For DOH, a year of public health challenges

MANILA, Philippines — With the re-emergence of polio and widespread outbreaks of measles and dengue in the Philippines in the past months, the Department of Health (DOH) has described 2019 as a year full of “public health challenges.” 

According to Health Secretary Francisco Duque III, 2019 was not easy for the DOH in terms of the spread of major diseases like polio, measles and dengue. Cases of meningococcemia and diphtheria were also reported.

“It’s a year full of challenges … But I think the DOH, the health workers, health professionals, everyone who has something to contribute really came and rose to the challenge. And I salute our very hardworking dedicated civil servants or public health workers who really took on the job effectively,” he said in an interview.

He noted that 2019 marked a milestone because Republic Act 11223 or the Universal Health Care (UHC) bill was signed into law by President Duterte.

Even the World Health Organization (WHO) considers UHC a vital measure because it ushers in “a new dawn for health care” in the country. 

“It is a time for celebration in the Philippines… This (UHC) gives citizens access to the full continuum of health services they need, while protecting them from enduring financial hardship as a result,” WHO added.

Under the law, all Filipinos shall automatically be enrolled with the Philippine Health Insurance Corp. (PhilHealth), which is mandated to expand its benefit packages. 

Important legislation

Aside from the UHC, Duque said other important measures were also signed this year. These include the HIV and AIDS Policy Act of 2018; Republic Act 11215 or National Cancer Control Act; RA 11463 or the Malasakit Center Act and RA11346

“If you come to think of it, all other laws that are really building blocks of the UHC law. So we just have to make sure that there will be enough funding and that we need to create as much value as we can for every peso that we receive through our budgets,” he added.

The health chief said the DOH is “one of the busiest” social service agencies of the government and their “plates have never been empty.” 

“Our plates will be full (again) next year. We will make the most of it, we will continue to be very busy. We hope that we continue to win the trust and confidence of our people,” he added.

This year, the DOH had ranked 2nd in majority approval scores among government agencies based on the September Ulat ng Bayan Report of Pulse Asia. The agency garnered an approval rating of 78 percent, following the Department of Education (DepEd) with 81 percent. 

Duque also ranked second to Education Secretary Leonor Briones in approval rating among select Cabinet members, with 67 percent and 69 percent, respectively. 

Disease outbreaks 

The year was highlighted by outbreaks of three major diseases – measles, dengue and polio.

In February, Duque declared an outbreak of measles in five regions (National Capital Region, Central Luzon, Calabarzon, Western Visayas and Central Visayas) due to the soaring number of measles cases in these areas.  

Other regions were also reporting a rise in measles cases and warned of its spread if not immediately contained, which prompted the DOH to launch a series of aggressive door-to-door vaccination campaigns to augment the routine immunization at health centers. 

The rise in cases was primarily seen as a consequence of the scare created by the anti-dengue vaccine Dengvaxia in 2017 that, some claimed, led to the death of a number of children.

Because of the Dengvaxia fiasco, the agency noted, the country’s measles vaccination rate plummeted from a high of 90-95 percent to only 32 percent.

To achieve herd immunity, the DOH was aiming to achieve an immunization coverage of 95 percent among all eligible children – a level that means protection even for vulnerable members of the population who are too young to be vaccinated, the elderly and those with weak immune system. 

In August, a national dengue epidemic was declared for the first time by DOH after 146,062 people had contracted the mosquito-borne disease since January. This was 98 percent higher compared to the same period in 2018. At least 622 of them have died.

Aside from the vaccination scare, DOH explained that the increase in the number of cases this year could partly be attributed to the three-year cycle of the disease. It was in 2016 when large dengue outbreaks took place worldwide.

In September, the DOH also revealed that polio had re-emerged in the country after 12 years, as it reported the case of a three-year-old girl from Lanao del Sur.  Again, it said this was also a result of the public’s lost of confidence in vaccination. 

The girl, who was not vaccinated against the debilitating disease, had acquired the vaccine-derived poliovirus (VDPV).  

Seven more VDPV cases were documented by the DOH – those of a five-year-old boy from Laguna, four-year-old girl from Maguindanao, three-year-old girl from Sultan Kudarat, two-year-old girl from Maguindanao, one-year-old boy from Cotabato City, four-year-old girl from North Cotabato and a nine-year-old girl from Basilan. 

The DOH embarked on Sabayang Patak Kontra Polio campaigns in Mindanao, where most of the patients came from, and in Metro Manila.

Duque said parents could have realized the importance of immunization as a majority of the target children were submitted for vaccination.

“With all these very high coverage, there are indications that the Dengvaxia issue should already be laid to rest,” he added.

Expensive medicines

This year, the DOH also submitted a draft executive order to Malacañang. It proposes to President Duterte that 122 of the “most expensive but commonly used medicines” be included in the second batch of the Maximum Drug Retail Price (MDRP) list.

According to Duque, the first MDRP in 2009 only included five drugs. Under the program, the prices of medicines covered by MDRP shall go down by as much as 50 percent. 

But the Pharmaceutical and Healthcare Association of the Philippines (PHAP) has strongly opposed the MDRP as it claimed that its members have offered to cut the prices of 150 medicines by up to 75 percent.   

The group alleged that imposing a price ceiling will kill small companies and discourage pharmaceutical firms from introducing new medicines in the Philippines.

These arguments, however, were countered by Duque, who pointed out that PHAP does not have control over pricing at the levels of drug stores, suppliers, distributors and retailers.

He stressed that with MDRP, the price limits would cover the “pricing structure in the entire supply chain.”

“The market is so huge. They are saying that because they just want to protect their profitability … It is almost unconscionable for a country like ours which is a middle income country to find the prices of anti-cancer drug, for instance, higher than in countries that are much richer than us,” Duque added.

DOH data showed that generic drugs in the Philippines are sold up to four times higher than those in the international reference prices, while the branded innovator products are being peddled up to 22 times higher, especially in private hospitals and pharmacies.