SCANDAL OVER THE "VACCINATION CAMPAIGNS" UNDERTAKEN BY CODEVI CORPORATION IN MARCH & APRIL 2004 IN THE OUANAMINTHE FREE TRADE ZONE

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A-INTRODUCTION
B-CONTEXT
C- PROCEDURE
D-THE SITUATION

• In the Free Trade Zone
  
• The Facts
  
  

F- RECOMMENDATIONS

G-CONCLUSION

H-ANNEX: CASE STUDIES

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PURPOSE OF THE INVESTIGATION

Warned by Batay Ouvriyé and other members of the population, the UMHA (Union des Médecins Haïtiens) decided to investigate about the vaccination program undertaken by the "Clinica CODEVI" and its consequences on the health condition of workers at the Ouanaminthe Free Trade Zone, on the border between Haiti and the Dominican Republic. After this program workers claimed to suffer from disrupted menstruation, sexual disturbances, risk of abortion and even abortion. Many of them believe the tetanus vaccination was a cover-up for a sterilization program.

IIn order to shed some light on this peculiar situation the UMHA set up a commission whose members were:

• Dr Iresmick SAMPEUR Obstetrician / Gynaecologist
  
• Dr Cherro GERMEIL Intern
  
• Dr Armel DEMORCY Surgeon / Legal Examiner (Coroner)
  
  
  

CONTEXT

The commission arrived in Ouanaminthe, in the North-East District, during a crisis in the area brought on by the establishment of the CODEVI Free Trade Zone, enabled by an agreement involving the governments of Haiti and the Dominican Republic.

The CODEVI Free Trade Zone consists of a textile assembly industry set up by the group M (in Dominican: "Grupo M"), a Dominican consortium, using funds created by the conversion of both countries' debt to bilateral creditors (particularly the U.S.).

According to this agreement, this business should be the first of a series of free trade zones all along the border. The inauguration of the works on April the 2nd, 2002, met – and still meets – with considerable protest from politicians and civil society organizations. They contest it as a breach in territorial integrity, decided by the Lavalas administration without any previous consultation.

Another issue was the construction of the free trade zone on fertile land.

This crisis, based on political and patriotic concerns, gathered momentum as the system's first signs of malfunction appeared: wages disputes opposing management to trade union.

IIndeed what were first individual and isolated claims took on a more organized form after the creation of the first Union in the Codevi Free Trade Zone in February 2004.

Relations between the Codevi management and the workers rapidly got worse, especially after mass firings aimed particularly at union members, followed by the brutal and humiliating intervention of Dominican soldiers – on Haitian territory – and then the "rebel army", "l'Armée Rebelle".

IIt was during this period that the management decided to go ahead with the first vaccination campaign.

Our commission therefore, had to carry out the investigation within an atmosphere of distrust: on the one side workers were constantly threatened of being fired if they joined the union, on the other side Codevi managers were eager to give visitors a good and fair image of the firm.

PROCEDURE

The information was gathered from:

• Different interviews with: workers (union members or not), the person in charge for the sanitary institution, doctors working at the free trade zone clinic, first-hand witnesses: doctors from the North-East district (public and private institutions), a nun whose congregation assists the workers, the parish priest.
  
• Medical records of workers with a discomfort or an ailment justifying a visit to a public or a private institution, or to the free trade zone clinic.
  
• Visits of the free trade zone and of local sanitary institutions.
  
  
• Participants in the interviews were chosen on the basis of their being free and willing to talk, seeing as the commission's stay was restricted to a couple of days.
  
  

The questionnaires were elaborated so as to ask identical questions to participants belonging to the same socio-professional group.

The workers were asked:

• Identity
  
• Origin
  
• Date of the vaccination campaigns
  
• Appearance and presentation of the injected substances
  
• Previous surgery, gynaecological or urological events
  
• Post-injection symptoms
  
• Date at which these symptoms appeared
  
• Evolution and/or complications
  
  

The medical staffs were asked:

• Identity
  
• Origin
  
• Date of the vaccination campaigns
  
• Aim of the vaccination campaigns
  
• Appearance and presentation of the injected substances
  
• How many patients came for a consultation and for what reasons or ailments
  
• Medical record
  
  

This information was then compared to that given by the first-hand witnesses (see above: local doctors, the parish priest …).

THE SITUATION

THE "CLINICA CODEVI"

For health services the Free Trade Zone includes a clinic, the "clinica de CODEVI", supervised by a Haitian doctor, replaced by Dominican doctor 3 or 4 days after the second vaccination campaign, for reasons that are still unclear. The doctor has a staff composed of one nurse (Dominican) and two auxiliaries (Haitian). The clinic takes care of minor ailments and delivers medical certificates when needed. It has no formal link with Haitian health services. Apparently it is part of the sanitary structure of the central office of the Group M in Santiago.

The workers have no medical care through the Social Affairs Departement (Ministère des Affaires Sociales) even though the ONA (who should pay social security) seems to deduct a contribution on each worker's pay each week. Sick workers in need of a special consultation or surgery have to pay for it out of their own pocket. In these conditions they have to get treatment in a public or private sanitary institution in the district or in the Dominican Republic.

THE FACTS

Most outstanding throughout the interviews was the fact that the positions and points of view adopted by the different groups involved in this vaccination affair are totally contradictory. Accordingly the task of establishing factual elements with certainty becomes an extremely difficult one. The question "have vaccinations really been administered?" which would seem so simple to any human being apparently requires a great deal of mental gymnastics before getting an answer. Before going through the different points of view on that question, let's try to have a closer look at the context in which the vaccination campaigns took place.

The factory's doors first opened in August 2003 in spite of opposition not only from the Ouanaminthe population but also from other sensible Haitians. It was not long before the company's management had to face the workers' claims about wages and work conditions. Mass firings were the result and the hostility between workers and management was increasing daily, when these vaccination campaigns were implemented.

The country was the scene of a great political stir as a consequence of Aristide's departure from power. A new government had just been set up. The Haitian State was not functional. The situation was near chaotic. It was in this singular context that the company management decided to "vaccinate" their workers.

Were the vaccination campaigns actually carried out?

In order to implement a vaccination campaign, it is required to submit to the following procedure beforehand:

• Permission by the Health department (Ministère de la Santé Publique et de la Population)
  
• An awareness and motivation campaign aimed at the people who are to be vaccinated
  
• The date of the vaccination
  
• The nature of the injected substance
  
• A vaccination card for each person
  
  

(1) Permission by the Health department:

The people interviewed (the workers, the Ouanaminthe doctors, the Codevi clinic staff) unanimously stated that the Codevi clinic did not have the permission by the Health Department (MSPP) for implementing the "vaccination" campaigns and furthermore, there is no relation between the Codevi clinic and the MSPP. The representative for the MSPP in the North-East, Doctor Jean-Denis, seems to have been informed two months after the operation. However the Codevi clinic would not have been certain to get permission by the MSPP in this chaotic situation, the Health Department hardly being in working order.

In this case in which the workers and the management were in very bad terms, supervision of the vaccinations by member of the Health Department (MSPP) or the Social Affairs Department (Ministère des Affaires Sociales) would have been of absolute necessity. If this simple step had been taken many obscure issues could have been cleared. The question being, did the people in charge of the Codevi clinic consciously choose to keep away from any verification by Haitian sanitary authorities in order to freely use defenceless workers as guinea pigs?

(2) The awareness and motivation campaign

These vaccination campaigns would have called for an extensive awareness campaign, explaining the purpose of the vaccination to the workers, the procedure and the benefit they would get from it. On this question the statements of the workers, the Ouanaminthe doctors and the Codevi clinic staff differ.

Dr Alejandra Anido, in charge of human resources and development for Group M, and in charge of the Codevi clinic's activities, stressed the fact that the clinic had implemented an awareness campaign aimed at the workers a week or two before the vaccinations. Dr Claude Joazard, a Haitian doctor, working at the Free Trade Zone at the time, was in charge of this awareness campaign.

Dr Anido added that this awareness campaign did effectively take place.

Dr Claude Joazard, questioned about this problem, told us that he was aware of the vaccination campaign and that he was in charge of informing the workers. He even took part personally, calling on pregnant women in order to encourage them to get vaccinated. According to him, an awareness campaign did take place.

The other doctors we interviewed at Fort-Liberté and at Ouanaminthe knew about the vaccination campaigns when they had to treat the workers' ailments or when they saw the victims during a consultation, at their office.

The parish priest, the nun and other people interviewed about this were also unaware of the campaigns. They only came to know about the vaccinations when workers started suffering from a whole range of medical problems.

The workers do not agree in the least with Drs Joazard and Anido. They unanimously declare they were never told beforehand, and discovered the "vaccination" campaigns the day the first one went ahead. They were mostly forced to accept the vaccinations, or else they were to be fired. There certainly was never any awareness campaign, and moreover female workers recall their infrequent exchanges with Dr Claude Joazard who would tell them how to wash, how to clean the axillaries in order to prevent bad smells. There was never any question of awareness or willingness for any vaccination campaign whatsoever.

(3) The date of the vaccination

It is difficult to understand the disagreement about this simple issue. Why is it impossible to gather the same information about this apparently simple issue from the different protagonists? Why was there on one side an attempt to hide the truth?

According to Dr Anido Alejandra, in charge of the Codevi clinic, the first series of vaccinations took place on April 15th, 2004, and 690 people got injections, 372 women and 318 men. The second vaccination campaign was carried out on May 19th, 2004, and 350 people got injections, 179 women and 171 men.

The victims of the vaccination campaigns, the workers, affirm that the first campaign was on March 2004. The second campaign took place on April 19th, 2004. They are adamant about this: there were no vaccination campaigns in May 2004. They gave a number of chronological landmarks to prove their point.

Dr Claude Joazard did not procrastinate about this issue, he does not remember exactly the date of the first series of vaccinations, in which he took an active part, but he is convinced there were no vaccinations on May 15th, 2004. He was then no longer working for Codevi clinic. During the second vaccination campaign, he was still an employee there but he did not take part in it, being assigned to consultation that day, not to vaccination.

What is the advantage in modifying the dates of events?

Here we have to stress the fact that the main medical concerns appeared roughly 2 weeks after the second series of vaccinations, especially the cases of miscarriage, abortion, stillbirth, and risk of abortion. Documents like a pelvic scan or a reasonably elaborate medical record, when available, have all been made before May 15th. If the second vaccination campaign did take place on May 15th instead of April 19th, it cannot be seen as the cause of the above-mentioned health hazards, in which case the Codevi clinic would have limited responsibility in this tragedy. If, on the contrary, the second vaccination campaign took place on April 19th, 2004, the link between the vaccine and the health disorders suffered by the workers is easily established, as well as the responsibility of the Codevi clinic in this tragedy.

(4) The nature of the injected substance

This is the most thorny and mysterious issue of all. It is the issue about which the different protagonists disagree most.

According to Dr Anido Alejandra, they undertook anti-tetanus vaccination campaigns for the workers' good health and for the company's needs. The workers use machines to make the clothes. They can easily get pricked and catch tetanus, a lethal disease. This was the reason for inoculating the workers against tetanus, using the toxoïd tetanus vaccine recommended by the W.H.O. The vaccine comes as a 5cc flask filled with a transparent liquid. Administering it does not require mixing anything. Dr Anido does not understand why the workers complain about health conditions after being injected. When we asked her to show us a sample flask, Dr Anido declared the vaccines were kept in Santiago, because the Codevi clinic did not meet with storage compliances (temperature).

Dr Joazard's position is almost identical to Dr Anido's on this issue. He stressed that he had taken an active part in the first vaccination campaign. He helped administer the vaccine. He checked the flasks, their expiry date, but does not recall the colour of the contents. He was convinced it was toxoïd tetanus. He also remembered that two different substances had been mixed in an insulin syringe before the actual injection. He did not take part in the second vaccination campaign. He does not understand why anything else than toxoïd tetanus could have been used. We asked him if he had checked the vaccines before the second vaccination campaign from which he was set aside; he answered he was not set aside, only assigned to consultation, and had absolutely no reason for checking the vaccines seeing as he was already sure that toxoïd tetanus was going to be injected.

The workers who were the victims of the vaccination campaigns seem to hold a different stance. Some of them stated they had not checked what the substances were; they were afraid and preferred to look away while they were receiving the injection. Others pointed out that they were no biochemical experts, nor doctors, however they are positive that they were injected with a mix of two substances: a white milky one and a transparent one. Later on, as health disorders appeared, they began to suspect abortive or sterilizing substances had been used, they think it could be Depo-Provera.

Indeed, the relatively harmless toxoïd tetanus vaccine can be given to people of any age, and of any group: male or female, pregnant or not, except people who have a known sensitivity to this substance, or an allergic reaction to it. Endeavouring to protect the workers from this lethal disease certainly is praiseworthy. Was this Codevi management's real aim with these vaccination campaigns? Was toxoïd tetanus really used?

It is noteworthy that Drs Anido and Joazard agree about the nature of the substance, but not about the presentation. If toxoïd tetanus was truly the only substance used for the vaccination campaigns, it seems strange that so many similar medical symptoms should occur in such a small population of workers.

CONCLUSION

In the first place the commission had planned to answer the following questions:

• What were these vaccination campaigns truly aimed at doing?
  
• What was the exact composition of the injected substances?
  
• What are the likely side-effects incurred by these substances?
  
• Are the victims' complaints real and justified?
  
• Are their complaints a consequence of the injections?
  
  

In the end, the commission suffers deep frustration in not being able to give an extensive answer to these questions.

However in visiting the place, interviewing the different actors and checking the medical records the commission has been able to come to the following conclusions:

The Codevi Free Trade Zone includes a clinic that depends only on Dominican Republic sanitary institutions, and has no relation with and is not supervised in any way by the MSPP or the Social Affairs Department (Ministère des Affaires Sociales).

The entire Codevi clinic staff (including Dr Joazard) unanimously declares that the vaccination campaigns took place in March and April 2004, disagreeing with the schedule given to us by the person in charge of the Codevi clinic.

An absence of any kind of vaccination card, including the date, dosage and nature of the vaccine that was administered.

Most complaints are about the genitals and started being felt between one week and one month after the second vaccination campaign.

As well as the toxoïd tetanus vaccine which is thought to have been administered, it is necessary to make further research in order to rule out the possibility of abortive, contraceptive or sterilizing substances having been used.

RECOMMENDATIONS

Haitian State, through its Public Health and Population Department, must rapidly take its responsibilities and clarify the following issues:

The real aims and details of implementation of the vaccination campaigns.

The exact nature of the substances used for the vaccinations. This should include the immunity tests and the chromatography.

Assessment and reinforcement of the health care the Department of Health and Population (MSPP) and the Social Affairs Department (Ministère des Affaires Sociales) provide to the workers.

Psychological help for workers complaining of health disorders as a result of the vaccinations.

Implementation of a surveillance plan for medium and long-term effects of the vaccinations.

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