PH declares polio outbreak as disease returns after 19
years
The Department of Health says a 3-year-old girl from
Lanao del Sur tests positive of the poliovirus, the first
case of the disease since the country was declared
polio-free in October 2000
MANILA, Philippines – The Department of Health (DOH)
on Thursday, September 19, declared a polio epidemic
after it recorded a case of the disease in Lanao del
Sur. This is the country's first confirmed case after 19
years of being polio-free.
The DOH said it found the disease in a 3-year-old girl
who is "now apparently well but with residual paralysis."
The case was confirmed on Saturday, September
14. (READ: EXPLAINER: What is polio?)
"The result of [the girl's stool exam showed vaccine-
derive poliovirus (VDPV) type 2, and the child was
unvaccinated against polio," DOH Epidemiology Bureau
Director Ferchito Avelino said.
The DOH said it is waiting for another case to be
confirmed, adding that they would make an
announcement once it is confirmed.
Health Secretary Francisco Duque III told media on
Thursday the DOH declared an "epidemic" or "outbreak"
after they found one positive case of the disease in
Lanao del Sur and after environmental samples from
Manila and Davao tested positive for poliovirus, as these
are "considered an epidemic in a polio-free country."
The country was declared polio-free since October 2000,
with the last case of poliovirus reported in 1993.
The DOH said it found type 1 poliovirus in Manila and
type 2 in Davao. There is another type of poliovirus, type
3. Their main difference is the makeup of the outer,
protective coating called the capsid.
According to Rotary International, an organization which
has been conducting anti-polio initiatives for 30 years,
type 1 poliovirus is the known cause of the few cases of
the disease existing in the world today. Type 2
poliovirus, meanwhile, was declared eradicated in
September 2015, with the last virus detected in India in
1999.
The DOH sees low vaccination coverage, poor early
surveillance of polio symptoms, and substandard
sanitation practices as culprits in this reemergence.
The DOH had earlier said that the Philippines was
at “high risk” of poliovirus transmission after Manila’s
sewage showed two samples that tested positive for
poliovirus.
Polio or poliomyelitis is a highly contagious disease
caused by poliovirus invading the nervous system.
Symptoms include fever, fatigue, headache, vomiting,
stiff neck and sudden onset of floppy arms or legs. In
severe cases, it can lead to permanent paralysis or even
death. Children under 5 years of age are most
vulnerable to the disease.
The Thursday announcement comes amid an
ongoing measles outbreak and dengue epidemic in the
country.
Vaccination, cleanliness are key
The health department found that polio vaccination for
children below 5 years old dropped to less than 95% in
2018. Health Secretary Duque said the average national
polio vaccination stands at about 66-68%.
"We need to bring this up to 95% level to ensure herd
immunity," he said. "We strongly urge parents, health
wrokers, and local governments to fully participate in the
synchronized polio vaccination," he added.
The DOH on August 19 launched its “Sabayang Patak
kontra Polio” campaign in the City of Manila, where the
poliovirus sample was found. On Friday, September 20,
Rotary Philippines will launch an NCR-wide polio
vaccination campaign, beginning in Quezon City.
The health department will expand the vaccination
campaign to other Metro Manila cities on October 1, with
a target of 1,276,658 children below 5 years old for its
second round. The vaccination campaign will also kick
off in Davao and Lanao del Sur in October.
The third round will be conducted in Central Luzon
(Region III) and Calabarzon (Region IV-A) from
November 19-30, targetting 4,090,228 children under 5
years of age.
The DOH had earlier said that the main challenge
confronting the agency in its conduct of door-to-door
vaccination was the fact that children and guardians are
usually not around when they make the rounds.
In a survey covering 370 households in the City of
Manila, the DOH found that 153 kids were not
vaccinated because they were not in their homes during
the campaign. Meanwhile, 8 kids had their guardians
around but refused vaccination due to vaccine
hesitancy. (READ: A year after Dengvaxia: Immunization
drops, measles outbreaks soar)
The DOH assured the public that aside from door-to-
door initiatives, it would deploy resources in health
centers nationwide.
The World Health Organization (WHO) is working closely
with the DOH in its anti-polio response. "Even if children
had already been vaccinated, they need these additional
doses to be fully protected," said WHO Country
Representative Rabindra Abeyasinghe.
The vaccination schedule for preventing polio, as
recommended by the (WHO), involves 3 doses of oral
polio vaccine (OPV) and one dose of inactivated polio
vaccine (IPV). It is the OPV that contains live, weakened
virus that may cause VDPV.
The health department also urges local governments to
intensify their Zero Open Defecation program and calls
for proper sanitation practices, like regularly washing
one's hands.
MANILA — The Philippines on Thursday announced an
outbreak of polio, 19 years after the World Health
Organization declared the Southeast Asian country free
of the infectious disease.
Health Secretary Francisco Duque said government
scientists have confirmed the “re-emergence of polio”
after one case in the southern province of Lanao del Sur
and another suspected case of the disease. He blamed
“poor immunization coverage,” a lack of sanitation and
proper hygiene and poor surveillance by health workers
as among the reasons the disease returned.
Polio is an infectious disease that can spread rapidly and
mainly affects young children. It can cause muscle
weakness, paralysis and, on rare occasions, it can be
fatal. There is no cure for polio, but it can be prevented
with multiple doses of polio vaccines.
Despite aggressive eradication efforts around the world,
the disease has hung on in a handful of countries and
even gained a stronger foothold in some, like Pakistan
and Afghanistan. There are currently cases this year in
several African countries, such as the Central African
Republic and Somalia.
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Mr. Duque said on Thursday that the case in Lanao del
Sur involved a 3-year-old girl. Apart from that confirmed
case, a case of “acute flaccid paralysis” thought to also
be polio was awaiting confirmation, he said.
He also announced that the government would be
embarking on a new polio vaccination campaign with the
help of the W.H.O. “We strongly urge parents, health
workers and local governments to fully participate in the
synchronized polio vaccination,” Mr. Duque said, adding
that vaccination was the only way “to stop the polio
outbreak and to protect your child against this paralyzing
disease.”
“Aside from immunization,” he said, “we remind the
public to practice good personal hygiene, wash their
hands regularly, use toilets, drink safe water, and cook
food thoroughly.”
Government scientists have also detected the polio virus
in samples taken from sewage in Manila and waterways
in the southern city of Davao, Mr. Duque said. Those
results, he said, were confirmed by the Research
Institute for Tropical Medicine in Manila, the Japanese
National Institute for Infectious Diseases and the
Centers for Disease Control and Prevention in the
United States.
“A single confirmed polio case of vaccine-derived polio
virus type 2 or two positive environmental samples that
are genetically linked isolated in two different locations is
considered an epidemic in a polio-free country,” Mr.
Duque said.
The W.H.O. and UNICEF will be working with the health
department on a “rapid response” to curb the outbreak. It
will include a series of oral polio vaccinations to protect
every child under the age of 5 years in areas at risk,
beginning next month.
Dr. Rabindra Abeyasinghe, the W.H.O.’s representative
in the country, urged all parents to have their children
vaccinated to protect against the disease.
He emphasized the urgent need of children being
immunized by polio vaccines regardless of their
immunization status.
The Philippines has been struggling to regain the
public’s trust in immunization since 2017, when it
stopped using a dengue vaccine manufactured by the
French firm Sanofi after it was found to pose health
risks to people who had not previously had the disease.
The Philippines was the first country in Asia to approve
the commercial sale of the vaccine, Dengvaxia, two
years earlier. The drug was administered to about a
million schoolchildren through a massive immunization
program.
Last month, the country declared a dengue epidemic,
with hundreds of patients dying from the mosquito-borne
disease. President Rodrigo Duterte has said he would
re-approve the sale of Dengvaxia if the health
department authorized it. It has not so far.
Correction: Sept. 19, 2019
An earlier version of this article misidentified Dr.
Rabindra Abeyasinghe, the W.H.O.’s representative in
the Philippines. He is a man, not a woman.
Abstract
This study examines the ways in which the public
discusses and debates the scientific issue of
vaccinations in the online social media environment of
Facebook. We apply a mixed-methods approach, where
a qualitative analysis is combined with a quantitative
analysis of the characteristics of the debate on polio
vaccinations in a Facebook group dedicated to parental
and professional dialogue. The qualitative analysis
suggested that dialogue became more political than
scientific overall, yet the quantitative analysis showed
that the discussants did not abandon the scientific nature
of the issue at hand.
INTRODUCTION
On May 28, 2013, traces of wild polio virus were found in
the sewage system near the settlement of Rahat in the
southern part of Israel. In mid-August 2013, Israel’s
Ministry of Health, with the massive encouragement of
the World Health Organization (WHO), launched a full-
scale vaccination campaign called “two drops.” The
Ministry of Health reinstated a vaccine that had been
taken off the national vaccination list eight years earlier.
This unconventional call by the Ministry of Health for all
parents to have their children vaccinated outside of the
routine set of vaccinations prompted a wide-ranging
public debate (1, 2). It involved public representatives,
as well as officials from the Ministry of Health, and
attracted tremendous media attention (3). The most
active and diverse public-debate platform at that time
was a Facebook discussion group called Parents Talk
About Polio Vaccination, or Horim Medabrim al Hisun
HaPolio in Hebrew
(https://www.facebook.com/groups/154989868031889/)
(4). We chose to base our research on this group. At its
peak, the group had 1,741 members (November 12,
2013), and a posting rate of 109 posts per day (August
21, 2013). The group is no longer active.
BACKGROUND
Vaccine hesitancy and public engagement with science
Although health authorities regard routine childhood
vaccines as safe and effective, and although vaccination
coverage rates are high in high-income countries, many
parents in these countries still hesitate to give them
(13% worldwide, 17% in WHO European region) (5).
Vaccine hesitancy is a decision-making process that
depends (among other variables) on trust in the health
authorities and in mainstream medicine (6, 7). The vast
majority of the public are not biologists or
epidemiologists, and they are not familiar with the
scientific apparatus of vaccinations. They thus need to
trust the sources that deliver the information to them and
act upon guidance from these sources (8, 9). In such
situations, people are more concerned with evaluating
and validating the source of the information (i.e., the
expert or the authority) than they are assessing the
veracity of a claim based on their own understanding
(10, 11). This opens the door to political considerations
and evaluations of the sources who deliver the
information. We consider “political” anything that
involves power relations, including dialogue and public
engagement in the scientific realm (12). The mainstream
media and social media are among the most important
and powerful agents that mediate between science and
the public (13, 14), and hence we relate to the concept
of “media logic.” Media logic is a term coined by David
Altheide and Robert Snow (1979), who first used it in
their book of the same name to depict the ways in which
the media culture affects how people see and interpret
social affairs. The term has been widely used since then
(15–17), including in the field of science communication,
where it usually refers to the ways in which scientists
alter descriptions and explanations of their findings to
better fit the way the media works (18). The media
researcher Lance Bennett (19) discusses four main
biases that affect almost every media product:
personalization (the focus on the personal rather than
the general and public), dramatization (the focus on
spectacle and sensationalism), fragmentation (bits of
information detached from context), and the authority-
disorder bias (focusing on the restoration of authority in
society).
The polio vaccination debates on Facebook are a clear
example of public engagement with a scientific issue,
and illustrate the ways people deploy scientific
knowledge alongside other resources in the case of
vaccine hesitancy (20, 21). When public engagement
with science is discussed in the literature, it is described
as a space for exchange of values and ideas (22); this
certainly applies to the social media environment. The
role of dialogue in such a space is often to build and
promote trust between decision-makers and/or scientific
experts and the lay public (23, 24). Facts alone are often
not enough to activate and influence attitudes and
behavior (25).
Online and social media discussions on vaccinations
have been previously examined in various forms and
cases. For example, a 2015 study of Italian online
forums on childhood vaccinations found that there is a
lot of misleading and false information online (26). This
study has also found that both vaccination supporters
and opponents use and cite medical professionals as
their information sources. Another study, from 2012, of a
Spanish website on vaccinations which offers a
personalized service called “ask the expert” (27),
analyzed the characteristics of the questions asked. This
study found that 30% of the questions were related to
vaccine safety and were associated with risk factors and
age. Nevertheless, it is still largely unknown how online
environments affect the communication between
scientific experts and nonexperts, and subsequent
decision-making among the public (28–30).
Our objective in this study was to characterize public
engagement with the 2013 polio crisis in Israel in a
social media environment. We followed two research
questions.
RQ1: To what extent are components of scientific
thinking observed in these discussions?
RQ2: What major themes appear in online discussions
about the polio vaccine?
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METHODS
Qualitative data collection
To collect the qualitative data, a manual search in the
Facebook group Parents Talk About Polio Vaccination
was conducted by the first author. This purposive
sampling was carried out according to three main
criteria: rich discussion (at least 25 comments per
conversation); diverse participants (both lay and
professional); and diverse views (both for and against
the vaccination).
Forty conversations (threads) were collected. The texts
are all in Hebrew and were originally analyzed in
Hebrew, and then translated for this paper. All the raw
data are available for scientific use from the authors.
Quantitative data collection and sampling
A data-mining technique was used to collect the group’s
written data using the Hypertext Preprocessor (PHP)
script available from the Facebook site. This script
served to collect each post’s first 25 comments (the
maximum number of comments that the script allowed
us to collect). If the post had more comments, which was
true for about 200 of the 1,039 posts comprising the
sampling frame, these comments did not appear in our
quantitative database. Overall, we collected all threads
posted from August 14 to November 12, 2013, for a total
of 11,535 items (where an “item” was defined as a post’s
headline or a single comment, both of which were
analyzed in the same way). On these, we performed a
random sub-sampling using a “randomize numbers”
command (≈20%), and ended up with 2,289 items. We
then performed a purposive subsampling on these items
as follows.
We first excluded “polite” items (such as thanking
everyone who helped and contributed information) and
“administrative” items (such as asking where the nearest
nurse’s office was). This left us with 1,793 items, written
by 321 different commentators. Then, we excluded all
items which did not express clear positions on the polio
vaccination (for, against, or a complex position) and all
items which did not include a clear narrative. The
presence of a narrative suggests there was an
interaction or an act of persuasion (31). Social narratives
of vaccination have been shown to inform and impact
the individual (32, 33). This left us with a final sample of
401 items.
Qualitative data analysis
A grounded theory approach guided our analysis
(34, 35). The qualitative data were analyzed thematically
(36, 37): the texts were tested for emerging themes, in a
triple-stage refinement procedure. The refinement
procedure is a process in which the categories that arise
in the grounded theory analysis are narrowed and
focused until the most representative and reflective
themes are found. Each refinement stage consisted of a
careful reading and examination of the texts, followed by
a mapping and straining of the themes that emerged. By
the end of each refinement stage, some of the themes
were fused together into a broader theme. Each
refinement stage left us with broader and more inclusive
themes. By the end of the third refinement stage, we felt
the themes could not be grouped or fused any further,
and this is where we ended the analysis. We were left
with three comprehensive themes, all of which reported
in the results section.
Quantitative operationalization and data analysis
The quantitative data were analyzed using a quantitative
content analysis approach (38). We coded the topics
covered in each item, the socio-demographics of the
writers, and their use of evidence.
The codes for topics were: administrative, expressions of
politeness, scientific/medical, political-economic issues,
personal concerns or dilemmas, societal issues and
concerns, moral issues and concerns.
The socio-demographic variables we coded were
gender, age, education, occupation, and marital and
family status.
Because the use of scientific evidence is a classic
indicator of the extent to which an item is scientific
(39, 40), the codebook contained several coding options
for what was considered evidence: the viewpoint of a
researcher; a reference to a completed, published study;
a reference to a research method; or a reference to a
research result.
For examples of classification of items according to topic
and use of evidence, see Appendix 1.
We also examined the scientific components present in
each item. We drew on the operational definitions of
nature of science (NOS) and scientific inquiry (SI)
suggested by the American Next Generation Science
Standards (NGSS, www.nextgenscience.org/next-
generation-science-standards).
The category nature of science included references to
the following: the methods employed in science;
scientific knowledge as based on empirical evidence;
scientific knowledge as subject to change and criticism;
the ways in which scientific models explain phenomena;
science as a way to obtain knowledge; scientific
knowledge as a means to achieve order; and the way
science relates to the natural world. The category
scientific inquiry included references to the following:
how scientific questions are asked, models are
developed, and research is planned; how scientists
analyze data, use mathematics or statistics, construct
their arguments, and use evidence; and the ways
scientists communicate their findings.
Finally, positions toward polio vaccinations and
vaccinations in general were coded for each item. For
example, the following was coded as a pro-vaccination
item: “If you leave yourself open to natural
contamination, you are at much greater risk.”
Validation and statistical analysis
The codebook benefited from the feedback and expert
content validation of two international science-
communication scholars: Professor Bruce Lewenstein
from Cornell University and Dr. Meghnaa Tallapragada
from Clemson University. Following their
recommendations, we modified the codes for primary
topic (added two codes for societal and moral issues),
and added a code for narrative.
The data were analyzed using Excel and IBM SPSS
Statistics v. 17 software. The Cohen’s Kappa score for
the agreement between the first author and a trained
coder on 150 items was 0.81. Since most of the
variables in the codebook were measured on a nominal
scale, non-parametric statistical tests (chi-squared and
correspondence analysis) were used to calculate the
relationship between variables. All outputs and materials
are available and will be provided upon request.
Ethical considerations
The study of the texts written and shared by this
particular content-driven Facebook group provided a
unique opportunity to analyze events and discussions
while the topic was very much “alive.” This analysis may
give rise to ethical concerns, given that the products of
public health–related human behavior are scrutinized
(41). Nevertheless, according to the codes of ethics and
conduct of internet research (42), if an observation of
public behavior takes place in public situations where
subjects would expect to be observed by strangers (such
as an open Facebook discussion), explicit individual
consent is not required (43–45). An IRB approval from
the Ethics Committee of the authors’ affiliate institute
was obtained. We based our conclusions solely on data
collected from open-group discussions and open
profiles. The names of the discussants used in the
results section are pseudonyms.
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RESULTS
The qualitative analysis of the discourse and dialogue in
the Facebook group Parents Talk About Polio
Vaccination revealed three major themes: capitulation to
media logic, fear of uncertainty, and a shift from the
scientific to the political domain.
Capitulation to media logic
Our analysis showed that the discussants in Parents
Talk About Polio Vaccination adhered to the culture and
conventions of the ways in which various topics are
portrayed in the media, or in other words, capitulated to
the biases and logic which govern the media. We found
the same biases suggested by Bennett (19) in the
dialogues in the group.
Personalization
This information bias is about focusing on the individual
and human perspective, such as personal tragedies or
victories. We saw that discussants in the group devoted
much of the dialogue to personal, unique stories. One
example widely referred to by the discussants was the
story of a young boy who was given a polio vaccine and
became permanently paralyzed afterwards. Maura, a
discussant, wrote:
My friends are all hysterical. No one wants to vaccinate
her children because of the story about that kid who is
now paralyzed.
Dramatization
This information bias is about focusing on the simpler
aspects of conflict and drama rather than complex and
elaborate explanations (such as scientific explanations).
Most discussants were reluctant to devote their time to
understanding the ways in which the immune system or
vaccinations work. Instead, they presented dramatic
stories and explanations about how the Israeli Ministry of
Health was cynically forcing innocent parents to give
“toxic” substances to their children. For example, Layla,
a discussant, wrote:
Can someone please tell me why am I supposed to
follow instructions that tell me to give my daughter
venom just so that the Ministry of Health can earn
money and enhance its reputation?
Fragmentation
This information bias is about isolating stories and bits of
information from their context, while disregarding “the big
picture,” namely, the social, institutional, or
organizational context. The information then becomes
fragmented, and the full setting becomes much harder to
obtain. The story of the paralyzed child whose paralysis
had nothing to do with his polio vaccination is an
example of fragmentation. This story was used
repeatedly as a reason why parents should refrain from
vaccinating their children, while ignoring the larger
context of the story itself, as well as the larger context of
the reasons why the vaccination was recommended in
the first place.
The authority-disorder bias
This information bias is about dealing extensively with
questions of public (dis) order, and whether the
authorities are capable of creating and maintaining
social order. This bias is expressed as an exaggerated
emphasis on emotional facets of finding who is guilty
and when order will be restored. For example, Dmitry, a
discussant, wrote:
Too many cases of paralysis ever since this vaccination
was brought to the attention of the public. I wonder who
is going to account for this? Who stands behind all this?
They are the ones to blame.
Fear of uncertainty
Many of the discussants were concerned about the
uncertain outcomes of the vaccination. Many demanded
complete certainty as regards the safety of the vaccine
and its ingredients, as well as reassurance about the
possible side effects of the vaccination, especially over
the long term. Many said that they were afraid of
vaccinating their children because an insufficient number
of clinical trials had been carried out, so there was not
enough evidence that the vaccination was 100% safe.
Many discussants demanded a “guarantee” that no side
effects would affect their children. For example, Nina
wrote:
No one knows what the consequences are going to be in
a year, two, or even ten years from now.
Another example can be found in a comment by
Theodore:
I need to be a million percent sure. It is scary because
there is a chance of one in…. no matter how much.
Once someone is the one, they don’t care about
statistics. There is a danger [of side effects] and the
parents are anxious and wondering what is right.
The shift of the debate to the political domain
Public knowledge about vaccinations is necessarily
second-hand knowledge; in other words, knowledge that
was not gathered from direct evidence. This knowledge
can only be acquired if people trust the source who
delivers the information. Carol, a physician, wrote the
following comment in response to Hannah, who
expressed panic and her inability to trust the
professionalism of the Ministry of Health:
Hannah, no one is putting any poison in our children’s
bodies. Nor is this an experiment at your expense. This
is a scare tactic. This is a method to create a wave of
panic and lack of trust by the opponents, and sadly, they
are succeeding. It is definitely important to read and be
engaged, but it is also important to realize that there are
complex issues, which not everyone can easily
understand, and we have no choice but to trust the
professionals who bear the responsibility for the health
of us all.
Thus, the nature of the debate in the group Parents Talk
About Polio Vaccination shifted from scientific to political
and ethical. Many ethical arguments against the Ministry
of Health, and even the World Health Organization, were
voiced. These organizations were accused of taking
advantage of their authoritative status and the trust the
public places in them. For example, Maureen wrote:
If there is a risk even the most minimal, we are putting
our children at risk, even though there is no health
advantage for them? That does not sound ethical to me.
Similarly, Paul wrote:
How can we trust the Ministry of Health ever again? The
Ministry of Health failed in their ability to protect public
health. We must independently examine the ingredients
of the vaccine.
Chloe wrote:
Maybe we should dismiss all the people who work at the
Ministry of Health, and hire people who have a
conscience.
In addition, many arguments regarding lack of
transparency were expressed. Many suggested that the
mainstream media were concealing the truth from the
public and conspiring with the Ministry of Health and
other stakeholders to promote their financial and political
interests. For example, Caitlin wrote:
The media are cooperating with the medical institutions
and the pharmaceutical companies, and together they
are hiding the truth from the public. The answers to the
real questions cannot be found in the traditional media.
Leon and Dotan are examples of two discussants who
were very critical of the Ministry of Health. They implied
that the recommendation to vaccinate children with Oral
Polio vaccine was motivated by political and financial
rather than scientific considerations. Dotan noted that:
It seems that the truth is not profitable enough.
Leon wrote:
I fully support science and scientific research. What I do
not support is research driven by interests, and the data
which they [the Ministry of Health] present are exactly
that.
Quantitative results
Our quantitative results indicate that science played a
substantial part in the dialogues in the group Parents
Talk About Polio Vaccination. Of the frequent
contributors, 22 were physicians, who answered
questions and addressed concerns rather than initiated
discussions. They were responsible for 15% (n = 59) of
the items. Nevertheless, they rarely identified
themselves as such. Only 3% of the items (13 items)
contained an explicit reference to self-expertise (e.g., “I
am a doctor”).
A quarter of the discussants had more than 300
Facebook friends, and 70% were members of at least 10
other groups, which suggests that the majority of
discussants were active Facebook users. The majority of
the discussants (67%, n = 270) were female. Thirty-three
percent (n = 131) of the discussants were male. The
majority of the items (75%) expressed a pro-vaccination
position, 8% were against the polio vaccination, and
17% took a complex position. Most of the items did not
reveal a position towards vaccinations in general. Marital
status could be deduced from 37% of the items,
indicating that 97% of the items came from people who
were married with children.
Discussion topics
Half of the items addressed scientific or medical content.
Of the 401 items analyzed, 50.1% (201 items) had
scientific or medical topics (such as the virus, its
characteristics, the vaccination, contagion, etc.) as
their primary content. The remainder addressed societal
issues and concerns (49 items, 12.2%); personal
concerns (28 items, 7%); and other issues, such as court
symposia or international contexts (117 items, 29.1%).
Use of evidence and scientific components
Although half the items addressed scientific or medical
topics, most items (386 items, 96%) did not present any
evidence at all to support their authors’ arguments. Only
a small percentage presented a viewpoint or a comment
by a researcher, or related to the results of a study or the
use of a research method (14 items, 3.5% of the
sample).
Nevertheless, we were able to identify scientific
components in about a quarter of the sample. Twenty-
four percent of the items (n = 96) contained features
related to the nature of science (NOS). Twenty-seven
percent of the items (n = 110) contained features of
scientific inquiry (SI). Those items that employed SI
features were more likely to employ NOS features as
well, with an overlap of 80% (in other words, 80% of the
items that employed SI features also employed NOS
features). Moreover, 22% of the items (n = 90)
discussed the ways in which science is communicated.
Twelve percent (n = 48) of the items expressed a
favorable position towards science and/or scientists.
There was a significant association between stance on
polio vaccination and the use of evidence (χ2 =
49.03, p < 0.005). Commentators who supported polio
vaccination tended to employ more empirical evidence
than those who opposed it or had a complex position.
The topic of discussion was marginally associated with
the use of scientific components (χ2 = 35.05, p < 0.06).
The use of scientific components in the text was also
related to the position on polio vaccination, with a value
of χ2 = 17.08 (p < 0.005) for the use of SI features, and
a value of χ2 = 28.03 (p < 0.005) for the use of NOS
features. Commentators who supported polio
vaccination were more likely to use scientific
components.
Go to:
DISCUSSION
Our quantitative findings revealed that the discussion
focused on science and medicine, and about a quarter of
the items contained scientific components, even though
empirical evidence was barely cited. This suggests that
public engagement with science needs to be regarded in
a more nuanced fashion (46). Our qualitative findings
revealed that the discussion focused on fear of uncertain
outcomes of vaccination, and on possible financial and
political motivations for vaccination. This implies that
expert sources are evaluated mostly as political agents,
and points to the importance of considering not only the
understanding of scientific aspects, but also the
emotional and social context of vaccine hesitancy, as
has been pointed out in various recent studies (32, 47–
49). Focusing on science comprehension or use of
empirical evidence may not be adequate to study and
address vaccine hesitancy (50, 51). We hence need to
regard the “science” component in public engagement
with science as a broad and versatile constituent, which
the public may interpret and deploy in many ways.
We found that most of the items in our sample were pro-
vaccination. This may be due to the vast amount of
information which was provided and exchanged in the
group, as information is known to reinforce the safety
and importance of routine childhood vaccinations (52).
Moreover, this finding is in line with the high eventual
compliance rates with the vaccination (59.2% among the
Jewish population and 92.4% among the Arab
population) (53). Interestingly, studies on vaccine
hesitancy suggest that the outcome of vaccine hesitancy
is not necessarily non-compliance and can very often
result in a decision to comply with vaccination (54, 55).
The results of a recent Pew Research Center survey,
which suggest that the vast majority of Americans
believe that the benefits of childhood vaccines outweigh
the risks (56), are in line with these studies.
The mixed-methods approach made it possible to look at
both single items detached from their context (in the
quantitative analysis) and items in the context of a full
conversation in a thread (in the qualitative analysis). This
complementary approach helped evaluate the dialogue
in the group Parents Talk About Polio Vaccination in a
“zoom out” and a “zoom in” fashion. In sum, qualitative
analysis suggested that dialogue became more political
than scientific overall, yet quantitative analysis showed
that the discussants did not abandon the scientific nature
of the issue at hand.
As noted in the introduction, public confidence in
vaccines is waning (57). The polio vaccine is only one
instance of vaccine hesitancy on social media (58).
Other vaccine controversies, such has the controversy
over the human papillomavirus (HPV) vaccination, have
also been studied in online environments. Keelan et
al. have studied discussions on the HPV vaccine on
MySpace blogs, and found that men were more likely to
hold negative views about the vaccine than women and
to disseminate negative messages through larger social
networks (59). They found, as we did, that the majority of
views were pro-vaccination. Another recent study on
vaccine-related Google searches has found that the
interest for vaccines is increasing over time, and that the
HPV vaccine was a popular Google search topic (60).
Social media has recently emerged as an effective and
strategic communication tool to address vaccine
hesitancy and may become more important in coming
years (61).
Limitations and future work
This study has two major limitations. First, in an informal
conversation, people do not always supply empirical
evidence for their claims (62). Therefore, the fact that
many of the commentators did not supply empirical
evidence does not necessarily mean they did not
consider empirical evidence as required or useful, but
could simply mean that they chose not to include it in
their particular comment. The use in about a quarter of
the comments of certain scientific components may
actually support this claim. Second, only one Facebook
group was studied, which limits our ability to draw wide-
ranging conclusions from the findings. More comparative
research is needed to extend generalizability.
Nevertheless, this case study of public engagement with
science highlights the versatile and flexible nature of
scientific dialogue in the public sphere. The main
contribution of this study is in its illustration that science
has much more malleable boundaries than is sometimes
assumed.
The Philippine Department of Health (DOH) today
announced an outbreak of polio in the country. A
poliovirus case was confirmed on 16 September 2019 in
a 3-year-old girl from Lanao del Sur. In addition,
environmental samples from sewage in Manila and
waterways in Davao were confirmed to contain the virus.
“We are very concerned that polioviruses are now
circulating in Manila, Davao, and Lanao del Sur,” said
World Health Organization (WHO) Representative in the
Philippines, Dr Rabindra Abeyasinghe. “WHO and
UNICEF are working closely with the Department of
Health to strengthen surveillance and swiftly respond to
this outbreak. We urge all parents and caregivers of
children under 5 years of age to have them vaccinated
so that they are protected against polio for life.”
“It is deeply disconcerting that poliovirus has re-emerged
in the Philippines after nearly two decades. The outbreak
calls for urgent action to protect more children from
being infected. It reminds us of the importance of
increasing immunization coverage to 95% of children to
stop polio virus transmission in the Philippines.
Vaccination is the only and best protection against polio
that mainly affects children under 5 years of age. As long
as one single child remains infected, children across the
country and even beyond are at risk of contracting polio,”
said Oyun Dendevnorov, UNICEF Philippines
Representative, “UNICEF is working with Department of
Health and WHO to accelerate actions for the health and
safety of children in the Philippines, especially in the
affected regions.”
Polio outbreak response
Prior to the declaration of the outbreak, the Department
of Health and its partners launched a polio immunization
campaign in the City of Manila. Further mass polio
immunization rounds will be rolled out from October
2019.
The Global Polio Eradication Initiative (GPEI) is
supporting the Philippine Government’s response,
providing technical advice, on-the-ground monitoring and
risk communication. The GPEI is a public-private
partnership led by national governments with five
partners – WHO, Rotary International, the US Centers
for Disease Control and Prevention (CDC), UNICEF, and
the Bill & Melinda Gates Foundation. Its goal is to
eradicate polio worldwide.
Local government action and advice to parents and
caregivers
WHO and UNICEF urge local governments to ensure
that vaccination campaigns are planned and
implemented effectively. Every community leader,
religious leader and celebrity must mobilize their
communities to participate in immunization activities.
Parents and caregivers are advised that the best
protection for their children is vaccination. It takes
multiple doses of polio vaccine to achieve full immunity
against polio.
WHO and UNICEF also remind families to wash their
hands regularly with soap and water, use a toilet,
consume food that is fully cooked, and drink safe water.
If the safety of your water is in doubt, boil it, ensuring it is
bubbling vigorously for at least one minute before
allowing it to cool.
Oral polio vaccine
The oral polio vaccine (OPV) is a safe and effective
vaccine that has saved millions of lives over the years.
More than 18 million people are able to walk today who
would otherwise have been paralyzed, and 1.5 million
childhood deaths have been averted thanks to the polio
vaccine. Since the introduction of the polio vaccine in
1988, cases have decreased by over 99%.
OPV contains an attenuated (weakened) form of the
virus, activating an immune response in the body. When
a child is immunized with OPV, the weakened virus
replicates in the intestine for a limited period, thereby
developing immunity by building up antibodies. During
this time, the virus is also excreted in their faeces. In
areas where there is inadequate sanitation and hygiene,
the excreted weakened virus can spread in the
immediate community before eventually dying out.
If a population is not sufficiently immunized, the
weakened virus can continue to circulate. The longer it is
allowed to survive, the more changes it undergoes. In
rare instances, the virus can change to a vaccine-
derived poliovirus (VDPV), a form that has regained the
ability to cause paralysis.
The polio outbreak in the Philippines is confirmed to be
from a circulating vaccine-derived poliovirus type 2. This
is of particular concern, as wild poliovirus type 2 was
certified as globally eradicated in 2015. Poorly
conducted immunization activities, when too few children
have received the required three doses of polio vaccine,
leave them susceptible to poliovirus, either from vaccine-
derived or wild polioviruses. Full immunization protects
them from both forms of the virus.
Philippines declared polio-free in 2000
The last known case of wild poliovirus recorded in the
Philippines was in 1993. The country was declared wild
polio-free in 2000 along with the rest of WHO’s Western
Pacific Region.
Vaccination coverage in the Philippines has been
steadily declining over the past few years. To stop the
spread of polio in the Philippines, at least 95% of
children under 5 years of age need to be vaccinated.
MANILA, Philippines — Experts had hoped that polio
would be a distant memory by now with the disfiguring
and potentially deadly disease only to be seen in the
pages of history books or depicted in stone carvings of
ancient Egyptians.
Since 1988 when the Global Polio Eradication Initiative
was launched, a public-private partnership led by
national governments, the World Health Organization,
Rotary International, the US Centers for Disease Control
and Prevention, UNICEF and the Bill & Melinda Gates
Foundation, giant strides were achieved to stamp out the
debilitating disease through an ambitious mass
vaccination campaign.
When the initiative was formed, over 350,000 people a
year were paralyzed by polio. This number dramatically
went down 99.9% to 33 in 2018, according to WHO.
Polio-endemic countries also considerably dwindled in
numbers from 125 to only three today — Pakistan,
Afghanistan and Nigeria.
But despite these breakthroughs, WHO said children in
all countries are at risk of contracting the disease as long
as a single child remains infected with poliovirus.
"The poliovirus can easily be imported into a polio-free
country and can spread rapidly amongst unimmunized
populations. Failure to eradicate polio could result in as
many as 200,000 new cases every year, within 10 years,
all over the world," it said.
Resurfacing after 19 years
Polio was supposed to be wiped off the face of the earth
by 2018, after an earlier deadline of 2000 set by the
initiative was pushed back, but a year later the highly
contagious disease remains unshakeable,
even reemerging in countries where it was once
declared eradicated like Congo, Ukraine, Syria, Papua
New Guinea, Indonesia, Laos, Myanmar and most
recently the Philippines.
Philippine health authorities said a three-year-old girl
from Lanao del Sur had contracted the paralyzing
disease, the country’s first case since it gained polio-free
status in 2000, while the virus was also detected in
Manila's sewage and in waterways of Davao.
READ: Beyond the Dengvaxia scare: Complacency,
devolution of health system also account for measles
outbreak
Polio strains detected in Lanao del Sur, Manila and
Davao are all of the vaccine-derived variety. This strain
has genetically mutated from a weakened wild poliovirus
type 2 contained in the oral vaccine used all over the
world to control the disease.
Polio has no cure but immunization can protect from
both vaccine-derived or wild forms of the virus that
mainly affects children under five years of age.
"The outbreak calls for urgent action to protect more
children from being infected. It reminds us of the
importance of increasing immunization coverage to 95%
of children to stop poliovirus transmission in the
Philippines," said Oyun Dendevnorov, UNICEF
Philippines representative.
In the Philippines, immunization for tuberculosis;
diphtheria, tetanus and pertussis; polio; measles;
mumps; German measles; Hepatitis-B; and H. Influenza
Type B are mandatory and free at any government
hospital or health center to infants and children up to five
years of age, according to Republic Act 10152 or the
Mandatory Basic Immunization Act.
Global mistrust
News on the polio epidemic in the Philippines comes
after measles and dengue outbreaks hit the country
earlier this year, killing more than a thousand people, as
public trust in vaccines broke down following the
controversy on the Dengvaxia vaccine.
In 2016, the dengue-prone country became the first to
use the vaccine in a country trial program involving
hundreds of thousands of schoolchildren.
A disclosure by Dengvaxia's French manufacturer Sanofi
a year later that it could worsen symptoms for people not
previously infected with the virus sparked nationwide
panic with some parents blaming the vaccine for their
child’s death.
READ: How the Dengvaxia scare helped erode decades
of public trust in vaccines
In countries where polio is still endemic, the deteriorating
security situation is the biggest reason why the disease
has gotten a foothold, a WHO review showed. The
increasing mistrust on vaccination is also cited as an
issue.
In Afghanistan, there have been accusations that the
polio program serves as a “Trojan Horse” to spy on
behalf of Afghan and North Alliance Treaty Organization
forces. In Pakistan, meanwhile, rumors persist that the
vaccine would reduce the size of a child’s heart to that of
a rat, while others claimed that it provoked premature
sexual activity and other misbehavior.
How it all started
A July report of WHO and UNICEF said vaccination
rates have “dangerously” stalled with 19.8 million
children under the age of one failing to get the basic
triple "DPT" vaccine against tetanus, diphtheria and
whooping cough, or were not protected against measles.
This despite having two to three million deaths every
year prevented due to immunization.
Two-thirds of these unvaccinated children live in 10
countries: Angola, Brazil, Ethiopia, India, Indonesia,
Nigeria, Pakistan, the Philippines, Democratic Republic
of Congo and Vietnam.
A lot of "anti-vaxers" cite a 1998 study published by The
Lancet, a respected medical journal, that reported a
causal link between vaccines and autism in children.
When it was revealed that evidence underlying this claim
had been falsified, the study was withdrawn and its
author Andrew Wakefield barred from the profession.
But the damage was done. — with AFP
Read more at
https://www.philstar.com/headlines/2019/09/20/1953468/
polio-resurges-philippines-ancient-disease-was-
supposed-be-extinct-last-year#cq4cYsTjWfBXgbIx.99
State and regional health planning should draw together
the public and private sectors in a collaborative model
that is publicly accountable. State and local health
agencies should articulate the division of labor between
agencies. State and local health agencies should
collaborate with purchasers and providers of personal
health care and with community-based organizations
representing ethnic and other minorities, women, and
vulnerable groups to assure that health plans and health
delivery are culturally sensitive and are appropriate to
meet population needs. Working with the private sector,
public health agencies must define standards to ensure
high quality services are provided to all populations, and
encourage a phased redistribution of resources from
illness to preventive care with targets and timelines.
Existing models need to be utilized and new models
need to be developed that go beyond the provision of
personal health care to enhance the health status of
populations. These models require particular emphasis
on culturally sensitive personal health delivery systems.
One such model is Community-Oriented Primary Care
(COPC), which designs and evaluates community health
interventions as an integral part of the provision of
primary medical care. Many community migrant health
centers and other models of integrated practice have
developed COPC practices in which personal health
services and public health interventions are combined in
one organizational model. Such programs have great
potential to develop more effective health promotion,
social support, and personal health care approaches to
all populations.5-9
Even when there are no financial barriers to care, private
providers may not meet the needs of all residents or
provide the special services and expertise required by
high risk populations that are now offered by many
public health programs and agencies. Local public health
agencies and other community-based organizations may
therefore need to continue to serve the needs of these
persons, in addition to the agencies' broader role in the
health care system as a whole. Particular attention must
be paid to assure personal health care for indigent
persons not eligible for Medicaid.
V. Methods of Implementation
APHA should play an active role in:
Educating public health workers, public and private
sector policy makers and leaders, health service payers
and providers, and the general public about essential
public health functions to be performed by federal, state,
and local governments and the private sectors, and their
implementation and effectiveness around the nation.
Encouraging the training of public health professionals to
participate in influencing public policy.
Encouraging academic health centers to emphasize the
teaching of concepts, skills, and attitudes about
prevention and coordination to students of the health
professions and research to document the cost
effectiveness of prevention.
Providing technical assistance and encouragement to
public health workers to actively participate in national
and state health reform efforts, articulating the
appropriate role for public health in such efforts.
Advocating funding for essential public health services.
Advocating a strong infrastructure that will be capable of
implementing the roles and responsibilities described in
this position paper.
References
Institute of Medicine. The Future of Public Health.
Washington, DC: National Academy Press, 1988.
Bunker JP, et al. Improving health: Measuring effects of
medical care. Milbank Q. 1994;72:255-258.
U.S. Public Health Service. For a Healthy Nation:
Returns on Investment in Public Health, 1994.
Freeman P, Robbins A. National health care reform
minus public health: A formula for failure. J of Public
Health Policy. 1994;15:261-282.
Institute of Medicine. COPC: A Practical Assessment,
Vol. 1 and 2. Washington, DC: National Academy Press.
1994.
Wright RA. Community-oriented primary care: The
cornerstone of health care reform. JAMA
1993;269:2544-2547.
Kark S, Abramson JH. Community Oriented Primary
Care: Meaning and Scope. Community Oriented Primary
Care: Conference Proceedings. Washington, DC:
National Academy of Sciences, 1982.
Geiger J. The Meaning of COPC in an American
Context. Community Oriented Primary Care: Conference
Proceedings. Washington, DC: National Academy of
Sciences, 1982.
Nutting P, ed. Community Oriented Primary Care: From
Principles to Practice. (HRSA Publication ITRS-A-PE-86-
1).1987.
MANILA — 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.”
“But it seems like it was not until it reached Manila [that]
it was declared an emergency and a very urgent
problem,” she said.
Health Secretary Francisco Duque and other members
of the medical community attribute the newfound fear of
immunization to a dengue vaccine scare last year.
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.
A global wave of measles cases fed by conspiracies has
health officials worried
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.
“The anti-vaccine group was also being felt in the
Philippines . . . But it is not as huge as in the U.S. or
Europe,” she said. “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.
Manila, Philippines - Health officials in
the Philippines are racing to contain a deadly measles
outbreak the government blames on a marked decline in
immunisations after a scandal surrounding a dengue
fever vaccine.
More than 70 people - mostly children - have died of
measles nationwide since January, with a high
concentration of cases in the capital, Manila, and its
surrounding provinces.
Across the country, over 4,300 people have contracted
the highly contagious disease this year, a 122-percent
jump compared with the previous year, according to the
Department of Health.
Many of those affected are from poor families who
depend on public health services for care and
medicines, both of which the government is now hard-
pressed to supply.
In downtown Manila, the government-run San Lazaro
Hospital is crammed with measles patients, while
doctors say they are stepping up preparations for more
admissions.
READ MORE
Fears grow as measles running rampant in southern
Thailand
In communities and villages, health workers have been
urging hesitant parents to immunise their children
against measles and other diseases such as polio,
diphtheria, hepatitis and the flu.
Over the past year, fewer parents have used the
government's free basic immunisations, fearing the
vaccines could harm their children.
Health officials say vaccination rates have gone down
from 85 percent to 60 percent, even as low as 30
percent in certain communities.
As a result, experts say, many children have been left
vulnerable to measles, with unvaccinated adults also
facing the risk of contagion.
Vaccine 'drama'
Francisco Duque III, the health secretary, has blamed
the falling vaccination rates on a scare he says was
caused by the Public Attorney's Office, particularly its
chief lawyer, Persida Acosta, who is leading an
investigation into a public vaccination campaign against
dengue fever in 2016 and 2017.
What is measles and how dangerous is it?
Measles, a contagious disease, killed an estimated
110,000 people in 2017, according to the World Health
Organization (WHO). The vast majority were children
under five.
The disease starts out like a common cold, progressing
into high fever and worsening symptoms. It is contagious
through direct contact and is airborne. Once it infects the
respiratory tract, it spreads rapidly throughout the whole
body. Within days, rashes appear on the face and neck
until fully covering the infected person.
The WHO says that deaths occur because of
complications with the disease, such as encephalitis (an
infection that causes brain swelling), diarrhoea,
dehydration, ear infections or severe respiratory
infections. Research from the WHO found that
Southeast Asia suffers from more cases of measles than
anywhere else in the world.
In 2017, there were 107,292 suspected cases in
Southeast Asia. The figure dropped to some 83,000
suspected cases the following year.
Acosta has insisted the vaccine used, Dengvaxia,
caused the deaths of dozens of children, even though
parallel investigations did not reach the same
conclusion.
The chief lawyer figured prominently in televised
Dengvaxia investigations by the Senate and the House
of Representatives, presenting relatives of alleged
victims and claiming that autopsies conducted by her
office found that the deaths were "possibly" linked to the
vaccine.
Acosta's public appearances were characterised by
emotional outbursts, drawing criticism from other officials
who described her behaviour as "hysterical".
The controversy began in November 2017, when
Dengvaxia manufacturer Sanofi Pasteur announced that
the vaccine may not be effective in some cases and
could lead to severe dengue infections in some
individuals who had not previously had the disease.
At the time, more than 700,000 people, mostly
schoolchildren, had already received at least one dose
of Dengvaxia through a $67m government project to
eliminate dengue fever, one of the most common and
lethal diseases among Filipino children.
The Department of Justice has since filed negligence
and corruption cases against former President Benigno
Aquino, two of his cabinet secretaries and several other
officials who implemented the Dengvaxia immunisation
programme.
Acosta's office filed separate charges, including against
Duque, who took over as health secretary a month
before Sanofi Pasteur's announcement, and who halted
the Dengvaxia project in December 2017.
Senator Risa Hontiveros, who used to lead the health
committee, has called on Acosta to resign.
"She stood at the gravesides of poor dead children to
wage a vicious campaign of disinformation, pseudo-
science and politically-motivated witch-
hunts," Hontiveros said.
"Her lies and hysterics contributed directly to the erosion
of public trust in our vaccination programmes."

Duque called the accusations "malicious and baseless". OPINION: Should Aquino, Duterte be held liable for
dengvaxia deaths?
"The Dengvaxia scare, all this drama that they were
doing, have really caused damage to the integrity and Raissa Robles
the effectiveness of the Department of Health," Duque
Posted at Feb 10 2018 05:28 AM
told reporters, referring to the Public Attorney’s Office.
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'Politically-motivated witch-hunts'
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Acosta denied responsibility for the vaccine scare,
saying it was "unfair" to pin the blame on her and her Facebook
office.
Twitter
"Maybe they should ask themselves whether they failed
to campaign for safe vaccines like the one for measles," LinkedIn
said Acosta, referring to Duque and other health officials.
Should former President Benigno Aquino III be held
Salvador Panelo, spokesman for President Rodrigo responsible for dengvaxia deaths?
Duterte, defended Acosta, saying she was "just doing
her job" in rallying alleged Dengvaxia victims to press Of course.
charges.
Along with President Rodrigo Duterte.
Panelo, however, also affirmed Duque's view that the
Both implemented the program: President Aquino for
Dengvaxia affair caused the vaccine scare that led to the
THREE MONTHS, and President Duterte for FIFTEEN
measles outbreak.
MONTHS.
In response, Duterte has called on his health officials to
Duterte bears a bigger burden because he continued it
increase efforts to immunise children, urging parents to
despite the fact that the World Health Organization
avail themselves of basic vaccines offered free at public
(WHO) had already issued a position paper outlining the
health centres.
risks.
Opposition figures allied with former President Aquino
In late July 2016—weeks after Duterte became
criticised Acosta and accused her of using the
President, the WHO finally came out with its findings and
Dengvaxia cases to discredit the political opponents of
recommendation:
Duterte, whose 2016 election campaign capitalised on
the public's disillusionment with Aquino's administration. “…vaccination may be ineffective or may theoretically
even increase the future risk of hospitalized or severe
"Our country's immunisation programme is now in a
dengue illness in those who are seronegative at the time
quandary and our children's health is under threat
of first vaccination regardless of age.”[i] As this risk had
because of the vaccine scare triggered by Acosta's
at that time not been seen in the age groups for which
grandstanding to be in Duterte's good graces," said
the vaccine was licensed, WHO issued a conditional
Senator Leila De Lima, who has been jailed on drug
recommendation, emphasizing the use of the vaccine in
charges following her probe into killings in Duterte's war
populations having been previously infected with dengue
on drugs.
virus.
To minimize illness for seronegative vaccinated people,
WHO recommends enhancing measures that reduce
exposure to dengue infection among populations where
the vaccine has already been administered. For vaccine
recipients who present with clinical symptoms
compatible with dengue virus infection, access to
medical care should be expedited to allow for proper
evaluation, identification, and management of severe
forms of the disease.”
By July 1, 2016, Duterte had assumed office and Paulyn
Ubial was his Secretary of Health. Despite the WHO
position paper, Ubial said she continued the dengvaxia
vaccination program.
Over a year later in December 2017, Ubial told a Senate
committee probe that certain House lawmakers had
pressured her into expanding the vaccination program.
See: news.abs-com timeline
Duterte could have stopped the program when he
assumed office in July, but he didn’t. Ubial temporarily
halted it TEN MONTHS LATER in May 2017. But she
resumed it in June 2017. Then scrapped it SIX MONTHS
LATER in December 2017.
When the Duterte government finally stopped giving
vaccinations, spokesman Harry Roque said: “He
(Duterte) would have done the same thing (Aquino did)
because he himself has suffered from dengue and you
can’t deprive the people of what they thought would be
protection against a deadly disease when it existed.”
Are dengvaxia deaths, if criminal neglect is proven, an
impeachable crime?
Most probably.
The bar for impeachable crimes has fallen quite
drastically, if you watch the House committee
deliberation on the impeachment of Chief Justice Maria
Lourdes Sereno.
***
I have also long been waiting for Senator Dick Gordon,
who wears the double hat of chairman of the Philippine
Red Cross, to summon before his probe committee
someone from the Red Cross as well as the International
Federation of the Red Cross.
He could then ask them—politely, or in his trademark
bellicose berating style – if they had endorsed the use of
dengvaxia.
The Philippine Red Cross is a prestigious and respected
Philippine NGO and volunteer organization. It is a
member of the International Federation of the Red
Cross.
In other words, both the Philippine Red Cross and
International Federation of the Red Cross are what you
would call “influencers”.
On March 9, 2016, during the heat of the 2016 electoral
campaign where Gordon was running for senator, the
International Federation of the Red Cross website
published a news release.
The release was entitled: “Philippine Red Cross aids
efforts to halt dengue and avert Zika.”
It was accompanied by a photo that had the following
caption: “The IFRC plans to support the Philippine Red
Cross health teams and volunteers to spread awareness
of the dengue vaccine to health centres and
communities. Photo Credit: IFRC”
The name of the dengue vaccine was not mentioned in
the news release. But it was most probably the
dengvaxia vaccine of Sanofi. By then, dengvaxia was
the only commercially available anti-dengue vaccine in
the country.
The caption indicated that the Philippine Red Cross itself
mobilized its health teams and volunteers “to spread
awareness of the dengue vaccine to health centres and
communities.”
The story did not contain any of the words of caution that
we are hearing now—that those who have not had
dengue should NOT be vaccinated.
In fact, Kate Marshall of the IFRC wrote that:
“Dr Bhanu Pratap, Health Coordinator for the
International Federation of Red Cross and Red Crescent
Societies (IFRC) in Philippines, says the introduction of
the vaccine is a positive move, especially for those living
in the worst affected areas and for children.
The IFRC plans to support Philippine Red Cross health
teams and volunteers to spread awareness of the
vaccine to health centres and communities as part of the
overall Epidemic Preparation and Response Plan.
Through its donor network, the Philippine Red Cross
provides 53% of the Philippines’ total blood supply.
Some dengue sufferers require platelet transfusions to
stop internal bleeding. Blood platelets are essential for
normal blood clotting, but donation and extraction is a
time-consuming process. According to Dr Pratap the
vaccine would help reduce the burden on health and
blood facilities, especially in areas that are already
stretched to the limit, and on the donated blood supply.
The IFRC plans to support Philippine Red Cross health
teams and volunteers to spread awareness of the
vaccine to health centres and communities as part of the
overall Epidemic Preparation and Response Plan.”
***
The search for a dengue vaccine has been going on for
decades without success.
The gravity of the disease, also according to Kate
Marshall of IFRC, was tackled in an ASEAN Dengue
Summit in Angeles City, Pampanga in June 2014.

THAT is a categorical endorsement of the available
dengue vaccine.
The article stressed the importance of the vaccine by
stating the following:
In 2015, dengue affected some 400 million people
(NOTE: That’s 5% of the estimated 7.2 billion world
population).
However, two out of every three dengue cases were in
Asia.
The summit underscored that “the 10 member countries
have the highest number of dengue cases in the Asia-
Pacific, which accounts for 75 per cent of all infections
worldwide.”
Economic losses were cited:
“Speaking at the conference, Professor Donald Shepard
of the Schneider Institutes for Health Policy at Brandeis
University, US, said dengue outbreaks in Southeast Asia
were responsible for economic losses of $950 million US
dollars each year.”

The Philippine government spends some US$336 million ***

yearly to combat dengue. (NOTE: That’s roughly P16
billion based on the foreign exchange rate of P49 per US
dollar. In contrast, dengvaxia cost the government P3.5
billion.)
In the year 2015, the number of dengue cases in the
Philippines surged to 200,000 cases—or an increase of
80,000 cases in 2014, according to Marshall.
Curiously, her article stated that – “The World Health
Organisation has declared dengue a global epidemic
and will include vaccination as part of its global
prevention and control strategy to contain the disease.”
The WHO now says it never gave a blanket
endorsement of the vaccine in March 2016.
However, IFRC’s Kate Marshall seemed to be under the
impression that WHO was all for the vaccine in March
2016 because she says WHO “will include vaccination
as part of its global prevention and control strategy.”
I believe we should not lose this context in the ongoing
dengvaxia probe.
Dengue is a very serious and expensive disease to
have. There has been a long and pressing need for an
effective vaccine.
Given the 2014 ASEAN Dengue Summit and the
seeming March 2016 backing of the International
Federation of the Red Cross and the Philippine Red
Cross for a vaccine program, the few voices who had
expressed caution in injecting dengvaxia were all but
drowned out.
Disclaimer: The views in this blog are those of the
blogger and do not necessarily reflect the views of ABS-
CBN Corp.

Seeing that there was no other vaccine commercially

available at that time except for dengvaxia in the
Philippines, the WHO’s alleged intention to “include
vaccination as part of its global prevention and control
strategy” can only be referring to dengvaxia at that time.

You can read a copy of the IFRC news release in the

IFRC website by clicking here.

I believe writer Manolo Quezon also mentioned the

same news release in his opinion piece entitled last
December “Contrasting official reactions“.