IMPORTANCE OF RESEARCH TO PUBLIC HEALTH

Public health is a field for people who care about the greater good of human beings. Millions of
people are alive today thanks to a handful of public health initiatives, such as vaccination
programs, motor vehicle safety laws, restrictions on the use of tobacco, family planning, and
clean air and water standards.

The field of public health is constantly evolving in response to the needs of communities and
populations around the world. The underlying mission of public health is to improve the
conditions and behaviors that affect health so that all people can attain it. That mission includes
not only the practice of public health policy, but the research of public health issues and the
education of future leaders who eventually will translate that research into practices and policies
to improve the health of people regionally, nationally, and globally. The type of research needed
does not require resourcing on a scale comparable with that necessary for the development of
new drugs. It does, however, require qualitative and quantitative research capacity to engage in
a variety of research methods, including research that uncovers the nature and extent of
underlying health problems and their root causes (including determinants in and beyond the
health sector); examines the relevance and transferability of knowledge and tools developed
elsewhere; experiments with adaptations to local conditions and contexts; explores the scaling-
up and sustainability of interventions; monitors and evaluates the effectiveness of interventions
and the degree to which they are successful; measures the efficiency and cost-effectiveness of
all elements in the process; and explores social, economic, national and international obstacles
to closing this gap and attempts to find solutions.

The need for more research is never ending. The knowledge and tools available are not always
adequate to tackle existing health problems and there is a constant and never-ending need to
generate new information and develop improved and more effective ways of protecting and
promoting health and of reducing disease. This has always generated a dilemma for
policymakers: whether to support research that may lead eventually to improved interventions
and better outcomes, at the expense of diverting scarce resources from the immediate
deployment of existing knowledge. Time and again, research has demonstrated its value in the
longer term. For example, to the research done to conclude the link between smoking and lung
cancer leading now to large and sustained reductions in cancer incidence in the developed
countries, while smoking incidence in many developing countries is increasing. Some
contemporary examples of the continuing needs for research include:

 Growing microbiological resistance in, for example, diseases like tuberculosis and
malaria.
 Absence of effective treatments for diseases in low-income countries such as dengue
fever.
 The dengue vaccine dilemma
 Treatment and prevention in HIV/AIDS
 Preparedness for new/emerging infections w Need for new knowledge about the global
factors that influence health
 Need for new knowledge about local contexts, conditions and health priorities
 Need for new knowledge about social, political, economic and environmental
determinants of health, especially in understanding how to increase health equity within
and between countries
 Health policy and systems research – how to make the health system perform better
  Need to understand and monitor impacts of global policies on trade and of globalization
on the health of individuals, family, community and countries
 Research on environmental health, the interaction between economic activity,
environment and human health, which is of more and more pertinence to developing
countries
 Need for new knowledge about what people need to be and to remain healthy
 Need to understand how to best use research not only for health improvements, but also
for social and economic development – in an equitable manner.

This list is far from exhaustive. Thus, beyond the adoption, adaptation and application of
existing knowledge, there remains a substantial need for research to create new knowledge and
technologies and to translate these into effective interventions that will enable people to be
healthy … everywhere.

References:

Alliance for Health Policy and Systems Research. Strengthening Health Systems: The role and
promise of policy and systems research. Geneva: Alliance for Health Policy and Systems
Research, 2006.

Commission on Health Research for Development. Health Research. Essential Link to Equity in
Development. New York: Oxford University Press, 1990.

The Lancet. Infectious Diseases. Elsevier Ltd, 2018 .

https://doi.org/10.1016/S1473-3099(18)30023-9

Paris Declaration on Aid Effectiveness, 2005. http://www.oecd.org/dataoecd/11/41/34428351.pdf

World Health Organization (WHO) Ad Hoc Committee on Health Research Relating to Future
Intervention Options, Investing in health research and development. Geneva: WHO, 1996.
http://www.who.int/tdr/publications/publications/investing_report.html

Research Title. “INVESTIGATING VACCINE HESISTANCY AMONG TARLAQUEÑOS:

DESCRIPTION OF VACCINE ATTITUDES, BELIEFS, AND PERCEPTION AFTER DENGVAXIA
CONTROVERSY.”

STATEMENT OF THE PROBLEM

 1. What are the attitudes and beliefs of Tarlaqueños with respect to vaccines and
immunization, and do the latter differ before and after the dengvaxia scares controversy?

2. What are salient factors associated with individual decision-making and behavior in
relation to vaccination?

3. How the Dengvaxia controversy do affects the perception of Tarlaqueños towards the
immunization program of the Philippine government?

4. Does the past year’s effort at damage control towards Dengvaxia controversy enough to
regain public trust on safety and efficacy of vaccines given by the government?

REVIEW OF RELATED LITERATURE

Local Literature

Almost a year after the Dengvaxia controversy caused a media frenzy, the Department of Health
(DOH) said people are still scared of government’s free vaccines and the biggest losers are
Filipino children.

DOH National Immunization Program Manager Maria Silva said on Wednesday, September 26,
2018 parents are still unwilling to have their children immunized in their various vaccination
programs. A “very low (vaccination) coverage for most regions” in the Philippines has resulted in
several outbreaks of preventable diseases such as measles in early 2018.

“Not only were the 3 regions plus Cebu province that implemented dengue vaccination affected
because of the dengue controversy. But it’s all over the Philippines” Silva said during a forum of
health journalists. Because of controversies left and right left by the dengue vaccine, it harms
other vital vaccination programs. This is one of the challenges that are really putting the DOH
down. In February 2018, Health Undersecretary Enrique Domingo said that only 60% of
children were getting their scheduled vaccines. The DOH’s annual vaccination rate target is
between 85 to 90%. A few months later, they have not reached their targets.

Until a year after the controversy , the DOD haven’t hit 90%, the coverage remains at about
about 50 to 60%.

The Dengvaxia controversy started in November 2017 vaccine after its manufacturer Sanofi
Pasteur released an advisory warning that its vaccine could cause a person to later develop
severe dengue if he or she had not been infected by the virus prior to immunization. The “very
low (vaccination) coverage for most regions” in the Philippines has resulted in
several outbreaks of preventable diseases such as measles in early 2018.

Data in 2018 showed 19 out of 154 kids died of dengue despite getting immunize with the
Dengvaxia vaccine.

Silva said the health department’s “Ligtas Tigdas” supplemental immunization activities (SIA) as
well as the school-based and community immunization programs took the biggest hits affected
vaccination program. The “Ligtas Tigdas” SIAs were carried out to address the several measles
outbreaks that occurred in early 2018. The SIAs were done in Metro Manila and Mindanao to
achieve “herd immunity” status, wherein people who already have measles will be “walled off”
from the rest of the population.

Silva claims that the Dengvaxia issue resulted to a very low MCV1 and MCV 2 (measles
continuing vaccine) coverage, which is why we had outbreaks left and right.

Data from the DOH showed that in Metro Manila, as little as 36% of children received the
measles vaccine during the campaign. Silva also said the DOH’s school-based immunization
program was also hit hard.

Focus group discussions with health workers, community members, and local leaders done by
the health department revealed this much since this was the platform used to administer the
risky dengue vaccine introduced under then-Health Secretary Janette Garin in April 2016.
When it comes to the regular school-based immuninization, this is what had recall for
Dengvaxia. Many mothers did not give consent for their children (to be vaccinated) for fear it
might end up like Dengvaxia. That’s what has been greatly affected.

This alarmed the DOH as it is through the school-based immunization program that vaccines for
diseases like measles, rubella, tetanus, diphtheria, and cervical cancer are given to elementary
students.

Silva noted a drastic drop in the human papilloma vaccines for cervical cancer program. From
77% of female students covered for its first dose, only 8% availed of the second dose. She
added the refusal rate for the vaccine ranged from 50% to 80%, with Metro Manila having the
highest refusal rate.

The SIAs that were community based or done done door-to-door were also greatly affected.
Silva again attributed this to parents’ recall of Dengvaxia, which had been expanded to cover
communities under then-Health Secretary Paulyn Ubial.

DOH Undersecretary Enrique Domingo says less kids are getting vaccinated after the
Dengvaxia scare. Domingo likewise told reporters that in Metro Manila, health workers would
spend up to 30 minutes trying to convince parents to have their children vaccinated.

The Department of Health is trying to address the issue. A “mixed-strategy” approach is being
eyed by the DOH as discussions also showed that individuals willingness to be vaccinated may
depend on where immunization was given.

For instance, Silva said that routine immunization for babies in health centers were not greatly
affected in the aftermath of the Dengvaxia controversy. Meanwhile, health workers also found
that in some areas, more residents would bring their children for vaccinations if there was a
designated spot to give out immunization shots.

Seeing this was the case, Silva said the DOH would leave it to the discretion of health workers
who were the “best authority” to determine what strategy would be used to serve communities.

Silva also hoped that over time, it would be the norm once again to have children vaccinated.
Working harder is essential to get trust back.

While over 80 kilometres span the distance between the Baseco Compound in Manila and the
Bulaon Resettlement in the City of San Fernando, Pampanga, both communities have
similarities when it comes to vaccines. Both areas have seen the same challenges and have
solved some bottlenecks thanks to vaccine heroes in their community.
Baseco in Metro Manila and Bulaon in Central Luzon (Region 3) were part of the communities
where the controversial Dengvaxia was introduced. This exacerbated the already declining
immunization coverage in the Philippines. Both Baseco and Bulaon were part of the
communities that had measles outbreak early in 2019.
The dengue vaccine issue worsened the confidence of Filipinos to vaccines in general. A study
from the London School of Hygiene and Tropical Medicine showed that Filipinos who believe
“that vaccines are important, are safe and are effective” dropped from close to 100% in 2015 to
60-80% in 2018.
Health workers facing challenges on the frontlines. Health workers, who were the on the front
lines when the dengue controversy and measles outbreak occurred, particularly felt the
challenge in the community. In San Fernando, they had an added task of introducing the
Japanese encephalitis vaccine, WHO-prequalified vaccine that was introduced this year in
Ilocos Region, Cagayan Valley, Central Luzon and Cordillera Administrative Region. Japanese
encephalitis is endemic in the Philippines and there have been many cases reported from this
mosquito-borne disease in Central Luzon. The region also saw 1000% increase in measles
cases in 2019 compared to 2018. While over 80 kilometres span the distance between the
Baseco Compound in Manila and the Bulaon Resettlement in the City of San Fernando,
Pampanga, both communities have similarities when it comes to vaccines. Both areas have
seen the same challenges and have solved some bottlenecks thanks to vaccine heroes in their
community.
Baseco in Metro Manila and Bulaon in Central Luzon (Region 3) were part of the communities
where the controversial Dengvaxia was introduced. This exacerbated the already declining
immunization coverage in the Philippines. Both Baseco and Bulaon were part of the
communities that had measles outbreak early in 2019.
The dengue vaccine issue worsened the confidence of Filipinos to vaccines in general. A study
from the London School of Hygiene and Tropical Medicine showed that Filipinos who believe
“that vaccines are important, are safe and are effective” dropped from close to 100% in 2015 to
60-80% in 2018.
Dr Renely Tungol, a rural health physician and coordinator of the Expanded Programme on
Immunization in the City of San Fernando explained that people perceives vaccines from the
government as fake and low quality and this remain their challenge in immunization. So our
challenge really is to promote specific vaccines so that Fernandinos will support the
immunization program.
To address these challenges, every day heroes – from health workers to parents – are helping
to ensure that the community is protected with vaccines. In Baseco, barangay health worker
Christina makes sure she is able to visit all the 900 households in her jurisdiction. She goes
around and talks to parents one by one to explain the importance of vaccines.
She went house to house and convinced mother of recipients. I tell them that we need to work
together for the sake of their children. That’s our job as vaccine champions – we find those who
have not had their vaccines so that they are safe from measles and other diseases,” said
Christina. “We were able to encourage them, so gradually their trust in vaccines and with the
health center has returned. The efforts of barangay health workers like Christina have resulted
in zero new measles cases in Baseco.. In Bulaon, San Fernando, health workers from the
region to the barangay are introducing a different approach to promoting vaccines by working
with multisector influencers. Dr. Tungol claimed that they had an innovative project where they
tapped famous Fernandinos in the religious sector, business sector, and medical sector so that
they could help convince the people of San Fernando that vaccines are the most important
shield against diseases,” explained Dr Tungol. They are also using electric bicycles to
strengthen their community mobilization. These initiatives resulted in gains to the San Fernando
community. In just a month, they were able to cover over 90% of their defaulters and the people
are continuing to visit the health centers for regular immunization.
While she admires how the health workers have handled the challenges in the community, she
hopes that there are more health workers to help spread the word more about vaccines
especially in her community in Baseco to help mothers who are not aware about immunization
become more aware.

Tapped by former Justice Secretary Vitaliano Aguirre II to aid Dengvaxia victims in late 2017,
Public Attorney’s Office chief Persida Acosta has since become the face of those allegedly
affected by the controversial anti-dengue vaccine. Her office's forensics team—led by Erwin
Erfe—performed its own autopsies on vaccinated children and concluded that Dengvaxia is
directly linked to the deaths of at least 105 individuals despite no solid evidence. PAO is an
agency that provides free legal assistance to the poor.
But an expert panel from the University of the Philippines-Philippine General Hospital in
February last year found that the deaths of 14 children inoculated with Dengvaxia were “totally
not related to the vaccine” except for two cases, which may have been because of vaccine
failure.

Despite this, PAO insisted that its team has seen a “pattern” in autopsies.

Acosta, who in the past had shed tears in television interviews and spoken in high pitch
whenever accusing opponents, has been accused of grandstanding the Dengvaxia crisis and
has been blamed for putting the country's immunization programs at risk.

On December 2018, Doctors for Truth and Welfare, led by former Health chief Esperanza
Cabral, called Acosta and PAO forensics head Erwin Erfe “unqualified but noisy people who are
largely responsible for the fall of vaccine confidence in the country.”

In a statement last week, Health Secretary Francisco Duque III stressed that Acosta’s
“baseless” statements have eroded the agency’s reputation and affected trust in vaccines.

PAO claims that Dengvaxia killed vaccinated children. In November 2017, the DOH suspended
the government's dengue vaccination program following the announcement of French
pharmaceutical company Sanofi Pasteur that Dengvaxia could cause severe dengue if given to
those without prior exposure to dengue. Over 800,000 schoolchildren had already received the
vaccine when the administration of Dengvaxia was stopped.

While other countries dealt with Sanofi's announcement by updating guidelines, the news
sparked political drama, public outcry and a breakdown of trust in the Philippines.

Shortly after the announcement, the PAO, particularly Acosta and Erfe, began directly linking the
deaths of children to the vaccine.

Erfe, whose competence to speak on a matter that is the expertise of forensic pathologists has
been questioned by experts like Dr. Raquel Fortun, claimed there is a “pattern” in his autopsies,
with the children's organs enlarged and suffered from internal bleeding.He also said that the
children's symptoms occurred within six months after getting a shot of Dengvaxia.

As Erfe announced, The PAO forensic team had autopsied 105 of those who died of Dengvaxia,
they all manifested a 'Dengvaxia death pattern. They all showed what Sanofi had admitted—that
its vaccine can cause deadly adverse effects of viscerotropism, neurotropism, severe dengue
and anaphylactic reaction,” Erfe told The STAR.

But UP-PGH forensic pathologist Maria Cecilia Lim explained that internal bleeding or
hemorrhage and even enlargement of organs are not unique conditions for dengue cases.

Pathologist Raymundo Lo, one of those named in the suit filed by PAO against officials of the
Philippine Children's Medical Center, slammed the “incompetencies” of Erfe's autopsies, which
he said, were performed “without any training.”

The Cabral-led Doctors for Truth and Welfare stressed that Erfe and Acosta “should be held
accountable for the thousands of disabilities and deaths that could have been, and could be
avoided, were it not for their responsible behavior.”

PAO refused to cooperate with the UP-PGH experts on the conduct of forensic examinations,
claiming conflict of interest. The expert panel, however, was composed of pediatricians,
pathologists and other specialists with no financial or intellectual ties to Sanofi Pasteur.

Dengvaxia killed vaccinated children, PAO claims

In November 2017, the DOH suspended the government's dengue vaccination program
following the announcement of French pharmaceutical company Sanofi Pasteur that Dengvaxia
could cause severe dengue if given to those without prior exposure to dengue. Over 800,000
schoolchildren had already received the vaccine when the administration of Dengvaxia was
stopped.

While other countries dealt with Sanofi's announcement by updating guidelines, the news
sparked political drama, public outcry and a breakdown of trust in the Philippines.

Shortly after the announcement, the PAO, particularly Acosta and Erfe, began directly linking the
deaths of children to the vaccine.

Erfe, whose competence to speak on a matter that is the expertise of forensic pathologists has
been questioned by experts like Dr. Raquel Fortun, claimed there is a “pattern” in his autopsies,
with the children's organs enlarged and suffered from internal bleeding.He also said that the
children's symptoms occurred within six months after getting a shot of Dengvaxia.

DOH Defines Vaccine Hesitancy as One of the Reasons for Measles Outbreak
The Department of Health (DOH) today points to vaccine hesitancy as one of the reasons for
the recent measles outbreak in some regions of the country.

Validated data from different regions of the country by the Epidemiology Bureau of DoH
revealed that from 1 January to 9 February this year, a total of 4,302 measles cases have been
reported, with 70 deaths.
Ages of cases ranged from 1 month up to 75 years old with 1 to 4 years old (34%) followed by
less than 9 months old (27%) as the most affected age-groups. Sixty-six percent of them had
no history of vaccination against measles.
Of the total deaths, ages ranged from one month to 31 years old. Notably, 79% of those who
died had no history of vaccination.

Regions with high reported cases are NCR (1,296 cases and 18 deaths) CALABARZON (1,086
cases and 25 deaths), Central Luzon (481 cases with 3 deaths), Western Visayas (212 cases
and 4 deaths) and Northern Mindanao (189 cases and 2 deaths).

Eastern Visayas, MIMAROPA, CALABARZON, Central Visayas and Bicol are regions that have
shown increasing trend as to reported cases for this week.

Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of

vaccination services.

The causes of measles outbreak involved a number of factors or elements. Loss of public
confidence and trust in vaccines in the immunization program brought about by the Dengvaxia
controversy has been documented as one of many factors that contributed to vaccine hesitancy
in the country. This refers to mothers who became hesitant to have their children vaccinated
with vaccines that were long proven to be effective.

On October 2018, the World Health Organization conducted a study in selected areas in Metro
Manila to identify reasons for not bringing their children for immunization. The top reasons are
the following: fear due to Dengvaxia, and the lack of time among households.

Moreover, results of the vaccine confidence project in 2015 against 2018 by London School of
Hygiene and Tropical Medicine on the respondents’ views that vaccines are important
decreased from 93% to 32%; safe and effective from 82% down to 21% and vaccine confidence
dropped from 93 to 32% respectively.

DOH has been conducting vaccination activities against measles such as Outbreak
Immunization Responses (ORI) in several regions. This was followed by a nationwide
Supplemental Immunization Activity (SIA) for 6 to 59 months old which was conducted in 2
phases - in April 2018 (NCR and Mindanao) and in September 2018 (other parts of Luzon and
Visayas). Despite the efforts of health workers, the SIA campaign had achieved a coverage of
69% during Phase 1 of implementation and 29% in Phase 2.

Health Secretary Francisco T. Duque III appealed to the public to rebuild their trust and
confidence in vaccines that were long proven to be effective, and I am quite sure that all of us
sometime in our lives have been recipients of these vaccines which had protected us from
various diseases.

Foreign Literature

Dengue is a viral infection found in tropical and sub-tropical climates worldwide . It is the most
rapidly spreading mosquito-borne viral disease . During the past five decades, the global
incidence of dengue has risen 30-fold, with the disease now endemic in more than 100
countries . So far there is no specific treatment for dengue infection .

The quest for a suitable vaccine for dengue has been ongoing for the last six decades . In one
such effort, Sanofi, one of the biggest multinational pharmaceutical companies, developed the
world’s first dengue vaccine - Dengvaxia. The vaccine is now approved in 19 countries and was
used in vaccination campaigns in Philippines, involving more than 800 000 school children .

Soon after its authorization, Dengvaxia has now become a subject to controversy following
Sanofi’s recent analysis which suggests that the vaccine may put some people at an increased
risk of a more severe form of dengue . Dengvaxia was found to reduce the overall risk of severe
dengue and hospitalizations due to this disease . This protection, however, was more apparent
in those who had a prior history of dengue infection. Sanofi recently discovered that individuals
who have never had a dengue infection before pose a significantly higher risk of a more severe
form of the disease and hospitalizations with Dengvaxia than if they had not been vaccinated
against dengue at all .

Considering dengue infection rates reach up to 90% in Philippines, majority of the school
children who were inoculated with Dengvaxia will get the protective benefits of the vaccine. This
projection, however, means that at least 10% or around 80 000 of those children who do not
have a prior history of dengue infection are now at an increased risk of developing severe
dengue . Dengvaxia’s sale and distribution has been suspended in Philippines but due to the
fear resulting from this controversy, parents are now refusing to vaccinate their children even
against vaccine preventable diseases, giving rise to a phenomenon known as Vaccine
Hesitancy .

“Vaccine hesitancy” refers to delay in acceptance or refusal of safe vaccines despite the
availability of vaccination services. Even today, 1 in 5 children worldwide fail to receive routine
immunization, and about 1.5 million children die each year of diseases that could be prevented
by vaccination . Concern over vaccine safety is one of the most dominant reasons for vaccine
hesitancy. Earlier, these concerns were mainly due to widely circulating media reports
highlighting a rare occurrence of an adverse reaction to a vaccine, or associating certain
disorders to vaccines or their components . Most of these concerns, however, were based on
rumors rather than the facts and yet somehow managed to instill fear in the hearts and minds of
parents. Unfortunately, the crisis that we are dealing with now is based on results from clinical
trials backed up by autopsies linking some deaths to Dengvaxia . These findings may serve as
proof against vaccine safety and might have a negative impact on other vaccination programs.
With the news being widely circulated through media, this would not just affect Philippines but
also other parts of the world.

In light of the above discussion, it is necessary to educate the public regarding safety and
success of all other available vaccines through mass education programs, awareness
campaigns and conferences to overcome fear and confusion. Media can play a key role in
eliminating misconceptions and skepticism resulting from this controversy. Highlighting the
positive roles and benefits vaccination campaigns possess may prove to be efficacious as
previous vaccination programs have had a tremendous success rate in reducing the mortality
and morbidity of various infectious diseases worldwide. It must be emphasized that this
particular crisis should not be linked with other vaccines and that the medical sector should be
trusted in the formation of newer dengue vaccines. Considering the scale and scope of this
issue, all government and non-government health care authorities must work together in efforts
to regain parents’ trust. WHO, being a global organization, should play its part in supporting and
sustaining public health by helping prevent a drop in vaccination rates and ensuring the
acceptability of future vaccines.

Public Trust In Vaccines Plummets After Dengvaxia Controversy. Confidence in vaccine safety
and efficacy have declined precipitously following the Dengvaxia scandal in 2017.

AsianScientist (Oct. 18, 2018) – The Philippines’ highly politicized response to newly-reported
risks of a dengue vaccine led to a dramatic drop in public trust in vaccines, according to a study
published in Human Vaccines & Immunotherapeutics. Dengue is a viral infection spread mainly
by the bite of the Aedes aegypti mosquito, which is widespread in the Southern hemisphere.
The symptoms of infection include fever, headache and pain in the joints and muscles. In some
cases, death may even occur. With the number of dengue cases in the Philippines rising from
2012 to 2015, it was hoped that an immunization campaign with a new dengue vaccine licensed
in December 2015 (Dengvaxia), would stem the spread. However, in November 2017, the
manufacturer, Sanofi Pasteur, announced that Dengvaxia posed a risk to people who had not
previously been exposed to dengue. While other countries dealt with this assessment by
updating their guidelines and labeling accordingly, the news triggered outrage and political
turmoil in the Philippines, leading to broken public trust in the dengue vaccine and anxiety
around vaccines in general. In the present study led by the London School of Hygiene &
Tropical Medicine (LSHTM), UK, researchers measured the impact of the Dengvaxia crisis on
overall vaccine confidence before and after the manufacturer highlighted the risk associated
with the vaccine. The study of 1,500 participants revealed a dramatic drop in vaccine
confidence. Whereas in 2015, 93 percent of the participants strongly agreed that vaccines are
important, this statistic fell to just 32 percent in 2018. The positive perception of vaccine safety
also took a hit. In 2015, 82 percent of the participants strongly agreed that vaccines are safe.
This was reduced to 21 percent in 2018. Similarly, confidence in the effectiveness of vaccines
dropped from 82 percent in 2015 to 22 percent in 2018. “The Sanofi announcement was a spark
that fueled the flames of underlying political ferment in the Philippines. Health authorities and
immunization programs cannot solve political tensions, but trust issues and potential areas of
anxiety and possible dissent must be considered in advance of a pandemic. This is especially
important in an era of social media and the ability for mis-information to be spread far and wide
at the touch of a button,” said lead author Professor Heidi Larson, director of the Vaccine
Confidence Project at LSHTM. “We cannot wait until pandemics strike; we must make trust-
building an ongoing effort, preparing the ground for the next ‘big one’, when trust and
cooperation will be key to containing the spread of disease and mitigating its health and societal
impacts,” she added.

The Philippines declares national epidemic as cases surge across South East Asia. The
government of the Philippines has declared a national epidemic of dengue fever for the first time
this century, as the number of infections surged to twice last year’s toll, killing 622 people, many
of them young children.

The country recorded 146 062 dengue cases from January to 20 July, 2019 98% more than in
the same period in 2018.

The health secretary, Francisco Duque, told a press conference on 7 August 2019 that his
ministry was now recording more than 5000 new cases a week. “This is really staggering,” he
said. “This is going to be a record number.”

As reported on February 13, 2019 by the Washington Post, The Philippine had been in a
measles crisis after it was gripped by a fear of vaccines. Doctors in the Philippine capital are
battling an acute measles crisis, with more than 4,000 cases and 70 deaths so far, that has
been blamed in part on an unwillingness to immunize babies after a scare surrounding a
separate vaccination program last year.

The Philippines crisis comes as the United States is also dealing with new measles outbreaks,
especially in parts of Washington state where the anti-vaccine movement is strong.

Health and government authorities are now pleading with parents to vaccinate their children,
noting that unvaccinated babies have accounted for a vast majority of the deaths.

The number of measles cases last year soared by 547 percent, according to the Philippine
Pediatric Society, to more than 5,000 confirmed cases. And that number is climbing even higher
in the first months of this year, causing chaos in children’s wards and overwhelming doctors in
both urban and more rural parts of the country.

“Do not be lulled and complacent about it, because infants really need that,” President Rodrigo
Duterte said in a speech in late January. He added vaccines are “good, and . . . for the health of
the person.”

The spread of the disease is a huge setback to a country that had been on its way to eliminating
measles in 2010, and it underscores the dangers of movements against vaccinations. Just over
a decade ago, in 2005, the Philippines had almost no deaths from measles, according to the
Philippine Foundation for Vaccination.

It also follows a global wave of measles outbreaks — with 6.7 million cases worldwide in 2017
— including in parts of the United States and Europe, similarly fed by conspiracy theories and
misinformation.

The Health Department first declared the measles outbreak in metropolitan Manila in early
February and has since expanded it across other areas on the islands of Luzon and the
Visayas. Cases have increased 122 percent compared with the same period last year. Manila, a
chaotic, crowded city dotted with high-rises and slums, is home to 12.8 million people.

But experts say the country has already been fighting the spread of the disease in more rural
parts of the archipelago, where doctors struggle to get communities vaccinated. The Philippines’
UNICEF representative, Lotta Sylwander, said the agency has been working with the country’s
Ministry of Health to raise the alert level “for some time now.”

She claims that it seems like it was not until it reached Manila that it was declared an
emergency and a very urgent problem.

Health Secretary Francisco Duque and other members of the medical community attribute the
newfound fear of immunization to a dengue vaccine scare in 2018.
The controversy began in 2017, when pharmaceutical company Sanofi Pasteur made a sudden
announcement that its Dengvaxia vaccine could lead to severe cases of dengue among those
who had not contracted the disease before. This threw concerned parents and the public into a
frenzy, as Dengvaxia had been administered to more than 8,000 public school students in a
mass immunization program the year before.

The political blame game that followed included an investigation from the Public Attorney’s
Office into the deaths of 39 children. Its officials prematurely linked a fraction of those deaths to
the vaccine, and health professionals later slammed the office for being unqualified to draw
such conclusions.

The media, too, has been accused of adding fuel to the fear. The Center for Media Freedom
and Responsibility found that three major newspapers concentrated on the “politics” of the
scare, and it said a broadcast network sensationalized the issue by running footage of
emotionally distraught parents.

The media watchdog said local news outlets should have highlighted that the Public Attorney’s
Office findings “were not conclusive, and as such, should not have been given so much
prominence, if it was to be reported at all.”

What the Health Department identifies as “vaccine hesitancy” also comes amid a resistance to
immunization in the West. Lulu C. Bravo, executive director of the Philippine Foundation for
Vaccination, said the country has had its fair share of vaccination skeptics — but they never had
much impact until the dengue vaccine controversy. Lulu C. Bravo claims that the anti-vaccine
group was also being felt in the Philippines but it is not as huge as in the U.S. or Europe. The
Dengvaxia scare really gave a fatal blow to our vaccination program. She described how the
foundation’s health workers were being called “child killers” when they went into communities,
because so many people had heard Dengvaxia caused death.

“They were being lambasted, insulted when they [went] into communities to do their
deworming,” she said, referring to campaigns to distribute medication to combat intestinal
worms. “They were being shunned out.”

Health authorities say they are focused on a mass immunization campaign to counter the steep
rise in measles cases. According to local media reports, they are forming measles “fast lines” in
government hospitals. The armed forces are helping to deploy medical personnel to conflict and
hard-to-reach areas.

“While we consider it necessary to bring to account those who are responsible for the loss of
confidence in the vaccination program . . . it is more important for all of us to come together to
support the efforts to get our children vaccinated as quickly and completely as we can,” said
Esperanza Cabral, a former health secretary and co-organizer of Doctors for Truth and Public
Welfare.

UNICEF’s Sylwander warned, however, that a massive advocacy campaign, ideally led by well-
known personalities in the Philippines, is needed to counter both the mistrust of vaccines in
more urban communities and the lack of awareness in more rural areas. While the spike in
measles deaths and media coverage have prompted more parents to inquire about vaccinations
and their benefits, actual vaccinations continue to lag, she added.

REFERENCES:

Cabato, Regine., Mahtani, Shibani. (February 13, 2019). Philippines Was Gripped by a Fear of
Vaccines. Now Theres’s a Measles Crisis. The Washington Post, Democracy Dies in
Darkness. Retrieved from https://www.washingtonpost.com/world/asia_pacific/philippines-
was-gripped-by-a-fear-of-vaccines-now-theres-a-measles-crisis/2019/02/13/a28b1c8a-
2f75-11e9-ac6c-14eea99d5e24_story.html
Dyer Owen. Dengue: Philippines declares national epidemic as cases surge across South East
Asia BMJ 2019; 366 :l5098

Fatima, K., & Syed, N. I. (2018). Dengvaxia controversy: impact on vaccine hesitancy. Journal
of global health, 8(2), 010312. doi:10.7189/jogh.08-020312

Gaena Katreena Cabico. (February 6, 2019).How the Dengvaxia Scare Helped Erode Decades
of Public Trust in Vaccines. Philstar Global. Retrieved from
https://www.philstar.com/headlines/2019/02/06/1891084/how-dengvaxia-scare-helped-
erode-decades-public-trust-vaccines

https://www.who.int/philippines/news/feature-stories/detail/overcoming-challenges-in-the-
immunization-programme-with-vaccine-heroes

Public Trust In Vaccines Plummets After Dengvaxia Controversy. ( October 18, 2018). Asian
Scientist Newsroom. Retrived from
https://www.asianscientist.com/2018/10/health/philippines-dengue-vaccine-confidence

Tomacruz, Sofia. ( September 27, 2018). Parents Still Scared of Government’s Free Vaccines a
Year After DengvaXia Scare. Rappler https://www.rappler.com/nation/212927-child-
vaccination-rate-philippines-as-of-september-2018

www.doh.gov.ph/node/16721