Venezuela is in the midst of “a major, major emergency” when it comes to health.

That’s the view of Dr. Paul Spiegel, who edited and reviewed a new report from the Johns Hopkins Bloomberg School of Public Health and the international group Human Rights Watch. Released this week, the study outlines the enormity of the health crisis in Venezuela and calls for international action.

The health crisis began in 2012, two years after the economic crisis began in 2010. But it took a drastic turn for the worse in 2017, and the situation now is even more dismal than researchers expected.

“It is surprising, the magnitude,” says Spiegel, who is director of the Johns Hopkins Center for Humanitarian Health and a professor in the Department of International Health at the Bloomberg School. “The situation in Venezuela is dire.”

Things are so bad that, according to the report and other sources, patients who go to the hospital need to bring not only their own food but also medical supplies like syringes and scalpels as well as their own soap and water.

“The international community must respond,” Spiegel says. “Because millions of people are suffering.”

The government of Venezuela stopped publishing health statistics in 2017, so it can be difficult to track exactly how bad the crisis is. But by interviewing doctors and organizations within Venezuela, as well as migrants who recently fled the country and health officials in neighboring Colombia and Brazil, the researchers pieced together a detailed picture of the failing health system. Some of the data also come from the last official government health report, issued in 2017. (The health minister who released the report was promptly fired.)

Diseases that are preventable with vaccines are making a major comeback throughout the country. Cases of measles and diphtheria, which were rare or nonexistent before the economic crisis, have surged to 9,300 and 2,500 respectively.

Since 2009, confirmed cases of malaria increased from 36,000 to 414,000 in 2017.

The Ministry of Health report from 2017 showed that maternal mortality had shot up by 65 percent in one year — from 456 women who died in 2015 to 756 women in 2016. At the same time, infant mortality rose by 30 percent — from 8,812 children under age 1 dying in 2015 to 11,466 children the following year.

The rate of tuberculosis is the highest it has been in the country in the past four decades, with approximately 13,000 cases in 2017.

New HIV infections and AIDS-related deaths have increased sharply, the researchers write, in large part because the vast majority of HIV-positive Venezuelans no longer have access to antiretroviral medications.

A recent report from the Pan American Health Organization estimated that new HIV infections increased by 24 percent from 2010 to 2016, the last year the government published data. And nearly 9 out of 10 Venezuelans known to be living with HIV (69,308 of 79,467 people) were not receiving antiretroviral treatments.

In addition, the lack of HIV test kits may mean there are Venezuelans who are living with HIV but don’t know it.

Cáritas Venezuela, a Catholic humanitarian organization, found that the percentage of children under 5 experiencing malnutrition had increased from 10 to 17 percent from 2017 to 2018 — “a level indicative of a crisis, based on WHO standards,” the authors of the report write.

An estimated 3.4 million people — about a tenth of Venezuela’s entire population — have left the country in recent years to survive. Venezuela’s neighbors, particularly Colombia and Brazil, have seen a huge uptick in Venezuelans seeking medical care.

Health officials in those countries say that thousands of pregnant women who have arrived received no prenatal care in Venezuela. The flow of migrants includes hundreds of children suffering from malnutrition.

Despite all the headlines about Venezuela’s collapse, researchers were still surprised by the scope of the crisis.

Venezuela is a middle-income country with a previously strong infrastructure, Spiegel says. “So just to see this incredible decline in the health infrastructure in such a short period of time is quite astonishing.”

Despite the severity of the health crisis, the government continues to paint a rosy picture of its health care system — and to retaliate against anyone who reports otherwise, according to the report.

Dr. Alberto Paniz Mondolfi, who was not affiliated with the report, spoke with NPR about the situation in his home country. Paniz practices in Barquisimeto, Venezuela, and is a member of the Venezuelan National Academy of Medicine.

Paniz says he has seen children in hospitals who appear to be malnourished — and there aren’t even catheters available to hook them up to IVs. He has seen people on the streets searching the trash for food to eat. And he adds that a blackout that began on March 7 and lasted for a week has had lingering impact: Some areas still lack electricity or access to running water even now, he says.

Paniz says the report from Johns Hopkins and Human Rights Watch paints an accurate picture of the situation on the ground. “It’s a very, very timely and complete paper,” he says. He praised the thorough research and said he was “relieved” that the health crisis might finally get international attention.

So far, aid from the U.S. and other countries has been insufficient to address the crisis, the authors of this report say.

But Spiegel sees some signs of hope: Last week, President Nicolás Maduro decided to allow the International Federation of the Red Cross and Red Crescent to enter the country with medical supplies for about 650,000 people.

“It’s still a drop in the bucket compared to the 7 million or so people who are in desperate need,” Spiegel says. But he believes it is a sign that Venezuela’s leader may begin acknowledging the crisis and opening the country up to assistance.

And the good news, Spiegel says, is that once aid arrives in Venezuela, it can be distributed very quickly. “Venezuela has an infrastructure; it has very well trained people,” he says.

Paniz agrees that international assistance will be crucial to ending the crisis. “It’s a desperate call to not leave us alone,” he says. “There is no way in which Venezuela could come out of this by its own.”

Melody Schreiber (@m_scribe on Twitter) is a freelance journalist in Washington, D.C.

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As the heat turns up on drug manufacturers who determine the price of insulin and the health insurers and middlemen who determine what patients pay, one company — Cigna’s Express Scripts — announced Wednesday it will take steps by the end of the year to help limit the drug’s cost to consumers.

Express Scripts, which manages prescription drug insurance for more than 80 million people, is launching a “patient assurance program” that Steve Miller, Cigna’s chief clinical officer, says “caps the copay for a patient at $25 a month for their insulin — no matter what.”

The move by Express Scripts comes as lawmakers are focused on high drug prices and listening to stories about patients who can’t afford their medication.

Insulin has become a major focus. A Minnesota man died last year, according to his mother, when he tried to ration his insulin because he couldn’t afford the $1,300 monthly cost.

Though the drug has been in use for more than a century, its price in the U.S. is 10 times higher than it was 20 years ago, according to a report by the House of Representatives released last week.

“What we’re hoping is that we’re going to see more diabetics taking more insulin, [fewer] complications for those patients, and hopefully lower health care costs,” Miller tells Shots.

Express Scripts covers 1.4 million people who take insulin, Miller says.

Under the discount program, patients who haven’t met their deductible and normally would have to pay the full retail price for their insulin would pay $25. The same goes for those whose normal copayment is a percentage of that retail price. Miller says on average patients pay about $40 a month for insulin copayments — but the price can vary widely month to month, depending on the design of a patient’s prescription drug plan.

The announcement by Express Scripts, one of the biggest pharmacy benefit managers, comes a day after a subcommittee hearing in the House of Representatives that focused on the high costs of insulin.

Patient advocate Gail DeVore testified at the hearing.

“Every day I get emails from people asking, ‘How do I afford insulin?’ ” DeVore told the members of the Energy and Commerce Subcommittee on Oversight and Investigations. “Every day. And every day I have to help them find a way to find insulin.”

DeVore, who has been dependent on insulin to control her diabetes for 47 years, says the full retail price for her insulin is $1,400 per month. She has good insurance, she says, so her cost for that drug is manageable. But her insurance doesn’t cover a second, fast-acting insulin she sometimes needs, so she says she dilutes it to make it last longer.

A recent study by researchers at Yale found that about a quarter of people with diabetes skip doses to save money or use less of the medication than prescribed.

“Patients who rationed insulin were more likely to have poor control of their blood sugars,” Dr. Kasia Lipska, an endocrinologist and assistant professor at Yale, testified at the hearing. She said patients who don’t maintain good control of their blood sugar run the risk of amputations, blindness and other diabetes complications.

Lipska told the lawmakers that drug companies are raising prices for no apparent reason. She urged the committee members to focus on the list prices of the drugs that pharmaceutical companies set rather than worrying about discounts and rebates.

“The bottom line is that drug prices are set by drugmakers,” she told lawmakers. “The list price for insulin has gone up dramatically — and that’s the price that many patients pay. This is what needs to come down. It’s as simple as that.”

Express Scripts’ program doesn’t do that, Miller acknowledges.

“This is not lowering the price of the drug,” Miller says. “We think there is a whole different issue, and that is, ‘What’s the price of pharmaceuticals in the United States?’ This does not address that. This truly is addressing the pain that patients are experiencing at the counter.”

Last month, Eli Lilly & Co. said it would begin selling an “authorized generic” version of one of its insulin products at half the retail price.

According to Express Scripts, its $25 copay deal will be available near the end of this year to patients who are not covered by a government insurance program (such as Medicare or Medicaid).

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