News reports about the dengue epidemic and the burgeoning cases of leptospirosis have hardly faded from the front pages, and yet the country is facing another health emergency: a measles outbreak.
According to the World Health Organization (WHO), the Philippines now ranks third worldwide in terms of the highest incidence of measles over a 12-month period up to June this year, with 45,847 cases. Madagascar ranks first with more than 150,000 cases, followed by Ukraine, with more than 84,300 cases.
How has the Philippines come to this — that it’s joined such perennially war-torn countries like Angola, Cameroon, Chad, Nigeria and Sudan as among the backwaters where health care has become so neglected and services so inaccessible that a major measles outbreak would occur?
Measles — long thought to have been tamed if not totally eliminated, thanks to that trio of mandatory vaccines for infants called MMR, for measles, mumps and rubella shots — is on the rise again, with cases worldwide the “highest” since 2006, “straining health care systems and leading to serious illness, disability and deaths,” according to the WHO.
That’s been reflected on the local front, where over the past seven months, measles cases have tripled while the number of deaths has quadrupled, said the Department of Health (DOH). Hardest hit are children aged 1 to 4 and infants below 9 months, who account for some 80 percent of deaths due to measles.
The WHO noted that the highest incidence of measles are in countries with low vaccination coverage, leaving large numbers of the population vulnerable to the disease. To prevent measles from spreading, vaccination coverage in a community should be at 95 percent, according to the organization.
By that measure, the Philippines represents an alarming case of regression, with the immunization rate dropping to just 40 percent early this year, per the DOH, or less than half the peak average 90.8 percent coverage in 2011. The major cause? Fear of vaccines.
The hardening resistance to vaccines has a clear proximate cause: the hysteria and misinformation about the Dengvaxia vaccine that were generated and amplified by the actions of Public Attorney’s Office chief Persida Acosta starting in 2017.
Despite warnings and strong objections from medical and health professionals, Acosta’s clamorous crusade to find Dengvaxia causality in several children’s deaths and criminality in the immunization program caused widespread panic among households, many of which ended up hiding their children from health workers offering free vaccination for dengue and other diseases, including measles, in their communities.
Vaccine confidence plummeted so severely that, according to the London School of Hygiene and Tropical Medicine, those who believe “that vaccines are important, are safe and are effective” dropped from close to 100 percent in 2015 to 20-30 percent in 2018.
Other factors aggravated the situation. Eduardo Janairo, Calabarzon health director, cited the insurgency problem as also limiting people’s access to health services. “In areas with security problems, for example (General) Nakar (in Quezon), it is difficult to deploy people,” he said.
The Calabarzon region, composed of Cavite, Laguna, Batangas, Rizal and Quezon, is among those with the highest number of measles cases, with 8,943 cases and 168 deaths from Jan. 1 to Aug. 24. The DOH recorded just 1,133 cases in the same period last year.
Health workers have also identified poor hygiene habits as a fuel for this infectious disease. “(Measles) actually spreads faster than dengue because it is (by) droplet infection,” Janairo said, referring to the spread of the virus usually through sneezing or coughing.
To arrest the rise in measles cases, the DOH urges parents to ensure that their children get the required immunization: one when the infant is 9 months old and a booster shot at 12 months. They should also be vigilant and knowledgeable about measles symptoms to be able to bring the sick member of the household to the hospital before the ailment worsens.
To address the measles outbreak, the DOH’s “Ligtas Tigdas” immunization drive needs to be urgently expanded to unvaccinated children under 5. The WHO also recommends tailored approaches, such as making sure that clinics are accessible to all areas, and that house-to-house vaccination drives remain an option. The bottom line: The DOH needs all the help it can get at this time from the national and local governments as it battles multiple health crises on various fronts.