DOH approves dengue vaccine - should we?

Friday, April 01, 2016 Stef dela Cruz, MD 0 Comments

On March 30, 2016, a news outlet released an article about the dengue vaccine. About 24 hours after its publication, the article was pulled down.

Er, Happy April Fools’ Day?

The article was pulled down quietly. There was no erratum, no statement about why the link was taken down just a day after it went online.

What is going on?

Should I get out my tin foil hat?

Given the recent controversy surrounding the upcoming dengue vaccination program by the Department of Health, it makes one wonder if something is afoot.

This is a screenshot of the pulled-down article, courtesy of Google’s cache.
Click to enlarge.

I would never have noticed the disappearance of the article if not for the fact that the dengue vaccine was a matter of concern for me. It was just last February when I shared my second thoughts about DOH’s approval of the dengue vaccine in this MIMS article.


DOH dengue vaccine program: What Juan and Maria should know

When the government approves the use of a vaccine with a safety profile yet to be studied by WHO, it does make one wary. In my MIMS article, I said that “until WHO deems the dengue vaccine safe for public use, there is no need to wait with baited breath.”

MIMS dengue vaccine

Here’s a short excerpt from my MIMS write-up:

“Estimated projections by Sanofi Pasteur state that administering the vaccine as indicated to 20 percent of the population in endemic countries may reduce dengue burden by up to 50 percent within 5 years, as presented by Laurent Coudeville and Nicolas Baurin during the 64th American Society of Tropical Medicine & Hygiene Annual Meeting held in 2015. More data – and, ultimately, more time – is needed to prove that this forward-looking statement is more than merely hopeful.

I wrote this article about two months ago, published February 12, 2016. Since then, many things have happened – things I believe every discerning Filipino should know.


Fact #1:

A news article about the dengue vaccine being approved by the DOH despite the lack of WHO guidelines was pulled down

The article said, “A week before the Department of Health (DOH) starts administering the first ever anti-dengue vaccine to thousands of public school students, the World Health Organization (WHO) announced that it has not yet completed its review on the product.”

The pulled-down article mentioned the approval of a dengue vaccine by the Department of Health (DOH) despite the lack of guidelines from the World Health Organization (WHO).

Interestingly, the next day, the same news portal published this article on dengue:

new MB dengue vaccine article

New article, new sentiment. This is the new write-up published a day after the now-retracted article was released online.

The newer article – published the day after the currently-pulled-down article – mentions that an official of the WHO “expressed support” for the mass vaccination the DOH is planning to implement.

I have asked the author of the pulled-down article to enlighten the public about what happened. I am still waiting for his reply.


Fact #2:

DOH spent P3 billion on the dengue vaccination program

“So what?” you might ask. “The government should spend its money on vaccines that will benefit the Filipinos, right?”

Right. That’s why it is worth noting that DOH has spent on the dengue vaccine more than it did on all other vaccines of the Expanded Program on Immunization put together. In 2012, DOH spent only P1.8 billion on EPI. I doubt that the budget has doubled since then.

Your taxes are about to fund a vaccination program despite requests to reconsider from health experts who are concerned about the safety and cost-effectiveness of the vaccine.


Fact #3:

Children given the dengue vaccine may have a higher risk for severe dengue and hospitalization

As I mentioned in my MIMS article on the dengue vaccine, the vaccine trials point to a higher risk for severe dengue and hospitalization for children 2 to 5 years old if they are to be bitten by dengue-carrying mosquitoes three years after vaccination. This data was published in a 2015 article published in the New England Journal of Medicine.

How about for older children? Although the above study revealed no risk for severe dengue in older kids, information may not be enough to come up with a conclusion. After all, WHO has yet to establish guidelines that take into consideration the safety profile of the vaccine.

WHO has explained what the possible risks are in this dengue vaccine Q&A.

DOH will start its dengue vaccination program next week involving elementary students. I am crossing my fingers and praying for the sake of every child who receives the vaccine.


Fact #4:

The Philippine College of Physicians abruptly cancelled a forum on the dengue vaccine

The forum, scheduled March 31, was cancelled at the last minute due to the controversy surrounding the vaccine. Speakers were invited to tackle important concerns about the vaccine, including cost-effectiveness and safety issues.

It was the first time the Philippine College of Physicians (PCP) had to cancel a forum, an anonymous source revealed.

PCP has led the way in many important health battles, such as the stem cell treatment controversy. The organization has consistently carried the flag for ethical and compassionate medical practice.

Given their strong views on medical ethics, I wonder why PCP cancelled the forum on the dengue vaccine. Who asked that it be cancelled? Why?

These are questions that need to be asked and, eventually, answered.


The ethical choice

I reveal to you these facts because the Filipinos are at risk. There is an ethical way to implement a vaccination program involving a new vaccine – one that does not put people in harm’s way.

WHO will be convening soon to discuss the dengue vaccine. It won’t be long before they release guidelines based on an objective review.

We can wait until then, can’t we? We owe it to the Filipinos to keep them safe, don’t we?

Filipinos are smart. Present them with facts and they can spot the difference between a sad conspiracy theory involving stupid tin foil hats and a legit concern that needs to be addressed.

Filipinos will know the difference between a vaccination program and an experiment.

Don’t get me wrong: The dengue vaccine could be all that it promises to be. However, prudence is called for.

As is the case with any new drug, taking precautions is the rule. Pommeling through with a vaccination program despite the warnings of researchers and the lack of long-term studies  is the opposite of taking precautions.

Pulled-down articles and cancelled forums aside, I’m hopeful that stakeholders are doing everything they can to do this the right way. I’m hopeful that our Health Department will listen to the many health experts airing their educated viewpoints which are supported by research that cannot be disputed.

We all have to remember that regret, after all, always comes last.

Stef dela CruzAbout the blogger
Stef dela Cruz is a vegan doctor and writer. She received the 2013 Award for Health Media from the Department of Health. She is the editor of The Manila Bulletin's Animal Scene Magazine. Get in touch if you want to invite her as a speaker!