Poor Dr Ona!

I am starting to get the feeling that poor Dr. Enrique Ona is getting a raw deal. What is happening to him now is proof that no good intention of serving the country is left unpunished with serious reputation risk.

I know the DOJ investigation is still ongoing, but I am starting to get worried Dr. Ona had been prejudged. The tone of P-Noy’s voice in his televised interviews gives the impression that Sec. Ona is already guilty as suspected. Galit siya talaga. Sec. De Lima can only pick it up from there.

I do not know Dr. Ona that well, but since I come from a family of doctors, I have been asking around. It seems that he has a pretty respectable professional reputation. I get the impression that his colleagues, specially those who knew him from his UP Medicine days, are rather surprised and bothered by what they are reading and hearing about him in the news media.

I am ready to wait for the results of the DOJ investigation on possible violations of government procedures. It is possible Dr. Ona had been blindsided by some of the old hands with bad habits in DOH. But there is an absolute need to understand the scientific part of the case against Dr. Ona.

I heard P-Noy say on television that Dr. Ona is being investigated for choosing a type of pneumonia vaccine that is cheaper, but not as good as a more expensive type. P-Noy said the vaccine Dr. Ona bought for DOH is only for children, while the more expensive one can be used for adults and thus may be the better choice. I also heard P-Noy say that among others, the WHO favors the more expensive vaccine.

I wish it was as simple as P-Noy seems to have understood it. Doctors who are familiar with vaccines told me it isn’t as simple.

Let me try and explain what a vaccine is from what I recall my late father, a specialist in infectious diseases, told me. A vaccine is something that is supposed to help fight a disease by improving immunity to a virus or microorganism causing a particular disease.

A vaccine is made from weakened or dead forms of a virus or some microorganism that stimulates the body’s immune system to recognize it and destroy the more virulent form. The body’s immune system also “remembers” it so as to protect the person from future infections.

The thing is… vaccines are as good as the strains they carry. Take the flu vaccine for example. There are so many strains of the flu virus and it is constantly mutating. You can only get immunity if the strain of the virus used in your flu shots happens to be the same as the one prevalent or in season.

Vaccine makers only try to make an intelligent guess what flu strain will be prevalent about a year before it is needed. If they guessed it right, then you are protected. But if not, it is as if you didn’t get a flu shot. Personally, I often feel a flu shot is more trouble than it is worth.

Pneumonia also has so many strains and Dr. Ona had to choose which vaccine is more cost efficient. Choosing one must be on the basis of factors like the more prevalent form and the cost.

I get the feeling P-Noy was misinformed when he was made to understand that the vaccine Dr. Ona bought was inferior to the other one. Dr. Ona had to make a professional decision on what makes the most sense, given cost and need.

To make the choice far from simple, there are 90 serotypes of pneumo which obviously will be difficult to lump in one vaccine. If the number of serotypes is the deciding factor, I am told there is a pneumo 23 which is even more expensive. But do we need a sledgehammer to kill a fly?

My brother-in-law, Dr. Arturo Ludan, who is one of the more respected pediatricians in the country with a lifetime of experience dealing with pneumonia, told me that “more is not necessarily better in the absence of solid data on prevalence of pneumococcal infections.” He feels that Prevnar 13 may be, to use a layman term, somewhat “overdesigned” for the initial phase of the pneumo vaccine program.

For that reason, Dr. Ludan feels Dr. Ona’s decision for the 10 for the initial phase of the program was cost-effective. “Following the full implementation of the program the DOH should monitor the incidence of pneumonia, since this infection is a child-killer in our country.”

This is why even other doctors I consulted say that Sec de Lima should stop saying that the 13 is superior and more cost effective because that is scientifically questionable. It is also not true that only the 13 is being recommended by WHO. Whoever told P-Noy that was misleading him.

I have a copy of a letter circulating in the medical community written by Dr. Zulkifli Ismail who is chairman of the Asian Strategic Alliance for Pneumococcal disease prevention based in Malaysia. Dr. Ismail said that “there is no WHO document that recommends one vaccine brand over another. WHO recommends pneumococcal vaccination be used in countries in which the infant mortality is high.”

Dr. Ismail explains that “every doctor and pharmacist knows that there are two brands of the vaccine in the market and the choice of which brand depends on the predominant serotypes in the particular country, but there is an overlap in choosing between the 10-and 13-valent one. The only significant difference would be in serotype 19A, the prevalence of which fluctuates year by year and is little known in the region.”

Dr. Ismail further explains that cost is an issue in a middle income country like ours. “In the selection of the vaccine to be used in the Philippines, we are certain the Department of Health took into consideration the cost and effectiveness of each of the vaccine brands.

“With limited serotype prevalence data in the Philippines and most Asian countries, the choice of vaccine really depends on cost. The Philippines wisely decided to procure the cheaper of the two vaccines, rather than not to start the program altogether like the other countries.”

In fact, Dr. Ismail said, “when the other countries in the ASEAN region heard about the Philippines introducing the pneumococcal conjugate vaccine in the National Immunization Program (NIP), they were envious and wished that their own governments would take this bold step in committing such a large sum of money in the prevention of a major killer of children, pneumonia and meningitis, caused by the bacteria Streptococcus pneumoniae.”

Dr. Ismail continues: “The Asian Strategic Alliance for Pneumococcal disease prevention (ASAP) congratulates the Philippines for introducing the pneumococcal conjugate vaccine in the NIP ahead of many other relatively wealthier countries. It therefore saddens us to see this controversy being played up and we hope that it will not result in reduced uptake of this life-saving vaccine that the children of the Philippines desperately need at this time.”

I am all for cleaning up government and I am sure the DOH has its share of entrenched corruption that even the most honest Health secretary cannot easily dislodge. But I feel sad that P-Noy, through the tenor of his voice, made it look like Dr. Ona is guilty pending investigation and explanation.

I suspect P-Noy had been misled by a bureaucrat who wants Dr. Ona’s position or a disgruntled vendor or both of the above working together. I tried to reach out to Dr. Ona but he has not responded to e-mails or other means. I guess he is depressed by the turn of events but does not want to make it look like he is speaking out of turn by publicly defending himself.

I am trying to understand what ticked off P-Noy so much about Dr. Ona on a case that must be resolved by looking at the scientific basis of Dr. Ona’s decision more than anything else. Yet, P-Noy has turned a blind eye to obvious cases of corruption among those who are close to him.

Now close to 80, Dr. Ona only wanted to cap an illustrious medical career by being Secretary of Health. It doesn’t make sense for Dr. Ona, who is already rather well off, to knowingly make decisions that could tarnish a lifetime of work and good reputation. Ending his career in shame, specially if undeserved, would simply be unfair and tragic.

I am hoping for a just outcome of Dr. Ona’s case. Otherwise, good people who only want to serve but have no political clout are well advised to stay away from public service. That would be bad for our country and its future, as we all can imagine.

Boo Chanco’s e-mail address is [email protected]. Follow him on Twitter @boochanco