“In situations of conflict, you often see a variety of different parties using the provision of health services as a way of generating favor,” said Katherine Bliss, director of the Immunizations and Health Systems Resilience program at the Washington-based Center for Strategic and International Studies. “That may also be manifested in a lack of trust in public authorities and a lack of trust in public programs, like vaccination programs.”

The wails pierced the walls of the walk-in clinic tucked among rundown homes in the heart of Venezuela’s capital. Artemis Parra got one vaccine in each arm, for polio and measles. The shots were free at the government site, and they filled gaps in the 1-year-old’s vaccination record. But they weren’t enough to meet national requirements for children her age. Artemis needs two more, at a cost of $400 — a bill her unemployed mother and government-worker father can’t afford, AP reports.

Public health officials have long warned that Venezuela, with an unraveling health-care system and roughly a decade of political unrest, has alarmingly low vaccination rates. The country is banned from purchasing vaccines through a regional system that offers affordable prices until it pays off an $11 million debt — largely the result of a power struggle between the government and the U.S.-backed opposition.

Specific data on vaccination rates have been elusive in Venezuela, where institutions are shrouded in secrecy, corruption and bureaucracy. The country hasn’t published rates since 2015.

But an Associated Press analysis of rare government data and estimates from public health agencies shows that Venezuela’s vaccination crisis is growing, putting it among the world’s worst countries for inoculating children against potentially fatal diseases.

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