Friday, October 21, 2016

In Search of the Truth About the Controversial Dengue Vaccine

Wazzup PIlipinas!

"The majority of the people are not really aware on how Dengue really attacks the body. I do believe if we can educate them the chances of surviving will increase dramatically and we may even reach a point that dengue deaths will be zero. Thus, this advocacy." - Dr. Richard Mata

Sanofi Pasteur, a French multinational pharmaceutical company, led by Dr. Bouckenooghe, Mr. Joshua_Nealon, and Dr. Ruby Dizon, recently conducted a media conference about the dengue vaccine.

The event was held at the Dusit Thani hotel in Makati city on October 20, 2016. It allowed us the opportunity to ask them several questions about the dengue vaccine, including the many issues that has made it very controversial.

While the Department of Health (DOH) Secretary Paulyn Jean Ubial assured that the newly registered vaccine was safe for use, there has been an awful lot of questions about this sudden, undue haste in providing the dengue vaccine. The vaccine is the first ever approved for use to prevent dengue, a mosquito-borne disease endemic in the Philippines. Should we express concern that children in the Philippines are being used as “guinea pigs” since the country was the first in Asia to implement the vaccination?

The government purchased the dengue vaccine in March this year and was delivered in the same month. The vaccine was just registered by the Food and Drug Authority on Dec. 22, 2015. The Department of Health (DOH) started to give the first of three doses of the vaccine from April to July this year to almost 500,000 children in Metro Manila, Southern Luzon and Central Luzon.

The question that people ask is "What was the “undue haste” in providing a dengue vaccine worth P3.5 billion to almost half-a-million children during the administration of former President Benigno Aquino III?"

From Dr. Antonio Dans, Professor from the UP College of Medicine, "Just an opinion - excellent trial which reduces dengue cases by almost 60%. Hope at last! But should government fund this vaccine for P3B? The incidence of Dengue is 400 cases per million (Philippine health Stats 2012). Thus, vaccination of 1M children, as planned by DOH, will prevent 240 cases a year - which is good. But at the cost of P3B?? That's >12M per case of dengue prevented."

A post from the top Emergency Medicine expert who used to serve as DOH Usec. himself, Prof. Dr. Ted Herbosa, reiterates that "We are today the "laughing stock" of the international health policy expert community because we registered a nouvelle dengue vaccine for marketing to our people. That is still fine, even Mexico did that. For the rest of all the other countries in the world, this dengue vaccine is still in Phase III. By registering this in our FDA and giving it PNDF exempt status, we artificially have declared it to be in Phase IV Trials. Pharma company benefits on this one.

Here is the punch line, and Mexico didn't do this. And why we are now the big joke in the international health policy world.

Our government funded this vaccine with 3.5 billion pesos of people's tax money sans WHO Strategic Advisory Group of Experts (SAGE) and cost benefit analysis research not funded by the pharmaceutical industry."

Aside from the DOH Dengue prevention campaign, there should also be a campaign that focuses on truths about the disease and hydration. The dengue vaccine is surrounded by multiple issues brought about mostly by rumored political agendas mainly due to the transition from one administrations to the next, we can't help but think that the Filipino people are the ones made to suffer. In the middle of all these debatable greed, the citizens of the Philippines would have to live with the thought that we may have become the victims.

Not that we are saying that the facts about the vaccine are true or false, but we can't help to be concerned with all these doubts since the overwhelming truth to all of these is the lack of trust we have with our government. Why are we doubting our government? Because there has been so many occurrences of corruption. Also, the pharmaceutical industry is likewise filled with controversial issues even to the point of being accused of keeping the people sick so they could continue selling their supposedly cures at prices too high to fathom. This is why generic medicines have emerged as popular, but lately they have also invested on the generics game as more and more of these pharmaceutical companies are already competing with each other with their corresponding generic medicines.

But how do we go on with our lives if we continue to distrust everyone else? That is the question whose answer is too elusive.

Below are some facts about Dengue in the Philippines:

Dengue cases rose to epidemic levels in 2015 with an average of 220 reported cases per day

Dengue is a high-profile and ongoing public health concern in the Philippines. The first known epidemic of severe dengue or dengue hemorrhagic fever anywhere in the world was recorded in Manila in 1953.[i] By the mid-1970s, severe dengue had become a leading cause of hospitalization and death among children in the region.[ii] Between 2004 and 2010, the Philippines experienced the seventh highest number of dengue cases in the world according to the World Health Organization (WHO).[iii]

2016 data suggests an increasing trend in reported dengue cases
In 2013, DOH reported 204,906 cases of dengue, the highest number recorded since the establishment of the National Dengue Prevention and Control Program in 1993. More than 200,000 dengue cases were reported in the Philippines in 2015, 80,000 more than were reported in 2014.[iv] In both September and October 2015, the number of reported cases rose above the epidemic threshold.[v]

Although the number of reported dengue cases slightly decreased in 2014, the 2015 data suggest an increasing trend in cases in the coming years.[vi] Recent data gathered by the Department of Health from January to 24 September this year shows an increase of 11.5 percent year on year across the country, with total dengue infections at 142,247 compared to 127,525 last year and 604 recorded fatalities[vii]

Based on Philippine surveillance data collected between 2011 and 2015, an average of 220 dengue cases were reported in the country every day.[viii] In 2015, almost 50% of reported cases came from three most urbanized regions: Region 3 (17.6%), Region 4 (17.3%), and the National Capital Region (12.6%).[ix] Cases stemming from all four serotypes of dengue were reported in 2015.[x]

Disease burden: US$345 million per year
The economic burden of dengue in the Philippines is substantial. A study published in 2015 estimated that between 2008 and 2012, clinically diagnosed dengue cases in the Philippines were associated with a direct medical cost (in 2012 US dollars) of $345 million annually. The study calculated the average cost of treatment per case to be $409, representing 16% of the Philippines’ 2012 per capita GDP. Sixty-five percent of cases were treated in inpatient hospitals, representing 90% of direct costs.[xi]

In addition to dengue’s burden on a household, the illness can adversely impact a country’s economy through a loss of productivity caused by the illness and pre-mature death, increased healthcare costs and a possible reduction in tourism.[xii]

Seasonality and global climate change
Dengue has become a year-round threat in the Philippines. However, data suggests that the number of dengue cases increases one to two months after the onset of the rainy season, resulting in a peak of dengue cases between July and November each year.[xiii]

The Philippines is severely affected by extreme weather events and is vulnerable to the effects of climate change. Vector-borne diseases like dengue may be particularly sensitive to both periodic fluctuations and sustained changes in global and local climates.[xiv] Additionally, a study examining data from eight Asian countries including the Philippines over 18 years revealed a strong correlation between regional dengue epidemics and elevated temperatures associated with El NiƱo.[xv]

DoH implements a step-wise public vaccination program in 2016
The Department of Health announced on 4 January 2016 that one million (1M) nine-year-old Filipinos enrolled in government schools in Region 3, Region 4-A and the National Capital Region will be the first beneficiaries of the government-procured dengue vaccine.[xvi]

In a recent dengue vaccine cost-effectiveness study performed by Professor Hilton Lam of the UP-National Institutes of Health, a nationwide annual routine vaccination of nine-year olds starting in 2016 would lead to an estimated 24.2% reduction in dengue cases in the country over a five-year period. This would translate to 775,053 avoided cases of dengue, 502,000 avoided hospitalizations, 22,010 avoided deaths and almost Php 21 billion in avoided cost to society.[xvii]

[i] Gubler, D. J. (1998, July). Clinical Microbiology Reviews. Retrieved from American Society for Microbiology.
[ii] Anonymous (1986) Dengue hemorrhagic fever, diagnosis, treatment and control. (World Health Organization, Geneva, Switzerland).
[iii] World Health Organization. (2012) Global Strategy for Dengue Prevention Control. 2012-2020.
[iv] Philippines dengue fever cases update and Dengvaxia plan, March 14, 2016.
[v] WHO Western Pacific Region Dengue Situation Updates.
[vi] DOH to provide dengue vaccine for poor Filipino children in NCR, Regions III and IV-A, Press Release, January 4, 2016,
[vii] Philippines data provided by Epidemiology Bureau of DOH.
[viii] DOH to provide dengue vaccine for poor Filipino children in NCR, Regions III and IV-A, Press Release, January 4, 2016.
[ix] Ibid.
[x] WHO Western Pacific Region Dengue Situation Updates.
[xi] Economic Cost and Burden of Dengue in the Philippines. Am J Trop Med Hyg. 2015 Feb 4; 92(2): 360–366.
[xii] Ibid.
[xiii] Epidemiology of Dengue Disease in the Philippines (2000–2011): A Systematic Literature Review.
[xiv] Ibid.
[xv] Region-wide synchrony and traveling waves of dengue across eight countries in Southeast Asia, August 25, 2015, Proceedings of the National Academy of Sciences of the United States of America.
[xvi] DOH to provide dengue vaccine for poor Filipino children in NCR, Regions III and IV-A, Press Release, January 4, 2016.
[xvii] Lam H. et al. Cost effectiveness analysis of dengue vaccination in the Philippines. Presented at ICID, Hyderabad, India, March 2016. Abstract number 43.160.

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