Vaccine-preventable diseases on the upswing again
UNDER THE MICROSCOPE
As of today, there are reports of multiple outbreaks of vaccine-preventable diseases in different areas of the country.
In Pasig City, two of 17 children with pertussis (known as whooping cough because of the sound produced by coughing in affected persons) died of the disease. Eight other children are being monitored as probable cases. Pertussis cases are also increasing in the Cordillera region. Five pertussis cases were reported in Iloilo. Quezon City declared a pertussis outbreak after recording 23 cases with four deaths, all in infants.
Pertussis is preventable with the three-in-one vaccine known as Tdap (formerly DPT) vaccine, which also protects against tetanus and diphtheria.
As of Feb. 24, 569 measles and rubella cases were reported, with all regions except Bicol and Central Visayas experiencing an increase in cases over the past month. Measles, mumps and rubella are preventable with the MMR vaccine, which is highly effective and has been used all over the world for decades.
Measles cases have been on the increase since the WHO reported the Philippines as having the largest measles outbreak in the Western Pacific region with 2,428 cases in 2017, to 20,827 cases in 2018, to 48,525 cases in 2019. The rise in cases coincided with the onset of the Dengvaxia controversy starting in 2017. It was also cited as the main cause of vaccine hesitancy among many parents, and led to doubts about the safety and efficacy of other vaccines, including MMR and Tdap.
The Vaccine Confidence Project stated that there has been a marked decline in vaccine acceptance in the Philippines from a high of 93 percent acceptance in 2015 to a low of 32 percent in 2018. This was attributed to the controversy surrounding the Dengvaxia vaccination program.
Then, news media engaged in a campaign of reporting including live televised reporting of “autopsies” on alleged Dengvaxia victims by a government agency whose mandate was to provide legal aid to poor citizens and does not have the budget for medicolegal autopsies (which the PNP and NBI are mandated to do). Even the Senate conducted hearings in aid of legislation on Dengvaxia which were attended with much publicity of grieving parents.
Dengue epidemics are now hyper-endemic, with no more seasonality but present year-round. In 2022, the Philippines reached almost 221,000 cases with 722 deaths and a case fatality ratio of 0.3 percent. This is the highest recorded figure so far.
What is sad is that DOH vaccination teams who used to be welcomed in communities are now viewed with distrust and even threatened with violence by parents who not only refuse to have their children vaccinated, but also actively prevent access to communities by health workers.
The Covid-19 pandemic severe lockdown restrictions on movement contributed to a lack of access to these childhood vaccines, causing more disruptions in vaccination programs nationwide. Hence, the Department of Health is playing catch-up to vaccinate at least 90 percent of children in order to produce herd immunity. As of 2022, only 69 percent of the target children population has been immunized with routine childhood vaccines (MMR and Tdap). This has failed to reach herd immunity levels.
These outbreaks are a huge burden on the public health system with no less than the PhilHealth reporting dengue as the number three diagnosis in claims payment amounting to almost ₱1 billion in 2021, number two diagnosis in 2022 with claims payments of almost ₱2 billion, number three again in 2023 with claims payments of over ₱759 million. We can just imagine how much the country will save had there been an effective dengue vaccination program. Unfortunately, we may never know if we continue to have widespread vaccine hesitancy.
The human cost of vaccine-preventable diseases is likewise enormous, considering the premature loss of lives and the morbidity endured by the unwitting victims of a political war they cannot comprehend nor deserve. Who knows if one or more of those lost children could have grown up to be the doctor who discovers a medical breakthrough or one who invents a device that will benefit mankind.
For once, let us put aside our animosities and biases and protect our children’s health, for they are truly this country’s future. Let the Dengvaxia trials proceed to their conclusion, whatever it may be. It should not be too much to ask for the sake of the children.
Let me state that I am a respondent of several Dengvaxia cases following a testimony in Congress in 2017. I fervently wish a quick resolution of all the Dengvaxia cases, no matter what the outcome is. As a medical practitioner, I absolutely believe in the efficacy and safety of properly tested and researched vaccines, as documented in medical literature.