Rise in dengue, measles cases underline value of vaccines

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MANILA, Philippines — The Philippines is facing two public health crises in 2019—a simmering measles outbreak and the soaring number of dengue cases.

Measles has long been prevented by vaccination while the vaccine against dengue has been mired in controversy.

There have been at least 34,950 measles cases—and 477 deaths from the disease—since the beginning of the year. The risk of the outbreak has been set to moderate at the national level due to a decreasing number of newly reported cases but the outbreak cannot be declared over until the Health department reaches its target vaccination coverage of 95%.

And while health workers are containing the highly contagious disease, they are also fighting the war against the deadly dengue.

Rise in dengue cases

In mid-July, the Department of Health declared a national dengue alert after five regions—CALABARZON, Bicol region, Western Visayas, Eastern Visayas and Zamboanga Peninsula—exceeded the epidemic threshold, or the "the level of occurrence of disease above which an urgent response is required."

Even cases in MIMAROPA, Northern Mindanao, SOCCSKSARGEN and the Bangsamoro Autonomous Region in Muslim Mindanao are significantly higher than in previous years.

From January 1 to July 13, there were 130,463 dengue cases, including 561 deaths. During the same period in 2018, the DOH had documented only 67,690 cases, including 367 deaths.

Health officials attributed this to the spike of dengue cases every three years, not only in the Philippines but also in other Asian countries. 

Palace open to reconsidering Dengvaxia

As the cases of dengue continues to surge, Malacañang said it is open to making Dengvaxia—the controversial first vaccine licensed to protect against the mosquito-borne virus—available again if experts declare it to be effective in addressing the current situation.

“If the weight of findings shows that there is benefit using Dengvaxia against dengue, then certainly the government should consider it,” presidential spokesperson Salvador Panelo said Wednesday.

At the tailend of 2017, the government stopped the P3.5-billion vaccination program after pharmaceutical firm Sanofi Pasteur disclosed that Dengvaxia may cause “severe dengue” if given to those without prior exposure to the virus.

RELATEDHow the Dengvaxia scare helped erode decades of public trust in vaccines

Sanofi: No link between deaths and Dengvaxia

Other countries simply dealt with the French drugmaker’s announcement by updating guidelines and labels. But in the Philippines, the news led to confusion and worse, mistrust in vaccination, as soon as the Public Attorney’s Office directly linked deaths of individuals to Dengvaxia despite no solid evidence.

The certificate of product registration of Dengvaxia was also revoked in February 2019. The country’s Food and Drug Administration cited the pharmaceutical firm’s failure to submit post-approval commitment documents—not the issue on the vaccine’s safety—as the reason.  

Sanofi Pasteur Philippines General Manager Jean-Antoine Zinsou maintained that the Dengue Investigative Task Force of the Philippine General Hospital and the WHO Global Advisory on Vaccine Safety had found there was no causality between the deaths and the vaccine.

“Of course, there are parents who lost their kids. Nobody wants to experience that. It’s extremely painful. Really I’m expressing my deep feeling for that but what people needs to remember is the conclusion of these two committees which is the absence of link between these deaths and the vaccine,” Zinsou told Philstar.com in an exclusive interview.

Zinsou said Sanofi Pasteur is currently appealing the decision of the FDA.

“We are optimistic in the fact that at the end of the day, we will find a common ground with the health authorities of this country,” he said.

In a 2018 position paper, WHO recommended to countries considering vaccination as part of their dengue control program to administer pre-vaccination screening for past dengue infection.

Only persons who have had a dengue virus infection in the past would be vaccinated.

RELATEDBeyond the Dengvaxia scare: Complacency, devolution of health system also account for measles outbreak

‘Vaccines as efficient triumph of public health’

Vaccination, according to WHO, has greatly reduced the burden of infectious diseases.

But the thriving anti-vaccine lobby and misguided safety concerns in some countries have led to vaccine hesitancy or the reluctance or refusal to vaccinate despite the availability of vaccines, which “threatens to reverse progress made in tackling vaccine-preventable diseases.”

Vaccine coverage in the country fell to only 40% last year after the scare stoked by the anti-dengue vaccine controversy. 

The DOH is targeting to vaccinate some nine million public school students across the country. Students from Grades 1 to 7 will be given measles and rubella vaccines and they will be also given booster doses against tetanus-diptheria. 

"It’s well known that vaccine has been the most efficient triumph of public health in the past century because it’s the only tool that can save lives, it’s the only tool of course after clean water," Zinsou said.

The Sanofi Pasteur Philippines general manager added: “Vaccination can prevent people from getting sick. And we’ve seen the damage of the mistrust and concerns about vaccination in this country.”

The low vaccination coverage—which led to the measles outbreak in different parts of the country—could be attributed to the erosion of trust in immunization.

"Vaccine is not a magic bullet; vaccine contributes to improving the performance of the immune system, the system that defends the organs. There is no vaccine that is 100-percent efficacious. Nevertheless, when you look at the value of the vaccines in preventing diseases, it’s worth being vaccinated," Zinsou said.

Sanofi Pasteur has launched a campaign that will allow the public to ask questions and concerns about health and vaccines through its website. The pharmaceutical company will responds to the concerns directly.

"Communication is very important for us and this is why we decided to have this public campaign to help us better listen to the people," Zinsou said.

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