Redirecting health priorities
UNDER THE MICROSCOPE
With the downgrading of Covid-19 from pandemic to endemic, our health system should be redirecting its priorities to other more prevalent and preventable infectious diseases. The following are the most prevalent and deadly infections/infestations that deserve a closer look:
1. Vaccine-preventable diseases like measles, chickenpox, diphtheria, dengue, and hepatitis B are still very much around, with the massive drop in vaccine confidence engendered by the Dengvaxia controversy.
The childhood vaccination program needs a reboot in the wake of the successful mass vaccination for Covid-19, which is responsible for downgrading the pandemic. There is still a significant degree of resistance from the anti-vaccine sector capitalizing on the Dengvaxia furor, which is fueled by undue publicity in the filing of court cases of alleged deaths due to the vaccine.
2. HIV/AIDS is deemed to be an epidemic in the country now. We have the fastest growth rate in HIV cases in the world. Many cases are in the late AIDS stage due to stigmatization and lack of ease in testing, caused by excessive documentation requirements, when what is needed is anonymity. We should consider the HIV prevalence as underreported due to these factors.
We need to rethink in approaches such as that for HIV, as we are seeing a rapid increase in the number of cases with the current approach. We need to work with the sectors most affected (LBGTQA+) to stem the rising incidence of HIV. Pre-exposure prophylaxis (PREP) is rapidly becoming popular, but safe-sex practices should still be emphasized, since PREP is still expensive and not widely available and is an out-of-pocket expense. Antiretroviral treatment is also available
3. TB is the number five leading cause of death in the Philippines. Despite the availability of good anti-TB medications, we are seeing a rise in drug resistance, which is fueling a more rapid spread of the disease. TB remains a serious health problem in the Philippines. The current approach of case-finding should include the wider use of rapid PCR diagnosis via GeneXpert equipment, now widely deployed in various public hospitals nationwide. It can also detect multi-drug resistant (MDR) cases that require more intensive and focused treatment. The deployment of a shorter period of treatment should encourage patients to complete their treatment course and prevent spread of MDR TB.
4. Rabies is a preventable zoonotic disease, which can be eliminated by a serious campaign to vaccinate 90 percent of dogs in the country. It is a disease with 100 percent mortality, and the death rate from rabies is also increasing. I have written about rabies before (Rabies Kills, July 12, 2022) and will not repeat what I stated. Suffice to say that this is a serious matter that should be addressed.
5. Viral respiratory infections are a group of diseases like Coronaviruses (including Covid-19), influenza, parainfluenza, adenovirus (common cold virus), respiratory syncytial virus (RSV), human metapneumovirus, and other less prevalent viruses. Our experience with the Covid-19 pandemic should help us realize the importance of prevention by masking in crowded places, hand and environmental hygiene, proper ventilation, and self-isolation when symptomatic. It also underscores the importance of the more susceptible population sectors (elderly, with co-morbidities, health care workers) availing themselves of the annual influenza vaccine. Viral respiratory infections are a common cause of morbidity and mortality, especially among the immunocompromised and the very young. Since there is underreporting of cases, we will never know the full extent of these infections.
6. Diarrheal diseases are another group preventable by proper food and water hygiene. Yet, year after year, we have high rates of typhoid fever, amebiasis, and cholera. Diarrheal diseases are intertwined with poor hygiene and are prevalent due to lack of safe drinking water, poor sanitation, and inadequate toilet facilities. With the majority of the population living below the poverty line, it is a harsh imposition on them to have to buy bottled water. The current water rationing will further exacerbate the problem. Poverty alleviation is the answer, but this is easier said than done in this country.
7. Parasitic infestations are prevalent. We have schistosomiasis, filariasis, and intestinal parasitism (mainly in children) to contend with. The Department of Health, with its programs to address schistosomiasis and filariasis, has reported significant progress in these two parasitic diseases. These are neglected tropical diseases that have to be continually addressed until eliminated.
Although the top three causes of mortality are now lifestyle diseases, with ischemic heart disease topping the list, followed by cerebrovascular disease and cancer, the sum total of the disease burden of communicable diseases far outweigh these three. The DOH has programs in place for many of these diseases, but with so many competing interests and priorities, some may have fallen by the wayside.