As Philippine scientists and politicians fight over the failure of Asia’s first mass dengue vaccination programme the biggest casualty may be people’s trust and confidence in vaccination and other government-led public health programmes as effective ways to fight diseases.
When the Philippines launched the dengue vaccination programme on April 4, 2016 using Sanofi Pasteur’s Dengvaxia®, it was with great fanfare and optimism. Dengue is highly endemic in the Philippines, with an average of 200,000 cases each year.
Today, the Philippine Senate is investigating the halted public health programme, while lawyers representing dengue victims are threatening a class action suit against Sanofi Pasteur and government officials involved in it.
With the media prominently reporting on suspected dengue vaccine-related child deaths, public trust in vaccination programmes has taken a beating, extending to other public health programmes. Families in poor communities are now refusing to take part in free basic child care programmes such as deworming.
The furore began on November 29, 2017 when Sanofi Pasteur warned in a statement that people inoculated with the dengue vaccine Dengvaxia would be at ‘severe risk’ if they had not been previously infected with the virus. Dengvaxia, according to the manufacturer, gives ‘persistent protective benefit against dengue’, but only for those who have been previously infected with the disease.
Almost immediately after the news came out a number of parents came forward claiming that their children either got sick or died as a result of the vaccination programme.
Timeline to a Public Health Nightmare
Let us review the facts briefly:
- On December 22, 2015, the Philippines became the first Asian country (and second in the world after Mexico) to license Sanofi Pasteur’s vaccine, Dengvaxia.
- On April 4, 2016, just four months later, the Philippines launched its school-based mass vaccination programme without the usually required World Health Organization (WHO) pre-qualification. However, this decision was presumably based on the advice of the Strategic Advisory Group of Experts (SAGE), a 15-member panel of independent ‘experts’ which provides recommendations to the WHO on global vaccine policies.
- On April 24, 2016, or 20 days later, a total of 204,397 dengue vaccinations were completed, 362 of which had adverse reactions. By the following year, a total of 837,000 people, mostly children, had been vaccinated, all of whom come from regions where dengue is endemic.
- On November 29, 2017, the vaccine’s manufacturer, Sanofi Pasteur, issued a statement warning that people who got vaccinated with Dengvaxia would be at “severe risk” if they had not been previously infected with the virus. The warning was based on a fresh analysis of six years-worth of data from clinical studies done by the company.
- Immediately in the wake of the announcement Philippine health secretary Francisco Duque announced at a media conference that the dengue vaccination programme was halted and a review ordered.
Vaccination Programme Fallout
| The Philippines mass vaccination programme comes to a grinding halt Video uploaded to YouTube by Rappler |
In an interview SciDev.Net, Mr Duque said that the Philippine Department of Health (PDH) is looking into at least 24 deaths with suspected links to the mass vaccination programme.
Unsurprisingly the Philippine media has kept the Dengvaxia issue in the headlines ever since Sanofi Pasteur made its announcement with broadcast and social media airing dramatic and emotive photos and videos of mothers crying over dead children whose deaths have been attributed to dengue, yet who had been vaccinated.
The general public is especially critical of Sanofi Pasteur, as well as former health officials, often voicing negative opinions about vaccination itself on various social media platforms.
The Philippine Senate, through its investigative and anti-corruption Blue Ribbon Committee, has conducted several hearings on the public health programme fiasco, with former Philippine President Benigno Aquino III among those who have testified and who could face charges.
So what has been learned from this fiasco?
First, we are reminded again that haste makes waste. I confess to being gung-ho when I wrote about the launch of the Philippine dengue vaccination programme in 2016. It seemed a bold and pioneering move, considering the number of cases in the Philippines.
However, the Philippine government could have been more conservative in deploying the new vaccine, especially in this case since it involved children. Why start on such a massive scale? Testing the dengue vaccine on a smaller sample size as an extension of the clinical trials while Sanofi Pasteur completed its own tests would have been ideal.
The result is that the public is now wary of other public health programmes. This scepticism could extend more broadly to scientists talking of new technologies that could affect health, such as genetically modified (GM) foods or crops.
The trickle-down effect is causing such concern that on January 31 a group of leading Filipino physicians and scientists published a statement in leading newspapers expressing concern that the misinformation generated by the Dengvaxia controversy ‘has eroded public confidence in the country’s vaccination programmes and other public healthcare endeavours.
‘If this trend continues then we may find ourselves faced with outbreaks of debilitating and life-threatening diseases that we have already been able to control through our vaccination programmes”, the statement emphasised.
While the Philippines has the distinction of being the first country in the world to introduce Dengvaxia in a mass vaccination public health programme, it is now paying the price for this dubious ‘honour’.
At the same time it is difficult to counter claims that Filipino children appear to have been used as ‘lab rats’ in the development of a new dengue vaccine, with the scientific and health community’s reputation taking a hit as a result.
What the long term effect this will have on future public health programme initiatives in the Philippines and elsewhere is at this stage unknown.
This article was written by Crispin Maslog, a former journalist with Agence France-Presse, an environmental activist and former science professor at Silliman University and University of the Philippines Los Baños. He is a founding member and now Chair of the Board of the Asian Media Information and Communication Centre (AMICC). It first appeared on SciDev.Net’s Asia & Pacific desk under a Creative Commons License and is reproduced here with its permission.
Related:
- Sanofi tells Philippines no refund for used dengue vaccine (Channel NewsAsia)
- Philippines: 3 deaths may be linked to dengue vaccinations (Miami Herald)
- Court Orders Philippine Health Department to Answer Mothers’ Concerns about Dengue Vaccine (BenarNews)
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