Losing steam in the war vs dengue

COMMONSENSE - Marichu A. Villanueva - The Philippine Star

The vaccine, called Dengvaxia, is the first vaccine developed against dengue in the world. The World Health Organization (WHO) recommended the use of CYD-TDV or Dengvaxia, the world’s first vaccine against dengue. It is a disease due to mosquito bites that could be deadly, especially to susceptible children and the elderly.

After having passed a battery of tests, the WHO approved the introduction of the anti-dengue vaccine in geographical areas with high incidence of the mosquito-borne disease among the targeted population. The Philippines is one of the major contributors to the development of this anti-dengue vaccine.

One gets dengue when bitten by female mosquitoes infected with aedes aegypti  which breed in stagnant clean waters. Dengue patients were found to be bitten by day-biting mosquitoes, and mostly these are schoolchildren.

The Department of Health (DOH) welcomed the WHO’s position, saying this is “consistent” with the department’s introduction of the anti-dengue vaccine among nine-year-old students in public schools, especially those in vulnerable areas in the country. Children of this age bracket  are Grade 4 school students in the regions, namely, Central Luzon, Calabarzon (Cavite-Laguna-Batangas-Quezon) and Metro Manila.

The three regions were chosen by the DOH because they posted the highest number of dengue cases in the country early this year. From last April to June this year, the DOH was able to administer the first dose of the vaccine among 489,003  students in the said three regions. The second and third doses will be given six months apart – or from October to December 2016 – and 12 months after – or from April to June 2017 – from the first.

The Philippines is the first country in the world to use the anti-dengue vaccine in a mass immunization campaign.

But the country was only second on the record, next to Mexico, to issue license to the vaccine manufactured by French-based Sanofi Pasteur. The French company first launched the only dengue vaccination program in April 2016.

Last August, Brazil and El Salvador where there are also high prevalence of dengue disease started their Dengvaxia immunization program.

Following the lead of the Philippines, Mexico and Indonesia are reportedly set to launch their respective nation-wide dengue vaccination programs. Proof of the safety record and efficacy of Sanofi’s Dengvaxia vaccine perhaps can be seen from other dengue-plagued countries like Paraguay, Costa Rica, Guatemala and Peru that issued license for its use in their respective immunization programs.

But from what I gathered are reports that the DOH is not about to expand its school-based immunization program despite this WHO approved anti-dengue vaccine. DOH spokesman Eric Tayag earlier cited their program covers only Grade 4 students in public elementary schools in the National Capital Region, Central Luzon and Calabarzon.

The P3-billion dengue vaccine contract – that was entered into by former DOH Secretary Janet Garin – was reportedly put on hold. My friend and colleague, Victor Agustin wrote last Monday in his Money-Go-Round column at The STAR business section that DOH stopped last July this year the expansion of anti-dengue vaccine to other regions even after delivery of P1-billion worth of this life-saving medicine to the Philippine government.

In fact, Agustin wrote the French company’s Global Medical Director Su-Peing Ng is currently here in Manila to further explain the latest medical and scientific evidence on the vaccine and allay any doubts about the vaccine’s impact on intended beneficiaries.

Newly installed DOH Secretary Paulyn Ubial supposedly earlier announced she was subjecting Sanofi’s anti-dengue vaccine Dengvaxia to another round of medical review. When President Rodrigo Duterte assumed office last June 30, he named then undersecretary Ubial to take over as his new DOH Secretary.

Ubial claimed the DOH is monitoring vaccine efficacy because of earlier reports that the current dengue vaccine has less than 50 percent protection against dengue serotypes 1 and 2, which are the most common circulating serotypes in the country. Ubial noted the vaccine efficacy is reportedly affected by previous infection “prior to vaccination and circulating serotypes.”

The DOH had initially planned to extend the program to Region 7, covering some 300,000 students in Grade 4. The health chief assured the public earlier that DOH continues to implement, however, other anti-dengue measures in Cordillera Autonomous Region, Western Visayas, Central Visayas, Zamboanga Peninsula, Northern Mindanao, and Davao Region.

The WHO, in a position paper issued last July 29, recommended “countries should consider introduction of the dengue vaccine CYD-TDV only in geographic setting (national or subnational) where epidemiological data indicate a high burden of disease.”

WHO defined the populations to be targeted for vaccination as those with “prior infection with dengue virus of any serotype, as measured by seroprevalence, should be approximately 70 percent or greater in the age group targeted for vaccination.” As defined in medical dictionaries, seroprevalence is the “level of pathogen in a population, as measured in blood serum.”

The WHO added that dengue vaccine introduction should be part of a “comprehensive dengue control strategy, including well-executed and sustained vector control, evidence-based best practices for clinical care for all patients with dengue illness and strong dengue surveillance.” It added this will “maximize public health impact and cost-effectiveness.”

The anti-dengue program incidentally is being funded from so-called “sin” taxes or taxes from cigarettes and liquor products. Despite the heavy tax burden, our local cigarette industry somehow is surviving. Incidentally, one of them, Mighty Corp., once known as La Campana, in fact, is observing its 71st founding anniversary and reportedly having 20% of the cigarette market.

Incidentally, the Duterte administration is pushing in the 17th Congress the passage of another round of hike in “sin” taxes among the new tax bills to fund health programs of the government.

While DOH still reviewing well-tested vaccine to prevent spread of this disease, the rainy season brings with it resurgence of dengue disease in these vulnerable areas. The DOH campaign against the spread of dengue disease is losing steam by default.

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