Filipinos becoming ‘scientifically illiterate’

Prompting this lament from Lulu Bravo of the Philippine Foundation for Vaccination was the rise in measles cases by November 2018 to 17,000, five times the count from the previous year. In 69 percent of the cases, parents had declined vaccination for their children. Equally alarming, confidence in vaccines reportedly declined from 93 to 32 percent between 2015 and 2018, a drop unseen in the other 37 states of the World Health Organization’s West Pacific Region.

Blame for this descent to scientific illiteracy has focused on the investigations conducted by Sen. Richard Gordon and the Public Attorney’s Office chief Persida Acosta on the use of the dengue vaccine Dengvaxia in a 2017 vaccination program that covered some 830,000 children. While prompted by the warning that the use of the vaccine on those who had not been previously infected by the virus may aggravate the symptoms of the disease, medical practitioners criticized the investigations for promoting sensationalistic media reporting that appeared more focused on political than public health objectives.

Delays in the Department of Justice decision on the first batch of Dengvaxia cases, expected last November, prolong public anxieties about vaccines. The group Doctors for Truth and Public Welfare has called for a halt to “fear-mongering” by spreading unproven claims against Dengvaxia that erode public trust in all vaccines.

Gordon has not addressed the problem to which he had contributed. Acosta and PAO officials remain unrepentant.  Director Erwin Erfe of the PAO forensic laboratory claimed that “increasing number of deaths of Dengvaxia vaccinees, now numbering hundreds, are real—the result of a criminal act perpetrated by doctors of DOH.”

But PAO has brought to court only nine cases. Erfe has claimed that autopsies conducted on 105 vaccinees showed a “Dengvaxia death pattern” of hemorrhages, edema and internal organ bleeding, without explaining how this pattern differs from that of dengue deaths, which claimed 730 casualties in 2017. His statement slides from “deaths of Dengvaxia vaccinees” to “Dengvaxia deaths,” suggesting that vaccinees died because of Dengvaxia—precisely what he has to prove.

In a parallel effort, a University of the Philippines medical team investigated 14 dengue-related deaths. Only three were attributed directly to dengue. Dengvaxia could not be conclusively determined as the cause of these deaths. If the PAO cases involved dengue-related deaths, we cannot conclude that Dengvaxia killed the vaccinees, only that Dengvaxia failed to save them.

Rarely does any vaccine guarantee 100- percent effectiveness. A New England Journal of Medicine (NEJM) study reported that Dengvaxia reduced rates of severe disease and hospitalization for previously exposed children aged 9 and older by 80 percent.

Given to those not previously exposed to dengue, Dengvaxia could result in more severe infection and increased risk of hospitalization. Unfortunately, no quick, safe and inexpensive way to test prior exposure is currently available. The required blood test itself poses some risks to children. Hence, individual testing is dispensed with in dengue-endemic areas where 50 percent or more of the population is likely affected.

The NEJM study quantified the tradeoff in using Dengvaxia without prior testing: The number of hospitalization cases prevented for the group previously exposed to dengue would be 11 times higher than the number of hospitalization cases that may be required for the group without previous exposure. The reduction in number of severe cases for the first group would be five times higher than might occur with the second group. The Dengvaxia risk of severe infection for those without prior exposure would be 1 in 2000. Meanwhile, PAO will be striving to prove that 9 of the 830,000 vaccinees died because of Dengvaxia. In 2015, the Philippines registered over 140,000 dengue cases, resulting in over 400 deaths.

Deaths averted provide little comfort to those families who lose members to dengue. But bureaucrats and politicians involved in managing public health issues must calculate the tradeoffs and consider the lives risked and lost when vaccination programs for dengue and other diseases are undermined by reckless fear-mongering. The ethical principle guiding the medical profession must apply equally to them: First, do no harm.

Edilberto C. de Jesus (edcdejesus@ gmail.com) is professor emeritus at the Asian Institute of Management.

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