What’s at stake with the dengue vaccine

The debate over the dengue vaccine is nothing new in the medical community, but it is far more complex than how it is being presented in popular discourse. In the first place, there is actually broad consensus—based on existing data — that the vaccine has benefits among those who’ve had previous dengue and risks among those who haven’t. Doctors also know that every intervention has risks and benefits, and it’s a matter of weighing them — a very difficult task, especially when dealing with large populations, ever-changing medical knowledge, and a particularly complex virology.

The disagreements lie in whether risks were fully considered at the time the decision was made (critics, citing the haste and lack of prior World Health Organization endorsement, claim they weren’t), whether the economic cost of P3 billion and medical risks justified a mass vaccination program (Sanofi, citing its own research, says the cost of vaccinations is less than the hospitalizations they would prevent), whether vested political and pharmaceutical interests were involved, and whether, in light of new evidence, the program should be continued. Fortunately, the Department of Health seems to be taking a prudent course by suspending the vaccination program and calling on experts to adjudicate the matter.

Others, alas, are overreacting and even fear-mongering, with some going as far to call the whole issue a “genocide.” This kind of sensationalist rhetoric is dangerous because it can cast doubts on the whole idea of vaccination, as has happened in the aftermath of previous vaccine-related scandals. For example, the completely baseless link between autism and measles has led to many parents refusing to have their children vaccinated — a phenomenon that led to more measles-related deaths. This can be particularly detrimental for the Philippines, which is already suffering from relatively-low immunization rates.

What’s worse is that it could feed into narratives that discredit the medical profession itself. While much criticism can be rightfully leveled at the healthcare system, including the influence of “Big Pharma,” a total mistrust in biomedicine can lead people not to seek healthcare at all or drive them to unproven alternatives, both of which can be more harmful than the risks they sought to avoid in the first place.

But even as we look at the broader implications of the dengue vaccine, the question remains: How do we move from this fracas?

First, the government should pursue a well-crafted communications strategy. Right now, many parents (and individuals) are worried: They were assured the vaccines were safe, and now they are hearing that these are dangerous. The public should be informed on what the risk really is and which dengue prevention measures they should take in any case. Importantly, they should be assured that there is no reason to panic.

A second, concurrent imperative is the establishment of facts. Have there really been deaths attributable to the dengue vaccine? Both Sanofi and the DOH deny this, and a thorough validation can allay public fears. An investigation of how the vaccine was approved, and why previous concerns were ignored, will also help, with the caveat that it should be independent—and that whatever findings it may gather should lead not just to accountability but also to reforms in the DOH procurement processes.

Finally, a challenge specifically for the medical profession is to find common ground in this issue. Sadly, I see people accusing one another of bias, diminishing each other’s “expert” credentials, and unwittingly sowing confusion in the medical community and among the general public. In many cases I suppose this is unavoidable because medicine is not an exact science and even leading authorities will interpret facts differently. The least we can ask of them, nevertheless, is not to allow conflicts of interest to cloud their judgment. Medicine, after all, is a search for the truth (the gnosis in “diagnosis” means “to know”) and its first principle is to do no harm; it is on these principles that our allegiance must ultimately lie.

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