Headline Dengvaxia: What President Duterte should do

MediaTitle Manila Times(manilatimes.net)

Date 08 Aug 2019 Section NEWS Order Rank 1 Language English Journalist N/A Frequency Daily

Dengvaxia: What President Duterte should do WITH a dengue epidemic officially declared by the Department of Health, the public and media pressure for a quick fix and a grand cure-all escalates, as cases near 150,000, nearly double the spread a year ago, and deaths have exceeded 600 so far. President and his Cabinet should resist it. Addressing the unprecedented dengue outbreak — DoH has not declared such an epidemic in at least two decades — must be done with thoughtful, effective measures, not populist, media-genic sound bites and gestures. The President and the Cabinet are right to defer any decision regarding the controversial Dengvaxia anti-dengue , until after a proper review of the two-year-old government ban, whatever its advocates, including those implicated in the Aquino regime’s controversial mass vaccination of 830,000 schoolchildren, may say. Health Secretary Francisco Duque 3rd said Dengvaxia would not be cost-effective, costing P1,000 a shot, and is not recommended by the World Health Organization (WHO) as an outbreak response. Duque adds that the formulation by French pharmaceuticals giant Sanofi Pasteur does not help the 5- 9 years age group that is most vulnerable. Dengvaxia is for patients age 9 or older. International data also shows that this current dengue upsurge may be the one coming around every three to four years, with infections also up in Vietnam (81,132 cases, triple last year), Thailand (about 40,500, double from 2018), Malaysia (62,421 cases this year, up 92.5 percent), and even Singapore (5,620, up 368 percent). So, the government has rightly focused efforts on destroying breeding areas of carrier mosquitoes while mobilizing more national and local government resources to care for the sick. And Dengvaxia? Not the main issue for now, though some quarters, including top medical figures, are pushing to get it approved for use amid the dengue epidemic. Who’s in charge here? So, is that it? Stop mosquitoes breeding, care for dengue victims, and down the road, reconsider Dengvaxia. Put DoH’s 4S protocol on steroids: Search and destroy breeding sites. Self-protect with mosquito nets, long sleeves and pants, and insect repellant. Seek early treatment. Spray and fumigate in hot spots. Not so fast. One thing President Duterte and the Senate and House health committees should closely look at is DoH’s anti-dengue campaign this year. Was it revved up, considering that the disease was already known to flare up every three or four years?

Notably, too, Secretary Duque was particularly conscientious in mounting anti-dengue programs during his first stint as DoH chief under then President Gloria Arroyo. One expects he would be even more vigorous now, with far greater resources. Well, the word in admittedly a few places is that the campaign might not have been as strong as before, with fumigation not done in certain areas previously sprayed. So, there may be need to assess if those in charge of anti-dengue efforts did their job. Normally, one would defer this performance review until after the dengue outbreak is over. But there may be one big reason to do the assessment now: Dengvaxia. In particular, were those holding key positions and exercising major functions in the anti-dengue campaign implicated or charged over the Dengvaxia mass vaccination? Why is that question important? Because if the anti-dengue campaign was not pursued as stringently as before, and those in charge were among the accused in Dengvaxia cases, then one has to ask if there might just be the possibility of dengue being allowed to flourish, so as to show that the Dengvaxia program was right. Already, we hear one key accused in the mass vaccination cases, Rep. Janet Garin, Aquino’s Health secretary when the Dengvaxia program was approved and funded, calling for the vaccine’s return as a weapon against the epidemic. Such a comeback, followed by dengue’s decline (since outbreaks eventually end), could be used to argue, at least in the public arena, for acquittal or at least lesser sentences for those behind the program of giving Dengvaxia to more than 800,000 children, many without parental permission. Many may ask if those health officials facing Dengvaxia cases, would go so far as to allow a dengue outbreak just to avoid prison. Well, these same officials put hundreds of thousands of children at risk, with the go-ahead of the Aquino leadership, who let the P3.5-billion vaccine purchase go ahead despite zero budget allocation and no review by the DoH panel vetting all medicine purchases by the government Bottom line: One has to raise concerns if Dengvaxia-linked officials are in charge of anti-dengue initiatives, especially if those efforts faltered under their watch, leading to the current epidemic. Their continued control of those programs may lead to more problems, with immense adverse impact on the health of millions of . And the people’s trust in the DoH, so crucial for its disease prevention programs, would be harder to rebuild with those officials in charge. Dengvaxia: In or out? Along with a probe into DoH anti-dengue programs and their implementing officials, President Duterte should revive his instructions two years ago to create an independent body with international experts to investigate the Dengvaxia controversy. That order has gone nowhere, at least judging from media reports, and now the panel is even more needed to review the vaccine ban. Like the mass vaccination controversy, the Dengvaxia ban provokes intense arguments and invectives. That makes any decision deeply divisive, and entangled with the clamor for justice for the dozens of deceased vaccinated children. Hence, there is great need to separate the criminal charges now with the Department of Justice, and the scientific question of Dengvaxia’s efficacy in preventing infections. One way to do this is through an international panel reviewing the vaccine ban, and making an impartial recommendation, with no DoH involvement raising questions of credibility and impartiality. Expediting Dengvaxia cases and reassigning affected officials away from disease programs would also help ease lingering qualms about the DoH. Quite simply, one has to ask if communities scarred by vaccine deaths would accept programs administered by officials who promoted Dengvaxia. And that could be a matter of life and death.