Dengvaxia’s aftermath

I hope medical populists like Persida Acosta realize how much damage they have wrought upon the health sector, and the Filipino people at large. For decades, health officials — from the Department of Health to local government units — have labored to build trust for government programs like vaccination and deworming. This trust, tenuous to begin with, has been compromised, as evidenced by the decreasing immunization rates — and reports of barangay health workers being shunned by communities. Moreover, instead of moving forward with their programs, health officials have to deal with the crises, setting back health reforms. Adding to the damage is the emotional toll: We actually have poor vaccinated kids asking their parents: “Am I going to die?” Time will tell how much psychological damage the misinformation has wrought.

I say all of that without canonizing the health sector, which is not immune to corruption and poor judgment, and without casting aspersions on all the actors opposing the vaccine. Indeed, I am firmly behind impartial efforts to determine whether there was dishonesty on Sanofi’s part and culpability on the part of government officials in the procurement of the vaccine. There are lessons that can be learned from this sad and costly episode, including greater transparency and better communications.

Still, it is time for the DOH to move beyond this issue. On a positive note, there is actually a lot going for the health sector: increased funding thanks to the Sin Tax Law, a generally cooperative legislature, and a president who is actually supportive of health reforms.

There are, however, some daunting tasks.

Foremost of these are emergent health problems — from infectious diseases to mental health issues. One example is the continued rise of HIV in the country despite a global decline. Sex education, voluntary testing, and access to condoms and pre-exposure prophylaxis (PrEP) all need serious work, with special attention to at-risk populations.

Noncommunicable diseases like hypertension and diabetes are also becoming more and more of a public health concern, even as prevention (e.g., diet and exercise) is often overlooked in favor of far more costly treatment (e.g., dialysis machines). This, too, requires serious work, which include increasing PhilHealth coverage for chronic diseases.

Meanwhile, we also have to deal with persistent health concerns. Malnutrition rates remain unacceptable; many Filipinos are short not because they are genetically pandak but because of poor childhood diet and health. The elimination of tuberculosis and malaria remains a pipe dream, even as they remain major causes of morbidity and morality in many parts of the country.

One area where the participation of the DOH is badly needed is drug policy. It was heartening that former health secretary Paulyn Ubial spoke of drug use as a “public health concern,” but there has been little follow through, and to date, the health sector has yet to come up with a comprehensive alternative to the abusive and ineffective “drug war.” This lacuna, alas, has allowed President Duterte’s discourse on drug users —  “subhumans,” beyond redemption — to go unopposed.

In the coming weeks, Congress will deliberate on proposals to legislate “universal healthcare,” which can be potentially transformative for the issues I articulated. While some of the provisions will be contentious (i.e., “How can we finance it?”), most health reform advocates agree that it should be a national aspiration — and, indeed, a government policy — to ensure that all Filipinos have access to quality healthcare. There is also consensus that primary care should be at the heart of our health system: Instead of just building hospitals, we should also strengthen our barangay health centers; instead of focusing on treatment, we should be focusing on prevention and promotion.

Amid all these challenges and prospects, we need a DOH that is allowed to do its mandate — and stakeholders that are willing to work together despite their differences. Without forgetting Dengvaxia and its painful lessons, we must not allow it to hold back the health agenda that our country badly needs.

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