An ounce of prevention

Mommy, bakit po hindi siya napabakunahan? “We had just lost a 5-month-old to pertussis and we could not help but feel not only grief but increasing frustration.

In the past year, in one institution alone, out of 23 suspected cases whose age range was from 1 to 6 months old, 12 were confirmed for pertussis and half of them had no history of vaccination even though they were age-eligible. On further history taking, none of the mothers were vaccinated against pertussis in their pregnancy. Three out of the 12 infants unfortunately succumbed despite combined efforts from a multidisciplinary team of doctors from the intensive, infectious disease, nephrology, pulmonology, and hematology services. Coming away from such an experience, borrowing an often repeated phrase, one can only say that such a “preventable loss is one death too many.”

Partial data gathered from the Philippine Integrated Disease Surveillance and Response of Region 4A documented the number of cases for the following vaccine-preventable diseases as follows: pertussis (36), measles-rubella (321), diphtheria (17), non-neonatal tetanus (110), neonatal tetanus (six), and rabies ( 58) for the period of Jan.-Dec. 10, 2023. While these may not be reflective of the nationwide count, it gives more than a fair idea that cases are being seen in one of the most populous regions in the country, and should not be dismissed. Measles, pertussis, rubella, and diphtheria are easily transmissible and highly contagious. Together with the others mentioned, these may cause not only significant morbidity but may lead to death. If one survives, there may be complications such as lingering deficits. The inadvertent exposure and the high risk of coming down with the disease for those who are vulnerable, nonimmune, or immunocompromised and the likely probability of untoward, unquantifiable consequences add to the horror story.

Last week, tasked to speak on the infectious disease highlights from the past year, I shared the national immunization coverage rates from January to November 2023, courtesy of the Public Health Operations Division of the Department of Health (DOH). I deliberately presented the data in black and white to emphasize the stark reality reflected in the numbers shown, that we failed to hit our targets, which is enough reason for the increased rise in the number of cases and occurrence and possibility of outbreaks. It was disheartening to note that despite the efforts exerted during the supplemental and catch-up immunization campaigns from last year, coverage for measles was at 70.7 percent and 64.8 percent for the first and second dose respectively, for polio it plateaued at 70 percent, with only 74 percent completing their third dose of diphtheria, pertussis, tetanus, hepatitis B, and Haemophilus influenza B for the immunizable population of infants less than 12 months of age. While we can always cite the pandemic as an excuse, perusing the statistics over the years prior, coverage rates were similar.

Shooting from the hip, why have we never gone beyond the target? Multiple factors have and are still playing a role with no single element to blame. To move forward, I attempted to do a SWOT analysis and invite you to make one of yours to answer the question. As a country, we have to appreciate that there is an existing national immunization program in place enabling the general public, access to free vaccines for those less than a year old, and through the years, a continuing collaboration between nongovernment and government agencies. As for the weaknesses, it is an undeniable fact that not everyone has the capacity or the grasp on the importance of health services, and with the devolved public health system, programs to be prioritized are dependent on the ones in position, for needless to say, they have a major voice in logistics and allocation of the needed budget. For opportunities, continued recognition of the need for surveillance of diseases beyond passive reporting and the existence of duty-bound and committed agencies, who are willing to work to address the situation, give hope that things will turn around for the better. As for threats, there are plenty, one of which is the growing problem of vaccine hesitancy and the lack of public education on the importance of health, most especially at the grassroots level.

Be that as it may, faced with the hard realities of the present situation, we cannot afford to wallow in negativity or inaction despite the fatigue and frustration from the loss of lives from vaccine-preventable diseases. For the next few months, as a citizenry, we are encouraged to support the DOH’s second phase for “Chikiting Ligtas.” We would need everyone’s utmost cooperation, so as not to be in the running for the title of being the sick man of Asia and of the world.

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