Statement on immunization

Immunization is one of the most cost-effective solutions to major global challenges and vaccination prevents an estimated 2.5 million deaths annually. With the exception of clean water, no other modality prevents more deaths than vaccination. The Philippines is now the 44th country to be certified as having eliminated maternal and neonatal tetanus. This was achieved primarily by ensuring hygienic delivery and cord care practices, and by immunizing children and women.

On Nov. 29, 2017, a press statement was released by Sanofi Pasteur regarding the results of the new analysis of clinical trial data of the dengue vaccine, CYD-TDV (Dengvaxia®). Based on this information, persistent protection against dengue fever was provided by the vaccine among those who had prior infection. However, for those not previously infected by the dengue virus, more cases of severe disease may occur upon a subsequent dengue infection following vaccination. Since this announcement, the Department of Health (DOH) placed the dengue vaccination program on hold until further review.

Concerns about the safety of dengue vaccine in the public health program are the trending topics in the news and in social media. In the ongoing discussions with the dengue vaccine, the value of routine childhood vaccination is being drowned by fear and panic. There is a possible risk that all the media attention to one vaccine will lead to distrust of all other vaccines in the national immunization program and result in lower vaccine coverage, affecting not just school-age vaccination, but even infant immunization. Reductions in vaccine coverage may lead to disease outbreaks such as the 2013 measles outbreak in the country. In 2013, Vietnam suspended the use of pentavalent (diphtheria-pertussis-tetanus-hepatitis B - Haemophilus influenzae b) vaccine after reports of deaths that occurred after pentavalent immunization. The suspension of the pentavalent vaccine in Vietnam is estimated to result in 90,137 chronic infections and 17,456 future deaths due to hepatitis B in the 2013 birth cohort. The deaths which lead to the suspension were eventually assessed as not due to the pentavalent vaccine.

In the past five years, the Philippines has introduced several new vaccines in the expanded immunization program of the government namely, mumps, rubella, inactivated poliovirus and pneumococcal conjugate vaccines. The school-based immunization for booster doses of measles-mumps-rubella and diphtheria-tetanus are substantial breakthroughs in ensuring prevention of disease for all Filipino children. Vaccines have never been free from risk, hence decisions on new vaccine introduction require risk-benefit analysis. This results in tension as public health benefits must be balanced against even remote and theoretical risks. Thorough review of available evidence must therefore be performed in a systematic, feasible and logical manner prior to introduction.

A survey on vaccine safety and confidence showed that 92.7 percent and 80 percent of surveyed Filipinos strongly agreed that vaccines are important and safe, respectively. The trust and confidence of the Filipinos in the immunization program should not be eroded by this experience to one vaccine. Health professionals and societies must strive to support all efforts to ensure that the country does not fail its citizenry in providing the best health care services.

The University of the Philippines Manila, the health science center of the University of the Philippines and the National Institutes of Health, a center of excellence for health research and development (established through Republic Act 8503), support the promotion of health and wellbeing of its citizens through immunization by conducting research that support the implementation of the country’s national immunization program. The UPM NIH will assist in its capacity to assess any new information on the dengue vaccine as part of its overall efforts in helping the Philippines achieve its immunization goals.