Dengue vaccine mess: Who’s to blame?

Do vaccines really work? Does Big Pharma promote them cleanly? In case of failure, who pays? Those old questions louden in the wake of the dengue vaccine fiasco.

Like a patient desperate for a cure, the Philippines was had on Dengvaxia. For decades it searched for a preventive to the mosquito-borne virus that kills or hospitalizes young and old, poor and rich, by 200,000 a year. In Dec. 2015 it was made to believe that Sanofi Pasteur’s invention was the solution. The World Health Organization even endorsed it, as the world’s first ever dengue vaccine. So the Philippines approved the formulation, the first country in Asia to do so.

At once, P3 billion worth of the vaccine was purchased. It was to be administered in three doses six months apart, on a million nine-year-old schoolchildren. The mosquito spread the virus through blood-sucking stings. So naturally targeted for vaccination were the three most thickly populated regions: Central Luzon, Metro Manila, Southern Tagalog. Lined up for the first batch were 491,990 kids in Apr. 2016 under departing Health Sec. Janette Garin. In Sept. 2016 under then-Sec. Paulyn Ubial, 415,681 of them returned for the booster. It’s unknown how many got the third and last dose in Feb. 2017.

There was always confusion in the dengue policy. To recall, Garin, a former health undersecretary, had ascended to the top post in 2014 in the midst of controversy. Big Pharma, and she, had denounced then-health secretary Enrique Ona of approving for possible dengue cure a drug already proven effective against malaria. Ona went on extended leave on the unlikeliest medical reason: scalp infection due to hair dye. Ubial, Garin’s successor, also was controversial. Then-congressman Harry Roque, now presidential spokesman, got the Commission on Appointments to reject her as unfit. His proof was damning: she had blown hot and cold on Dengvaxia, at first stopping then approving the second dose in Sept. 2016, then again stopping and approving it months later. In Dec. 2016 there already were reports that Dengvaxia was doing damage in other lands.

This Dec. 2017 finally came confirmation. Sanofi Pasteur admitted that the drug may be harmful when administered to individuals not previously infected with dengue. Long-term clinical trial data showed that “Dengvaxia provides persistent protective benefits against dengue fever in those who had prior infection,” the pharmaceutical giant said. “For those not previously infected by dengue virus, however, ... more cases of severe disease could occur following vaccination upon a subsequent dengue infection.”

Barely two weeks in office, new Health Sec. Francisco Duque quickly convened an expert panel to plot the next moves. “The safety of the children vaccinated is paramount and the health department will need to do surveillance of those given Dengvaxia with no prior infection. It’s a huge task.”

That was an understatement. For, none of the nearly half-million children were ever tested if previously infected with the dengue virus. One can get mildly infected and show no signs of sickness. It should be safe to assume that most of them never were previously infected. “It means some of them will develop severe dengue, we don’t know who,” said health activist Dr. Anthony Leachon. “All of them will have to live with this possibility for the rest of their lives.”

Having exposed them to danger, the government must now strive to prevent any more harm. Can it make Sanofi Pasteur bankroll part of that long-term effort, or at least reimburse the P3 billion wasted on Dengvaxia? About P1.4 billion worth of the vaccine remains unused, probably rotting in health centers due to haphazard cold storage. Even if those are still efficacious, no right-thinking parent will allow her child to be vaccinated now.

The House of Representatives is contemplating to investigate the mess. Will it dig deep enough if Big Pharma employed unethical means to get the Philippines to approve and purchase the vaccine? Before joining the health department, Garin was a congresswoman influential with the Arroyo and Aquino administrations. Will Congress grill one of its own, along with Ubial whom it already deposed?

The fiasco naturally will foment suspicions about vaccines in general. Polio and small pox have been nearly eradicated by global campaigns using preventives. Of late, however, conspiracy theorists have been spreading supposedly scientific reports of measles vaccines as the cause of autism. This has caused decline in measles vaccination in many areas, leading to many outbreaks.

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