Spot on solutions to killer diseases

Of the four victims, three children were found not vaccinated against polio to start with.

It is quite saddening that our country continues to experience epidemic-level polio disease when this was supposedly already eradicated completely decades ago. With the resurgence of one case, but now four children found positive of polio infection, the Philippines is now in the watch list required by 19 countries where travellers must have anti-polio shots as a prior entry requirement.

Understandably so because it is the only surest way to prevent global spread of polio virus at this present time when this scourge was already considered as zero public health threat. This debilitating illness is supposedly common to afflict children because they are the most susceptible age bracket to this highly infectious virus and other life-threatening diseases, for that matter. 

The Department of Health (DOH) confirmed the country’s fourth case of vaccine-derived poliovirus (VDPV) involving a three-year-old girl from Sultan Kudarat. According to Health Secretary Francisco Duque III, the stool samples taken from the victim tested positive for polio when examined by the Research Institute for Tropical Medicine.

The girl was found to be infected with Type 2 vaccine-derived poliovirus (VDPV), which was also detected in the three-year-old girl from Lanao del Sur who became the country’s first polio case last September. After 19 years of eradicating polio in the Philippines, just one case was enough for the DOH to declare epidemic.

Of the four victims, three children were found not vaccinated against polio to start with.

The VDPV is defined by Atlanta-based Center for Disease Prevention and Control as a strain of weakened poliovirus that has “changed over time and behaves more like a wild or natural occurring virus.” The two other polio cases documented by the DOH are a five-year-old boy from Laguna and a four-year-old girl from Datu Piang in Maguindanao.

But this latest public health scare has become a problem for adults like our overseas Filipinos workers (OFWs) who are the ones directly affected by this. In fact, the Bureau of Quarantine, an agency attached to the DOH, is being swarmed by OFWs and other Filipino travellers seeking anti-polio shots at a P300 fee. Only then will they be issued with a “yellow” card, to certify having undergone this vaccination, that they must present at their ports of entry.   

Duque has reminded parents and guardians to submit their children below five years old to anti-polio vaccination when the DOH holds the next round of door-to-door immunization in Mindanao from Nov. 25 to Dec. 8. “We can defeat polio but we need the public to trust and actively participate in our immunization program,” the DOH chief urged.

In an apparent bid to address the continued vaccine scare, the DOH has moved for an early call for tender for pediatric vaccines. However, the government agency was urged to ensure that all possible vaccines are considered for 2020 to avoid the same issues and problems that the government faced in the past.

This must be considered while the 18th Congress is still in the process of approval on the proposed 2020 General Appropriations Act (GAA) and DOH crafting of the implementing rules and regulations for the Universal Health Care program.

From information we received, a total of P4.9 billion was devoted to a specific vaccine for pneumococcal diseases – the biggest vaccine-preventable cause of death in children under five years old age bracket. However, certain medical experts observed that for pneumococcal conjugate vaccines (PCV), the DOH called to bid only one type of vaccine (PCV13).

In a position paper published by the World Health Organization (WHO) in February 2019, both PCV10 and PCV13 have been shown to be safe and effective and to have both direct (in vaccinated individuals) and indirect (in unvaccinated individuals living in communities with vaccinated children) effects against pneumococcal disease.

Despite the existence of other WHO-accredited PCVs, such as PCV10, the DOH reportedly changed this to their preferred PCV13. What gives?

The WHO position paper also stated there is at present insufficient evidence of a difference in the net impact of the PCV10 and PCV13 on overall disease burden. In other words, both PCVs available in the market have comparable effectiveness in protecting children from overall pneumococcal disease.

Last Monday, the DOH Secretary had to make renewed pitch amid the lack of follow up vaccine shots required for children to have complete anti-measles protection. As he explains it, the DOH is looking into an international study that showed having measles infection reduces a person’s protection against polio and other diseases.

In particular, he pointed to the Harvard Medical School study published last Oct. 31 that cited evidence showing the measles vaccine protects “in not one but two ways” because it provides a “general boost to the immune system.” The same study further revealed that measles can “influence the reduction of the antibodies to other infections like polio, diphtheria, pertussis.”

“It’s very compelling, you really have to have your vaccination. It takes two years for the protective antibodies against other bacteria and viruses to come back,” Dr. Duque pointed out.

Then here comes Iloilo Rep. Janette Garin, who is ex-DOH Secretary, now back in Congress prodding the administration of President Rodrigo Duterte to allow anti-dengue vaccination for inclusion in the government’s free immunization program. Had Garin not bungled the Dengvaxia program during her watch as DOH Secretary, the Philippines may have addressed this mosquito-borne disease most fatal to children and elderly people. She and other administration officials are facing charges in connection with the Dengvaxia controversy.

With Duque at the helm of the DOH, there should not be a problem in implementing the government’s immunization program spot on to put an end to killer diseases that are very preventable after all. Or is there a problem, or problems that the DOH chief needs the political muscle of President Duterte?