterfeiting are also timely and urgent as part of the Global Health Security Agenda [16] as the likelihood of deadly, cross-border epidemics increases [17] and as countries continue to require international travelers to provide proof of vaccination as a prerequisite for entry (or exit) as part of international health regulations recommended by WHO [18]. This directive combined with improved enforcement at ports of entry into a country and a global yellow fever vaccine shortage [19] could further drive the demand for counterfeit vaccination documents.

As providing proof of vaccination for travelers is one of several important HBR functions [20], HBRs deserve particular attention. For many travelers, proof of vaccination status is provided through a duly completed version of the International Certificate of Vaccination or Other Prophylaxis [18] recommended by the World Health Organization. In June 2007, a revised international certificate of vaccination was adopted following the 2005 revision of the International Health Regulations [21]. The revised certificate replaced the International Certificate of Vaccination or Revaccination Against Yellow Fever but did not include any anti-counterfeit guidelines or recommendations.

The prevalence and impact of counterfeit medical products highlighted in the 2017 WHO report [11] point to a very real public health problem: a counterfeit problem that is not limited to medicines [22]. In Nigeria counterfeit proof of yellow fever vaccination records have been noted since at least 2012 when travelers from the country holding alleged counterfeit documents were denied entry by officials on arrival in Ghana [23] and South Africa [24]. As a result, the Federal Ministry of Health has attempted to curb the problem by issuing documents that included additional security features; however, a November 2018 report from Lagos airport highlights opportunities for further improvement as the problem of counterfeit documentation may continue [25].

It is far too easy to dismiss HBR counterfeit incidents as a trivial matter. Such incidents are anything but trivial. More must be done to investigate HBR counterfeiting incidents with local authorities. Additionally, we must leverage existing knowledge and explore novel approaches to combat counterfeit proof of vaccination while also exploring design-related solutions to better ensure the integrity of HBRs. The risks of spread of vaccine-preventable diseases by international travelers is a public health concern [26], placing increased importance on safeguarding HBRs as a verified source of travelers’ vaccination status.

 

Acknowledgement

The author acknowledges the editorial support of Ms Stacy Young of Applied Scientific Consulting in preparing this work.

 

References

1. “Fake Health Certificates Scam Exposed.” Zambia Daily Mail Limited. 29 December 2018. Available online at: http://www.daily-mail.co.zm/fake-health-certificates-scam-exposed/. Accessed 4 January 2019.

2. “Ethiopia to Launch Massive Yellow Fever Vaccination.” Ethio Dailypost. 26 June 2018. Available online at: http://ethiodailypost.com/2018/06/26/ethiopia-to-launch-massive-yellow-fever-vaccination. Accessed 4 January 2019.

3. “Fake Yellow Fever Vaccine Certificates Pose Risk to Whole Indian Population.” RESET. 19 Jul 2013. Available online at: https://reset.org/node/24435. Accessed 4 January 2019.

4. “Ghana denies Nigerians entry over yellow fever card.” Daily Post. 25 July 2012. Available online at: http://dailypost.ng/2012/07/25/ghana-denies-nigerians-entry-yellow-fever-card/. Accessed 4 January 2019.

5. “India warns against ‘fake polio certificates’.” DAWN. 9 October 2014. Available online at: https://www.dawn.com/news/1136759. Accessed 4 January 2019.

6. “Sudan’s Vaccination Card Black Market.” The Daily Beast. 31 August 2015. Available online at: https://www.thedailybeast.com/sudans-vaccination-card-black-market. Accessed 4 January 2019.

7. “Travellers Resort to Fake Yellow Fever Cards.” TravelSafe Clinic. 28 October 2016. Available online at: http://travelsafeclinic.com/travellers-resort-to-fake-yellow-fever-cards-uganda/. Accessed 4 January 2019.

8. “Seven in Trouble Over Fake Vaccination Cards.” Daily News. 28 January 2017. Available online at: https://www.dailynews.co.tz/news/seven-in-trouble-over-fake-vaccination-cards.aspx. Accessed 4 January 2019.

9. “Fake vaccination certs sold.” The Zimbabwean. 9 January 2013. Available online at: http://www.thezimbabwean.co/2013/01/fake-vaccination-certs-sold/. Accessed 4 January 2019.

10. World Health Organization. Counterfeit Drugs. Guidelines for the development of measures to combat counterfeit drugs. Geneva: World Health Organization, 1999. Available online at: http://apps.who.int/medicinedocs/en/d/Jh1456e/. Accessed 4 January 2019.

11. World Health Organization. A study on the public health and socioeconomic impact of substandard and falsified medical products. Geneva: World Health Organization; 2017. License: CC BY-NC-SA 3.0 IGO. Available online at: https://www.who.int/medicines/regulation/ssffc/publications/se-study-sf/en/. Accessed 4 January 2019.

12. Soghaier MA, Saeed KMI, Zaman KK. Public Health Emergency of International Concern (PHEIC) has Declared Twice in 2014; Polio and Ebola at the Top. AIMS Public Health. 2015;2(2):218-222. doi: 10.3934/publichealth.2015.2.218.

13. Brent SE, Watts A, Cetron M, German M, Kraemer MU, Bogoch II, Brady OJ, Hay SI, Creatore MI, Khan K. International travel between global urban centres vulnerable to yellow fever transmission. Bull World Health Organ. 2018;96(5):343-354B. doi: 10.2471/BLT.17.205658.

14. World Health Organization. Eliminate Yellow fever Epidemics (EYE): a global strategy, 2017–2026. Wkly Epidemiol Rec. 2017;92(16):193-204.

15. World Health Organization. Essential medicines and health products. Available online at: https://www.who.int/medicines/about/en/. Accessed 4 January 2019.

16. Katz R, Sorrell EM, Kornblet SA, Fischer JE. Global health security agenda and the international health regulations: moving forward. Biosecur Bioterror. 2014;12(5):231-8. doi: 10.1089/bsp.2014.0038.

17. Suk JE, Van Cangh T, Beauté J, Bartels C, Tsolova S, Pharris A, Ciotti M, Semenza JC. The interconnected and cross-border nature of risks posed by infectious diseases. Glob Health Action. 2014;7:25287. doi: 10.3402/gha.v7.25287.

18. World Health Organization. International Health Regulations (2005). Third Edition. Geneva: World Health Organization, 2005. Available online at: https://www.who.int/ith/en/. Accessed 4 January 2019.

19. “What is behind the global shortage in yellow fever vaccine?” VOA News. 5 May 2016. Available online at: https://www.voanews.com/a/what-is-behind-the-global-shortage-in-yellow-fever-vaccine/3316820.html. Accessed 4 January 2019.

20. World Health Organization. Practical Guide for the Design, Use and Promotion of Home-based Records in Immunization Programmes. Geneva: World Health Organization, 2015. Available online at: https://www.who.int/immunization/monitoring_surveillance/routine/homebasedrecords/en/. Accessed 4 January 2019.

21. Gostin LO, DeBartolo MC, Friedman EA. The International Health Regulations 10 years on: the governing framework for global health security. Lancet. 2015;386(10009):2222-6.

22. Hamisu Hassan, Kate Kolaczinski, and Angela Acosta. Preventing, identifying, and mitigating the impact of fraud, theft, and diversion of insecticide treated nets: A summary of experience and best practices from country programs. VectorWorks Project, Johns Hopkins University-Center for Communication Programs (JHU-CCP), and Tropical Health LLP. 2016. Available online at: https://www.continuousdistribution.org/wp-content/uploads/2017/05/Preventing-Identifying-and-Mitigating-the-Impact-of-Fraud-Theft_mi.pdf. Accessed 4 January 2019.

23. “Ghana denies Nigerians entry over yellow fever card.” Daily Post. 25 July 2012. Available online at: http://dailypost.ng/2012/07/25/ghana-denies-nigerians-entry-yellow-fever-card/. Accessed 4 January 2019.

24. “On Yellow Fever, Yellow Cards, Nigeria And South Africa.” Nigeria Health Watch. 6 March 2012. Available online at: https://nigeriahealthwatch.com/on-yellow-fever-yellow-cards-nigeria-and-south-africa/#.XDUAU1xKg2w. Accessed 4 January 2019.

25. “Investigation: Inside Nigerian airport where cleaners, touts issue fake yellow cards to travelers.” Premium Times. 10 November 2018. Available online at: https://www.premiumtimesng.com/news/headlines/294967-investigation-inside-nigerian-airport-where-cleaners-touts-issue-fake-yellow-cards-to-travelers-2.html. Accessed 4 January 2019.

26. Gautret P, Botelho-Nevers E, Brouqui P, Parola P. The spread of vaccine-preventable diseases by international travellers: a public-health concern. Clin Microbiol Infect. 2012;18 Suppl 5:77-84. doi: 10.1111/j.1469-0691.2012.03940.x.

David Brown Accepted Answer

Yes, there almost certainly are other systems issues, like border agent compliance, that have to be considered. Counterfeit documentation is just one part of the problem. I know that in my own travels across Africa and Asia, routine checks of proof of vaccination at ports of entry are often nothing more than political theatre when such checks even occur. 

  1. more than a month ago
  2. Service delivery
  3. # 1

Hi David,

this is an amazing entry! I had never thought on this issue to this extent, despite having my yellow card certificate with me and travelling to places where I need it. It is indeed a version of the HBR! Having read your entry I feel that this has to be taken really seriously. I can see the risk of disease reintroduction and I could imagine that the human and economic costs of reintroducing a disease in a geographical area would totally justify measures to minimise the risk of falsification.

Besides this, there are some other issues, such as the compliance of border agents in inspecting HBR on arrival. I have witnessed myself many times people voluntarily or involuntarily escaping this control.

Thanks again for this contribution.

Xavier

  1. more than a month ago
  2. Service delivery
  3. # 2


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