Caracas Chronicles

Photo: Gobernación de Carabobo retrieved

63 years ago, the Venezuelan Center for Disease Classification (CEVECE, for its Spanish acronym) was created in Caracas and, ever since, it played a key role in the development and implementation of disease classification guidelines published by the World Health Organization (WHO) across Latin America. It also elaborated the Health Ministry’s epidemiological records.

That changed last June, when the center lost its WHO certification.

To understand the magnitude of this, we need to dig up the center’s role as a Collaborating Center of the WHO Family of International Classifications.

Until 1893, there was no standardized model for morbidity and mortality data.

Diseases have scourged mankind all over history, but just recently we’ve been able to compare their impact among different populations. Until 1893, there was no standardized model for morbidity and mortality data, and every single hospital around the world kept their records in different formats, making comparisons and international planning impossible. That year, French physician Jacques Bertillon introduced the Bertillon Classification of Causes of Death, a model quickly adopted by several countries, allowing statistical analysis and comparison. After its adoption and modification by the American Public Health Association, in 1898, the system was renamed as the International Classification of Diseases (ICD) and periodical updates were scheduled every ten years, initially under the supervision of the International Statistical Institute and, after World War I, by the League of Nations. The World Health Organization assumed responsibility of the ICD immediately after its creation in 1948, and one year later, published its sixth edition, ICD-6.

Since then, the ICD has been adopted by almost every country around the world, with its 11th edition to be endorsed next year. Besides the ICD, WHO regularly publishes a series of guidelines collectively known as the Family of International Classifications, and its update, translation and distribution among health care providers is responsibility of only twenty WHO-certified Collaborative Centers around the world.

CEVECE was one of them.

Founded on June, 1955, as “Latin American Center for Disease Classification,” it was the second institution of its kind in the world.

Founded on June, 1955, as “Latin American Center for Disease Classification,” it was the second institution of its kind in the world. Its first director, Dr. Darío Curiel Sánchez, was a John Hopkins University graduate, member of the WHO experts panel in charge of elaborating the ICD-6, and former director of the Epidemiology and Statistics Division of the Venezuelan Health Ministry, where he led the campaign that eradicated smallpox in the country. Under his administration, the center played a key role in the adoption of the ICD among Spanish-speaking countries and the development of functional sanitary records in Venezuela and Latin America, making possible important public health campaigns developed in the region in the following years. In 1979, the center adopted its current name and, in 1994, WHO assigns it the revision and translation of the ICD, tenth edition, to Spanish. It’s still in use all over the world.

Its status as a WHO Collaborating Center was renewed in 2011, 2014 and 2016, becoming the oldest active collaborative center in the world. But nothing lasts forever, especially under chavismo.

Alarms were first sounded by the Venezuelan Society of Public Health, which condemned the dismantling of key workgroups inside the center by the Venezuelan government in a letter released last week. Over the weekend, and in the absence of official information, José Moya, representative of the Pan-american Health Organization (PAHO) in Venezuela, assured the CEVECE would remain operative, but recognized that WHO revoked its status as a Collaborative Center, since, for the first time in 63 years, it “failed to provide an activity plan for the next period.”

Alarms were first sounded by the Venezuelan Society of Public Health, which condemned the dismantling of key workgroups inside the center.

The fact that an epidemiologic analysis center finds nothing to do in the middle of the country’s worst sanitary crisis ever, is beyond me. But then again, epidemiology is all about gathering information to solve public health problems, something chavismo has no interest in.

For Dr. Julio Castro, professor at UCV’s Tropical Medicine Institute and one of the aforementioned letter’s signatories, the decision raises serious doubts about the center’s future: “(This revoking) represents a step backwards for Venezuelan health,” he declared exclusively for Caracas Chronicles. “Besides its collaboration with WHO, the center helped manage the epidemiological data of the country and now we don’t have any idea of what will happen with that information.”

Dr. Castro’s doubts are well founded. The CEVECE has always played an important role in the elaboration of the Health Ministry’s weekly epidemiological bulletin and the National Mortality Yearbook, and with its WHO partnership gone, the logical thing would be to focus on those. But the government hasn’t released a single bulletin in 15 months, and the last yearbook published dates back to 2013. In fact, all data regarding public health emergencies, like malaria, measles and diphtheria, comes from international sources and estimates, with the Barrio Adentro hospital network allegedly refusing to report its data to local epidemiology units in opposition-governed states. The little data actually reported and processed is simply ignored by the government.

Moya says the Health Ministry will send a work plan to be evaluated by WHO, so the CEVECE can regain its status—hard to believe, considering the epidemiologic censorship policy that the same ministry has been pushing on for years.