UNDER THE MICROSCOPE

The last few days saw a flurry of news items on dengue hogging the headlines. First was the declaration of a dengue outbreak by the Quezon City Hall. Next was the disclosure of another eight cities/municipalities that  are expected to declare outbreaks of their own. 

Last year saw an increase of dengue cases over 2023, which were attributed to climate change. The start of this year saw an unseasonal rise in dengue cases, that has local governments scrambling for solutions. They resorted to releasing toads/frogs in canals to control mosquito reproduction, even as far as offering ₱1 for every mosquito captured, dead or alive. 

These measures of desperation are indications that the DOH-mandated 5S measures are either not being implemented or are ineffective to contain the tide of rising dengue cases, which I’ve discussed in another column (Dengue Reality Bites, Sept. 17, 2024). Emphasizing 5S seems to be a futile effort, and while other vector control measures are present, they’re either not available or require mass community actions that are difficult to implement.

Dengue control involves the virus, the mosquito vector and the person. Since controlling the mosquito vector is difficult, and virus engineering is not currently in the works, the best solution is to protect the person. The use of mosquito repellants is beyond the means of ordinary Filipinos, and no matter how you try to protect yourself, in this tropical country, the bug has a devious way of succeeding in getting to your blood.

The only effective method of personal protection is vaccination, the real infectious disease experts like Dr. Rontgene Solante say. Had the Dengvaxia vaccine not been demonized, which led to its being withdrawn from the Philippine market, these yearly outbreaks/epidemics could have been contained, just as we successfully tamed the Covid-19 pandemic with the use of vaccines.

Takeda Pharmaceuticals developed a dengue vaccine, QDENGA, which has undergone extensive clinical trials in several countries including the Philippines, which incidentally, has the biggest number of subjects. According to principal investigator Dr. Lulu Bravo, a vaccinologist, it is very safe and had no safety signals during the clinical trials. It is now in use in many countries including Indonesia, Thailand, Malaysia and Vietnam, yet its licensure in the Philippines is still pending.

It’s not a mystery why the Takeda dengue vaccine application for approval to use is languishing in the Food and Drug Administration (FDA) since April 2023. It should have been given top priority due to the hundreds of thousands of cases and many deaths, but there is a sense that the FDA officials are dilly-dallying due to the fear of a repeat of the Dengvaxia mass hysteria and the demonization of the vaccine, which spilled over to other vaccines (The Elephant in the Vaccination Room, Oct. 26, 2021)

If the FDA will continue to vacillate in evaluating the QDENGA vaccine and hope to wait it out until the Dengvaxia cases are resolved, then we will have to brace ourselves for rising numbers of dengue cases and deaths. 

There seems to be no end to the filing of new Dengvaxia cases, with many more cases filed in the Department of Justice (DOJ). Of these, the DOJ dismissed 98 cases, citing lack of evidence. A perusal of these cases show that they were “cut and paste” from the same cookie cutter pattern. But the Office of the Solicitor General (OSG) is appealing the decision.
Meanwhile, the first batch of eight cases were dismissed by the Quezon City regional trial court due to the “expert witnesses,” Cairo, Leachon and Erfe, being deemed not qualified in the subject matter, with their testimony rejected by the judge. 

It won’t be surprising if they appeal the cases all the way to the Supreme Court. With the glacial pace of justice in the country, the FDA may have to wait a decade or two before approving the new dengue vaccine.

Sans the immediate prospect of resolution of the Dengvaxia controversy, the DOH is left with the same options that, year after year, have been proven not to work. The rising number of cases have been blamed on climate change. The real truth is, we haven’t done enough to control the dengue epidemic due to vaccine hesitancy in the FDA.

Last year, The Philippine Medical Association asked that the new dengue vaccine be approved expeditiously after extensive clinical trials since 2016.

The FDA is under the Department of Health, and therefore, the Secretary of Health has overall responsibility for what the FDA does or doesn’t.

We appeal to Secretary Ted Herbosa, on behalf of the Filipino children, who are the most susceptible to dengue, to please bear upon the FDA  to approve the QDENGA vaccine.
Please act NOW to reduce the death and suffering of hundreds of thousands, majority of whom are children. One dengue death is too much, let alone  hundreds.