The terrible consequence

Last June, in this space, the Inquirer joined its voice to the anxious chorus lamenting the Duterte administration’s initial response to the Dengvaxia controversy. The focus of the editorial was on the opportunity to “reset” the official response, but it was necessary to note that the first response “had been so alarmist, and transparently political, that it stoked fearful speculation and even panic in the general population. One terrible, and entirely predictable, consequence was a kind of collateral damage; all other vaccines, even the uncontroversial ones, suffered some guilt by association. Many parents and guardians decided to forgo other vaccinations for their children and wards.”

A new study just released, led by the London School of Hygiene and Tropical Medicine and published in the Human Vaccines and Immunotherapeutics journal, quantifies that “terrible, and entirely predictable, consequence.”

A resurvey of 1,500 participants who had taken part in a 2015 study showed a startling drop in “vaccine confidence.” In 2015, a resounding majority of 93 percent of the participants classified themselves as “strongly agreeing” that vaccines were important; in the 2018 resurvey, months after the Dengvaxia controversy burst into the open, that proportion had fallen to 32 percent.

The lead author of the study, Prof. Heidi Larson, noted a possible explanation: “The Sanofi announcement was a spark that fuelled the flames of underlying political ferment in the Philippines. Health authorities and immunization programmes cannot solve political tensions, but trust issues and potential areas of anxiety and possible dissent must be considered in advance of a pandemic. This is especially important in an era of social media and the ability for misinformation to be spread far and wide at the touch of a button.”

Recall that last January, a group of over 50 doctors had issued a stern warning over the government’s initial handling of the controversy. “The unnecessary fear and panic, largely brought about by the imprudent language and unsubstantiated accusations by persons whose qualifications to render any expert opinion on the matter are questionable, at best, have caused many parents to resist having their children avail of life-saving vaccines that our government gives.” They were referring to what the June editorial described as “the politically motivated grandstanding of Sen. Richard Gordon and then Justice Secretary Vitaliano Aguirre, and the histrionic performance of public-attorney-turned-instant-medical-expert Persida Acosta.”

Acosta continues to refuse to learn the obvious lesson. Asked for her reaction to the latest study, she denied any role in lowering the people’s confidence in all vaccines (not just Sanofi’s Dengvaxia), and then once again “fuelled the flames of underlying political ferment.”

“This is not politics. This is a crime,” she said—a lawyer’s narrowly legalistic way of understanding a public health issue. But she did not stop there; she went on to demonstrate that her interest in Dengvaxia was in fact political. She just made sure to drop the political burden at somebody else’s doorsteps.

“Sino po ba ang namulitika dito? Kailan po ba itinurok ito? Noong 2016, di ba, before election? O, 2016 election? Sino namulitika dito? (Who is politicizing this? When was this injected? In 2016, right, before the election? So, 2016 election. Who is politicizing this?)” The lack of self-awareness Acosta’s series of questions betrays is breathtaking.

Contrast Acosta’s bleeding-heart, camera-ready performance with the steady conduct and calming demeanor of Health Secretary Francisco Duque III—the man President Duterte appointed to replace his previous health secretary, who had expanded the scope of coverage of the Dengvaxia vaccination. His approach to the problem does justice to the facts as painstakingly gathered by the Department of Health: As of Sept. 14, the DOH determined that 19 out of 154 children who had died after receiving at least one dose of Dengvaxia had dengue. This is not only 19 lives too many, but 154 lives too young to be taken. But not even the 19 dengue-stricken patients could be conclusively held to have died directly from Dengvaxia; medical specialists need to look at all the variables.

This approach does not lessen the significance of the problem; rather, it seeks to find solutions, without creating new ones.