Health is wealth

So goes the saying preached in earlier times to schoolchildren. The adage applies both to individuals and communities. Even more than education, the population’s health sets limits on the pace of its progress. The demographic dividend yielded by a young population to fill up the labor force becomes a demographic drag, if the youth lack the physical or mental capacity to benefit from education and produce value for the country.

Promoting public health, however, requires balancing a complex mix of issues relating to household economics, medical and technology research, business interests and government policies. Where regulatory authorities must interpret and rule on the views of differing domain experts, complexity opens opportunities for corruption. A steady stream of media reports alleging corruption against pharma companies and high officials of the Department of Health (DOH), Food and Drug Administration (FDA), Public Attorney’s Office (PAO) and PhilHealth has given the “health is wealth” prescription a cynical meaning.

Sen. Richard Gordon and PAO chief Persida Acosta are not medical doctors. Their approach to the Dengvaxia vaccine focused on corruption, a concern that excites the electorate and can be conveniently directed against political enemies. But prosecuting criminals does not eliminate the danger from infectious diseases already punishing the public. National and international health experts have attributed to the high drama of the Dengvaxia investigation the drastic drop in vaccination rates, not just against dengue but also against other diseases, from 93 percent in 2015 to the current 40 percent. We are now farther away from the 95-percent coverage necessary for effective disease containment.

Over 830,000 children received Dengvaxia shots. PAO has yet to establish conclusively one death caused by the vaccine. The Department of Justice ruling on the PAO cases was expected nine months ago. The delay in resolving the issue prolongs the anxiety among vaccine-takers. Meanwhile, the number of dengue cases now approaches 230,000 with over 950 deaths. Measles cases have tripled from last year’s 11,800 to over 39,000, with deaths rising five times from 100 to 500.

The Philippine Foundation for Vaccination wants a law to punish scaremongers complicit in producing and spreading fake news that undermines vaccine confidence in the country. While admitting the backlash against vaccination, Gordon and Acosta absolve themselves from accountability for it. But they continue to project Dengvaxia as an untested, defective drug, damaging and even deadly to the health of children. Politicians rarely admit mistakes.

The government stopped mass Dengvaxia immunization in 2017, trusting the World Health Organization (WHO) warning against the use of Dengvaxia on children not previously exposed to dengue. But what was the basis for its February 2019 decision to prohibit its sale to everyone? In July 2019, WHO added Dengvaxia to its List of Essential Medicines that should be available to the public. This time, DOH did not accept the WHO advisory, calling for further studies before possibly bringing the vaccine back to the market. Two months later, the FDA reaffirmed the ban, without clarifying the basis for rejecting the WHO recommendation on Dengvaxia that most of the world has accepted. Meanwhile, wealthy families get the vaccine abroad.

The statement of Health Secretary Francisco Duque that the FDA decision had nothing to do with the efficacy of the vaccine raised further questions about how health authorities made decisions on issues critical to people’s health. Health Undersecretary Enrique Domingo reported that international WHO experts could not comprehend the Philippine response to Dengvaxia: “Nobody understands why we’re acting this way… On a global level, it seems only the Philippines is reacting this way to the Dengvaxia issue.”

Perhaps, these foreign public health experts were “stumped,” because they approach issues narrowly, according to the methods and norms of their discipline. They may not appreciate how health problems can become political issues, or the burden placed on professionals in government service to massage their messages to avoid contradicting politicians who reject expert judgment.

When they publicly and stubbornly cling to conclusions unsupported by evidence, politicians put pressure on the bureaucrats to bend professional judgment to political interests, at the risk of violating professional ethics—a situation that invites a kind of corruption in the bureaucracy.

Edilberto C. de Jesus is professor emeritus at the Asian Institute of Management.

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