Revisiting Dengvaxia: Moving forward without the politics
DENGUE IS on the rise, reaching epidemic levels across the country.
Maria Rosario Vergeire, officer-in-charge of the DOH, announced during a press briefing on July 25 that the department had recorded nearly 74,000 cases since January this year. In a separate briefing on July 28, Undersecretary Beverly Ho said the figure was 96 percent higher compared to the reported cases in the same period in 2021. Ho added that at least 11 out of 17 regions have already exceeded their epidemic thresholds.
Dr. Rontgene Solante, an infectious disease specialist, had suggested in a Laging Handa briefing on July 11 that the government reconsider the data on Dengvaxia. Vergeire responded on July 12, saying the government was open to reviewing the use of the vaccine, but that they have to carefully study the evidence before it can approve it, because the Food and Drug Authority (FDA) prohibits its use.
On July 14, Teleradyo anchor Noli de Castro interviewed the Chief of the Public Attorney’s Office (PAO), Persida Acosta, and PAO’s Chief Medical Examiner, Dr. Erwin Erfe. The two officials who had led the government’s campaign against the use of Dengvaxia in 2017 presented updates on criminal cases the PAO has filed against officials who were involved in the decision to use Dengvaxia, including Janette Garin who served as Health Secretary in early 2016.
Acosta emphasized that the FDA permanently revoked Dengvaxia’s certificate of product registration in February 2019, as Sanofi failed to submit post-marketing authorization requirements to prove the product’s safety for public use. News reports in August 2019 said Sanofi had appealed the ban, but the Department of Health (DOH) upheld FDA’s decision.
On her Facebook account, Acosta posted the interviews that she and Erfe did in several radio programs.
De Castro himself was the reporter of the special series “Disgrasya sa Dengvaxia” that aired on TV Patrol in 2018. The reports featured parents mourning the deaths of their children. Acosta claimed then that Dengvaxia had caused the children’s deaths.
News will certainly pick up on the controversial vaccine if the DOH decides to review its position on the use of the vaccine in the country.
This time around, the media should include the background and context, along with current developments that might help formulate a more rational response that will diminish the threat of dengue.
Dengvaxia in the Philippines
Government measures for prevention of the disease in 2016 included the wide use of Dengvaxia, as the DOH under the second Aquino administration launched its school-based immunization program in April that year. Vaccinations were given to elementary school students in public schools in the NCR, Central Luzon and Calabarzon. More than 800,000 children received the vaccine.
In November of 2017, however, Sanofi Pasteur, the pharmaceutical company that manufactured Dengvaxia, issued a warning that recipients who had not previously contracted the disease are at risk of contracting severe dengue. This announcement and the concern of parents caused then DOH Secretary Francisco Duque III to suspend the use of Dengvaxia on December 1. Later, the FDA banned the sale and use of vaccine in the country.
The banning of Dengvaxia caused a drop in the national rate of immunization in general, including the older vaccines against childhood diseases. Health officials said parents were refusing to have their children vaccinated. Not surprisingly, the country experienced an outbreak of measles and polio cases, a disease long eradicated by the Salk vaccine. In August 2019, the DOH declared a national dengue epidemic.
Media coverage (2017-2018)
CMFR monitors from December 2017 to February 2018 noted the narrow scope of media coverage of the Dengvaxia issue and criticized how government statements dominated the news. The discussion had moved from the actual dangers posed by dengue and the risks of using Dengvaxia – an issue best discussed by doctors and other scientists. Media focused more on what was said by officials, and the finger-pointing, fault-finding about the use of Dengvaxia. The legislative hearings were more focused on exacting accountability from officials who implemented the Dengvaxia mass immunization program.
Outside Congress, the PAO surprisingly led the drive against the use of the vaccine, including filing criminal cases against officials during the previous administration. PAO searched out deaths of children, trying to establish sufficient evidence that Dengvaxia was the cause.
PAO chief Acosta, a lawyer by profession and not a physician, persisted with her investigation of cases, as parents and other communities were convinced that the deaths of children were due to the vaccine.
Media should have known better. But reports echoed PAO’s recitation of the results of autopsies done on exhumed corpses of children who had received the vaccine and then died. Scenes of parents’ grief and anger became a staple on TV news. Acosta and Dr. Erfe, who performed the autopsies, claimed the children died specifically because of Dengvaxia, but no other forensic experts were consulted about the reliability of that claim.
In December 2017, the DOH commissioned an independent panel of expert physicians from the University of the Philippines- Philippine General Hospital to perform their own investigation. The panel found that of 14 children examined, three died due to dengue despite receiving Dengvaxia. The panel did not conclude that Dengvaxia caused any of the deaths. Media picked up the findings as announced in February 2018, but did not give the work of the panel any prominence. The news about this crucial development did not match the space and time given to PAO’s claims.
Fear and misinformation
The politicized treatment of Dengvaxia in mainstream media did little to promote
informed public discussions. The misinformation was similarly replete in social media. Writing for First Draft News, journalists Jacquelyn Mason and Rory Smith said their examination of social media content from the Philippines showed that between December 2017 and February 2018, Dengvaxia was a popular topic, but the posts were “spurious, comprised of exaggerated claims and conspiratorial content.”
Existing gaps in childhood vaccination were exacerbated by these developments. On its website, the World Health Organization (WHO) reported in 2019 that the Philippines has had persistent low immunization coverage for measles in the past decade, consistently missing the optimal rate of 95 percent. Coverage was above 80 percent in 2008; it decreased to below 70 percent in 2017 and dropped further to 44 percent in 2018.
Other experts reported the negative impact on vaccination.
A 2018 paper by Heidi Larson, Kenneth Hartigan-Go and Alexandre de Figueiredo said dengue cases in the Philippines did drop in 2017, but news of Dengvaxia’s risks “overwhelmed any perception of vaccine benefit.” Citing the Vaccine Confidence Project of the London School of Hygiene & Tropical Medicine, the authors said the findings for the Philippines, which compared rates in 2015 and 2018, reflected “dramatic drops” in vaccine confidence, in perception of vaccine safety and belief in vaccine effectiveness. For these three categories, the rates dropped from a high 80 to 90 percent to as low as 20 percent.
Unfortunately, the Dengvaxia scare overtook discussion of the merits of the vaccine. In a 2021 paper, faculty of the Ateneo de Manila University correctly pointed out that the Philippine’s vaccination program for Dengvaxia and its target population adhered to WHO recommendations on the basis of available scientific evidence on safety and efficacy.
Updates on Dengvaxia
The Philippine Daily Inquirer reported in September 2019 that with the ban on Dengvaxia, “well-off” Filipino parents were sending children to neighboring Southeast Asian countries to be inoculated. Indonesia, Thailand and Singapore are currently offering the vaccine, in compliance with WHO recommendations that it be given only to individuals who had been previously infected with dengue.
The Inquirer added that in Singapore, serological testing to determine prior infection is available. Dr. Edsel Salvana, an infectious disease specialist, acknowledged this measure in a July 15 interview with ANC, saying Dengvaxia is effective in preventing severe disease as long as it is used properly.
The Philippines is currently recording high numbers of COVID-19 and dengue, with some patients reportedly contracting both. The severe challenge these two threats pose should remind all policy actors, in government and in other institutions, to hold discussions without politics and partisanship.
The media play a part in any development, for good or bad. Clearly, in times of public health emergencies, journalists should be sensitive to the risk that their reports might contribute to greater public hazard and the endangerment of lives. All policy formation must be based on correct information, scientific facts and data; and this becomes even more imperative in the realm of public health.
Physicians Gideon Lasco and Vincen Gregory Yu wrote for the British Medical Journal in 2021 that scientific institutions must take the lead in communications. They said these “remain our most credible sources of information; thus, they must lead without interference — or perceived interference — from partisan figures.”
Media, they wrote, “must ensure that the information being relayed to the public do not get sensationalized or distorted.”
Indeed, media must take the lead. News can form sound public opinion, but only if journalists are willing to do the hard work of diving deep into facts, data and scientific information as warranted by the subject. As global health crises now confront the entire world with unprecedented challenges; journalism must rise to the occasion and scale up reporting so as to encourage sound and rational public discourse. Journalists themselves must continue learning as they work in order to provide news that is updated with the latest scientific information. It is also important that journalists work to make such information understandable and interesting to ordinary people.