advertisement


A CRISIS OF TRUST

The Dengvaxia controversy shook an already declining public confidence in vaccination. With a measles outbreak putting enormous pressure on an overburdened system, rebuilding trust is critical to the future of Philippine health.


By ANNA FELICIA BAJO, JESSICA BARTOLOME, and NICOLE-ANNE LAGRIMAS
GMA News

February 14, 2019

Share This Story

I.

A MOTHER'S REGRET

After losing her firstborn son to measles, 21-year-old Diamond Macawaris remains in grief.

DIAMOND MACAWARIS remembers by numbers.

She is 21 years old. Her firstborn son Farhand Daniel died when he was just one year, two months, and 25 days old, after a week-long battle against measles.

She had rushed him to the Gat Andres Bonifacio Memorial Medical Center in Manila on November 1, 2018, worried about his fever. They spent one day and two nights in the emergency room, before being sent to the measles ward.

After that, days were marked by doctors telling her that her son’s condition was worsening. At some point, they had to pump the child’s body with oxygen for six hours, because it took that long for an oxygen tube to arrive.

Farhand Daniel died on November 8, 2018. Diamond remains holed up in her home, 100 days later.

Grief still laced her voice when she tells GMA News Online the exact details of the most tragic moment of her young life.

Ang hirap pa rin. Hindi pa rin kami nakaka-move on,” she says. “‘Yung baby ko lahat ng gamit niya nasa bahay pa rin, hindi ko pa rin tinatanggal. Katulad nga nito, ‘pag dadating ‘yung kabuwanan ng pagkawala niya nahihirapan kami, tinutulog ko na nga lang eh.”

(“It’s still so hard. We haven’t moved on. My baby’s things are still at home, I haven’t gotten rid of them yet. When the day of his death comes every month, we have a hard time, I just try to sleep it off.”)

Diamond is angry at the hospital. She thought the worst could have been prevented, because she brought him there the moment she felt the fever, and yet it turned into a drawn out, grueling battle against a disease that took health workers days to diagnose.

But she holds some of that anger against herself as well, because her son’s ailment could have been prevented with the right vaccine.

Farhand Daniel had nearly completed all his vaccine shots. The only doses he missed were the ones that would have protected him from measles.

Hindi ko siya nabakunahan ng MMR. ‘Yung sa measles ang wala, ‘yun ang wala ako, kasi nga nagtrabaho ako nu’n. Hindi ko siya napabakunahan, masyado akong naging busy sa trabaho. Nandito lang siya lagi sa bahay,” Diamond says. “Naniniwala ako sa bakuna, lagi ko naman pinapa-check-up ‘yung baby ko na ‘yun nu’ng wala pa akong trabaho, suki kami ng health center, pati mga private clinic.”

(“I wasn’t able to have him vaccinated with MMR. The one for measles, that’s what I missed because I was working at the time. I wasn’t able to have him vaccinated because I got busy with work. He was just always at home. I believe in vaccines. I always took him for check-ups before I got my job, we were always at the health center and even private clinics.”)

After she resigned from her job, she took her baby to the health center, but the schedule for the vaccine was pushed back because he had the flu.

Shortly afterwards, he got sick and never recovered.

DIAMOND LIVES IN BASECO, a community in Tondo, Manila that is especially susceptible to outbreaks of an airborne disease like measles because of its large, dense population. Children aged zero to two have been most affected.

Measles is the most contagious of the 13 diseases preventable by vaccines. Following declining coverage under the Department of Health’s immunization program, measles cases spiked, prompting the agency to declare an outbreak last February 6.

Nearby San Lazaro Hospital, to which clinics and health centers in the area refer measles cases, is bearing the brunt of that outbreak.

In 2016 and 2017, it reported 108 and 171 measles cases, respectively, and two deaths. The numbers increased more than tenfold in 2018, with 2,144 cases brought in. Sixty-eight patients died that year.

This year, as of February 13, San Lazaro has seen more than 1,500 cases, including 69 deaths.

With the onslaught of measles cases, health workers are working overtime to accommodate patients.

It used to allot just a single room with five beds for measles patients. Recently, admitted patients have spilled over to two full wards.

Overworked staff have pulled out beds from other wards to accommodate the swarm of measles cases. Rooms are cramped with multiple families and beds have been placed in the hallways. Cries of babies constantly pierce the air.

But it’s not just the children and families who suffer.

On a busy February morning, a nurse passed out due to heat and exhaustion, and had to be wheeled out of the pediatric ward where young measles patients were being treated.

Another pedia nurse, Jane (not her real name), says the stress has been getting to the staff. She herself was already working hours overtime just to tend to the patients, because there were only three nurses and two attendants per shift.

Ang nangyayari, hindi naman nakakaya ng tatlong nurses and dalawang attendant na ganito karaming pasyente. Lalong lalo na maraming calls,” she says .

(“What happens is that three nurses and two attendants can’t handle this many patients, especially because there are so many calls.”)

Tempers tend to flare in the wards as angry parents and exhausted staff clash. Sometimes the nurses would have to call a security guard to calm down parents who start picking fights, worried their child was not getting the care they needed.

Sa totoo lang, hindi minsan nabibigay yung sinasabing quality care, kasi nga understaffed. Kulang. Sobrang dami ng pasyente,” Jane says.

(“The truth is, sometimes, we can no longer give quality care because we are understaffed. There are too many patients.”)


“The truth is, sometimes, we can no longer give quality care because we are understaffed. There are too many patients.”

— Jane, pediatric nurse at San Lazaro Hospital

JANE SEES MANY FACTORS contributing to the surge of measles cases in the hospital, but she believes public fear of vaccines brought on by the controversy over Dengvaxia made the biggest impact.

Nu’ng last March or April 2018, nagpa-measles vaccination kami dito pero konti lang ‘yung pumunta,” Jane says. “Kasi siguro kung nagpabakuna sila at hindi sila natakot, hindi naman siguro dadami ng ganiyan eh.”

(“Last March or April 2018, we held a measles vaccination program here, but only few came. If they had vaccinated their children and weren’t afraid, the cases wouldn’t be this many.”)

The numbers seem to bear out Jane’s observations.

A poll by the Vaccine Confidence Project, an academic research group based at the London School of Hygiene and Tropical Medicine (LSHTM), on 1,500 participants shows a significant decline in vaccine confidence among Filipinos — from 93 percent “strongly agreeing” that vaccines are important in 2015 to 32 percent in 2018, following the Dengvaxia controversy.

Perceptions of vaccine safety decreased from 82 percent in 2015 to 21 percent in 2018; confidence in its efficacy fell from 82 percent to 22 percent, and even compatibility of vaccination with the respondents’ religious beliefs dropped from 63 percent agreeing to 21 percent, according to the survey results.

The article was written by Heidi Larson from the LSHTM, Kenneth Hartigan-Go of the Asian Institute of Management — a former health undersecretary and a respondent in complaints over the Dengvaxia controversy — and Alexandre Figueiredod of the Imperial College London.

“Episodes such as the Philippines response to the dengue vaccine risk, despite it benefits, are signals of deep dissent and distrust that needs to be considered in advance of a pandemic,” the authors of the survey’s accompanying solicited commentary article wrote.

Nering Gallo, a barangay health worker working in Baseco in Tondo, Manila, talks about the challenges of getting people to get their children vaccinated.

BARANGAY HEALTH WORKERS like Nering Gallo still recalls how parents had trooped to the Baseco Health Center when they first heard about Dengvaxia and eagerly had their children vaccinated. The center had used leftover stocks from their local school and conducted a mass immunization in the area.

But things changed when the Dengvaxia controversy broke out. 

Nering and her colleagues would knock on door after door in an attempt to convince parents to get their children vaccinated.  Mothers would clutch at their children, hide them, or say they’ll have them vaccinated next time.

‘Yung time na ‘yun talagang hahawakan ng nanay ‘yung anak nila, parang yayakapin nila, ayaw talaga nila pabakunahan. So kami naman bale health worker kami, nagpapaliwanag kami. May time na pinapakita namin ‘yung bote ng gamot na i-inject sa anak nila,” she says. “May ibang nanay na ayaw talaga, saka na lang daw. Talagang pinapakita namin ‘yung gamot. ‘Nay, iba ‘yung Dengvaxia...MMR po ito.’”

(“At the time, mothers would hug their children, they didn’t want to have them vaccinated. As health workers, we explain, we have to show them the bottles of vaccines we wanted to inject to their children. Some mothers would refuse. We would show them the vaccines, we would say ‘This isn’t Dengvaxia, this is MMR.’”)

Nering admits she also had fears when the Dengvaxia issue broke out, with mothers crying their children died from the dengue vaccine. Two of her 16 children were injected with the dengue vaccine, after all.

Kami bilang isang health worker, sinasabi ko sa kanila anak ko naturukan din ng Dengvaxia. Kaya ‘wag n’yo sabihin na ‘wag n’yo paturukan ‘yung mga anak n‘yo kasi ito lang ‘yung way na maiwasan natin ‘yung pagkakasakit ng mga bata,” she says.

(“As a health worker, I tell them my children were injected with Dengvaxia, so don’t say that you won’t get your children vaccinated because this is the only way we can prevent them from getting sick.”)

Presently, their barangay has yet to report any alleged Dengvaxia-related casualties.

MEASLES OUTBREAKS are not new in the Philippines, but health experts say this latest one fueled by a vaccine-related controversy such as the Dengvaxia scare is unprecedented.

DOH data shows hundreds and thousands of measles cases recorded in the past decade nationwide, the numbers peaking during an outbreak in 2013 and 2014, with more than 50,000 cases and more than 300 deaths.

In the years without outbreaks, measles-related deaths across the country never went over 30.

In 2016, only 713 cases and two deaths were reported.

But the reprieve proved to be short. The numbers spiked again in 2017, whose tail-end saw a dengue vaccine controversy begin and snowball into a national issue.

In 2018, the figures increased again exponentially, with 20,827 cases and 119 deaths reported nationwide.

This year, the DOH has declared an outbreak in Metro Manila, to Central Luzon, Calabarzon, Western Visayas and Central Visayas due to a similar increases in cases.

Diamond Macawaris, who lost her child to measles, recalls now that there were other kids who had measles in their neighborhood at the time.

Maraming nagkatigdas nu’n dito. ‘Di ko naman alam na ‘pag gumaling yung tigdas naghahanap na ng mahahawaaan. Akala ko magaling na. Akala ko magaling na sila. Pinapalaro ko na sa anak ako. Hindi ko alam na ganoon,” she says.

(“A lot had the measles here at the time. I didn’t know that even after they recover, the virus is still contagious. I thought they had recovered, I let them play with my child. I didn’t know it was like that.”)

The San Lazaro Hospital pediatric ward has been overrun by measles cases. Jessica Bartolome

IN A TWIST OF FATE, Diamond was at the hospital with her dying baby when she found out some happy news.

Eto nu’ng namatay baby ko, nalaman ko na buntis kami, lagi kasi akong nagsusuka sa ospital. Nu’ng namatay baby ko nalaman ko na three months na ako,” she says.

(“When my first child died, I learned that I was pregnant. I was always vomiting when we were at the hospital. When he died, I found out that I was already three months pregnant.”)

Now, Diamond counts by threes.

Her second baby was three months on the way when her firstborn died. It has now been three months since the tragedy, and it will be three months again before her home is brightened by another child’s presence.

She had no idea about the Dengvaxia issue, so her world was not shaken by the rumors that a vaccine could kill her baby.

Still, with her second baby, she’s determined to get it right. More than anyone, she is aware of how painful it is to lose a child.

Naaawa din ako sa ibang nanay kasi alam ko ‘yung pakiramdam na mawalan ng anak. Parang kumakalat na siya, so hindi lang pala sa anak ko, pati sa ibang lugar,” she says.

(“I feel sorry for the other mothers, because I know what it feels like to lose a child. The measles cases are spreading, so it wasn’t just my son, it also happened elsewhere.”)

II.

A LESSON IN COMMUNICATION

THE MEASLES OUTBREAK was declared more than a year after Sanofi Pasteur, the maker of Dengvaxia, the world’s first dengue vaccine, announced the product may lead to “severe” dengue symptoms among patients who have not had dengue before immunization.

But the chaos that erupted from the issue — investigations, dozens of criminal complaints, autopsies on dead vaccinated children — continues to be blamed for the plummeting vaccination confidence that is believed to have contributed to the outbreak.

By the time Sanofi announced its findings in late Nov. 2017, the government’s dengue immunization program had reached more than 800,000 school children. The program was suspended shortly after the Sanofi disclosure.

Months later, a group of immunization experts from the World Health Organization recommended that only persons who have had dengue — determined through a “screening strategy” — be vaccinated with Dengvaxia.

While health workers on the ground struggled to convince parents to have their children vaccinated for diseases other than dengue, a blame game among top officials played out in Congress, the Office of the Ombudsman, and the Department of Justice.

The accusations range from corruption to reckless imprudence resulting in homicide, with groups like the Volunteers Against Crime and Corruption and parents of Dengvaxia “victims” leading the charge against officials as high as former president Benigno Aquino III and his Health and Budget secretaries.

For its part, the Public Attorney’s Office under Persida Acosta has attributed more than a hundred deaths to the alleged “adverse effects” of the vaccine. Its forensic team, led by medico-legal officer Erwin Erfe, has told the DOJ that its autopsies reveal a “pattern” of symptoms that link causes of death to the vaccine.

In one of 32 complaints pending before DOJ prosecutors, for example, the PAO said its examination of a 12-year-old girl’s body showed multi-organ enlargement, hemorrhages and evidence of cellular/organ dysfunction, ischemia, inflammation, hypertrophy, edema or congestion in some organs.

This led them to conclude that edema and extensive brain hemorrhage was the immediate cause of death, with multi-organ hemorrhage as an antecedent, and “neurotropic-like disease and viscerotropic-like disease secondary to Dengvaxia vaccination” as an underlying cause.

According to the girl’s death certificate, she died of acute respiratory failure, with rheumatic heart disease as an antecedent cause.


“They are really desperate, sowing fear into the hearts of the populace and that’s why it is also creating a lot of distrust for the DOH’s immunization program,”

— DOH Secretary Francisco Duque on the PAO role in declining vaccine confidence

A number of medical professionals have criticized the PAO for its autopsies, finding fault in “non-specific” and “vague” findings that they say incorrectly connect deaths to the vaccine.

In February last year, pathologist John Arnel Amata, who examined some tissue samples in the PAO autopsies, said not all deaths of Dengvaxia recipients can be linked to the vaccine.

Dapat nga po maging maingat sa sasabihin natin kasi marami pong sakit ang nag-o-overlap po ang mga presentation. Lahat po ng mga viral diseases pwede po mag-present as mga rashes, pwede rin po mag-cause ng bleeding,” Amata said.

(“We have to be careful because a lot of ailments overlap in presentation. All viral diseases could present as rashes, they could also cause bleeding.”)

Raymundo Lo, formerly the chief of the Philippine Children’s Medical Center’s pathology division, says the PAO forensic team led by Erfe has been “selective” in its findings.

He says the standard for adverse effects following immunization, set by vaccine safety research network group Brighton Collaboration, follows a criteria that include temporal association — in which symptoms have to manifest not more than 30 days after vaccination — and the lack of a clear alternative diagnosis to account for the symptoms.

“What [Erfe] was actually looking at were events unrelated to immunization but may have a temporal association with it, which is coincidental,” Lo says.

Last November, Lo told a House of Representatives committee probing the issue that the PAO “jumped to conclusions.” He is now named by the PAO as a respondent in complaints at the DOJ for his alleged hand in the purchase request of the vaccine, a move Lo views as an act of intimidation.

When asked about the composition of the PAO’s forensic team working on Dengvaxia cases, Acosta lists more than a dozen “experts”: two pathologists, three medico-legal experts, including Erfe; three dengue experts, an epidemiologist, a public vaccination expert, two internists, a junior pathologist, and others.

On the legal side, she says only eight senior PAO lawyers are working on the cases.

Ramil Batuhan, the father of a measles patient at San Lazaro Hospital, did not get his child immunized because of fears over Dengvaxia.

Health Secretary Francisco Duque is not just critical of the PAO’s autopsies, but he also directly blames the office and its leader’s alleged fearmongering as a major contributor in the decline in vaccine confidence, a problem he says has cost the DOH millions of pesos.

“It was always on air, it was on TV, it was on the newspapers. And people’s impression was that no vaccine was safe anymore,” he says.

“They are really desperate, sowing fear into the hearts of the populace and that’s why it is also creating a lot of distrust for the DOH’s immunization program,” he adds.

Lo, for his part, is concerned that some parents’ distrust of government-sponsored immunization already shows a health care system being “demolished by all these attacks on Dengvaxia.”

But Chief Public Attorney Acosta, a vocal Dengvaxia critic who has represented parents in DOJ hearings and in press conferences, has repeatedly washed her hands off responsibility for the decline in vaccine confidence.

Her basis for the PAO’s work is an order by then-Justice secretary Vitaliano Aguirre for the office to “extend free legal assistance in civil, criminal and administrative cases to all possible victims of Dengvaxia related injuries, illnesses and deaths."

“We are just revealing the factual setting of the case. We are not telling the people na ‘wag magpabakuna, never lumabas sa bibig namin na ‘wag magpabakuna ang mga tao. Ang issue lang ng PAO ay Dengvaxia,” she says. “Bakit kami ang sisisihin? Sisihin nila ang sarili nila.”

(“We are just revealing the factual setting of the case. We are not telling the people not get vaccinated. The only issue of PAO is Dengvaxia. Why would they blame us? They should blame themselves.”)

The buzz over the Dengvaxia issue certainly made 52-year-old Ramil Batuhan wary not just of the dengue vaccine but all vaccines in general. Batuhan, the father of a year-old measles patient at San Lazaro Hospital, shared how he heard people on the streets and even in the jeep discuss the controversy. It scared him so much he packed up and brought his family to his province, but the debate was strong there as well. No distance helped anyway — his baby still ended up infected with measles.

Lo believes the poor are the most vulnerable victims of the “mass hysteria” against vaccines. Acosta, on the other hand, says her office is only helping the poor.

This back-and-forth has spilled over to the issue of accountability on the measles outbreak. Amid the he-said, she-said, public health expert Susan Mercado, a Philippine Red Cross official, believes that the government did not prioritize its immunization programs over the past years, which could have also contributed to the outbreak.

Ang pagbagsak ng coverage ng mga bata ay nangyari sa mahabang panahon. At marami pang iba’t ibang factors ang nag-cocontribute diyan,” Mercado said in an interview on Balitanghali.

(“The decline of coverage for children happened over a long period of time. There are also a lot of other factors that have contributed to that.”)

But with the crisis at hand, Mercado says the government should move beyond finger-pointing and instead focus on solutions to control the outbreak, noting that intense vaccination program and education of parents are the only answers to the present measles problem.


“We are just revealing the factual setting of the case. We are not telling the people not get vaccinated. The only issue of PAO is Dengvaxia. Why would they blame us? They should blame themselves.”

— PAO Chief Persida Acosta on criticism that her office caused the vaccine scare

HEALTH WORKERS AND PARENTS  interviewed for this story all point to television news as their primary source of information on the dengue vaccine controversy. Duque, Lo, and Fortun ascribe part of the problem to media coverage that may have prioritized “perceptions” over “evidence.”

On the other hand, Acosta, who has rallied aggrieved parents to many a press conference, claims a lack of news airtime for the vaccine’s “victims.”

As early as weeks after the Sanofi disclosure, infectious disease specialists blamed “miscommunication” for the panic it left in its wake.

Gundo Weiler, the Philippine representative to the World Health Organization, sees a “big lesson” in the use of different forms of media in communicating a health concern like the Dengvaxia issue.

Amplified and facilitated by traditional and social media, the response to the Dengvaxia controversy went two ways: one that treated it like a public health concern, and another that considered it political, Weiler says in an interview.

While he recognizes Sanofi’s “transparency” in releasing its findings, he says there might not have been enough time to plan a communications strategy to match the magnitude of the impact of the issue.

The number of actors involved, all providing different information in various forms of media, created a “very difficult situation,” according to the WHO official. “[The] health sector itself was kind of part of the political debate,” he notes, making it hard for the public to determine who to trust.

“I don’t think there is an easy solution to that, and that’s the complexities nowadays that we see in many different areas. It’s really difficult to distinguish between the validity and the intentions of different types of information,” Weiler says.

At the end of the day, however, it’s important for the public health sector to acknowledge fears and anger in the population, he says, stressing that “it’s not just about transmitting rational information.”

Public health expert Susan Mercado says the government should move beyond finger-pointing and instead focus on solutions to control the outbreak.

Weiler recalls the vaccination skepticism fueled by former British doctor Andrew Wakefield’s suggestion of a link between measles vaccine and autism in 1998. The medical journal that published his research retracted it. In 2010, Wakefield was removed from the United Kingdom’s medical register.

However, the European Union saw a “dramatic increase” of measles cases in 2018. While vaccination coverage in the region rose from 2016 to 2017, rates at the level local vary, according to WHO’s Europe office.

The United States, which is grappling with its own issues of vaccine hesitancy, has seen more than 100 measles cases this year.

“The perception that it’s really just about telling the truth and communicating evidence-based information and that this in itself would be sufficient to impact on people’s minds and behaviors — I think we’ve learned that this is really not the case in real life,” he says. “And we now understand better... that we have to prepare the grounds to communicate rational and evidence-based information by establishing a relationship with the audience, a relationship of trust and a relationship of mutual communication.”

When people feel their views and emotions are “appreciated,” Weiler says “they will be more receptive to evidence-based information.”

For their part, the authors of the London School study wrote that they saw a need to “re-establish” the credibility of the DOH and its immunization program and for the global players involved to “examine this experience and consider its handling of risk in times of uncertainty.”

But some recovery is apparent, says Weiler, one year and three months since the issue began.

“I think the trust in the Department of Health and health system… is also rebuilding and we certainly see that in the context of measles outbreaks that we see across the country,” he says.

“I think we are in an upward movement and we see trust coming back. But this type of trust can be affected negatively very quickly… to rehabilitate will certainly take some time.”

III.

AFTER TRAGEDY, HOPE

At the wake of six-month-old Jefferson Idao, who died of complications brought about by measles. Jessica Bartolome

A TINY COFFIN stands crammed against the wall in a wet, narrow walkway in Baseco, Manila.

A candle flickers, and beside it was a picture of a baby: six-month-old Jefferson, who died of complications brought by measles.

Jackie Idao, the grieving mother, sits nearby, with another of her children on her lap.

She had woken up one January morning and found her youngest child was no longer breathing.

They had only just returned to Baseco after spending the months after giving birth to Jefferson in their province in Bulacan. They had help there, she says. She didn’t think this would happen when they finally returned home.

She came back to Manila during a pile-up of measles cases. When her son caught a fever, she tried to care for him herself, scared that he will contract the disease if taken to the hospital.

Umpisa po lagnat, tapos nagka-ubo, tapos hanggang sa hinihingal na siya,” she recalls.

(“It started with fever, then he started coughing, and then he had difficulty breathing.”)

But she thought the fever was waning, and the baby’s breathing was aided by a nebulizer, so she laid her fears to rest.

Nu’ng pang three days na niya, bigla na lang po, nanghina ulit siya. Kinaumagahan, ayun na. Hindi na siya nagising,” she says. “Tapos may nakita ako, biglang naglabasan po, nung wala na siyang hininga ‘yun po biglang lumabas lahat.”

(“On the third day, he started to get weak again again. The following morning, he didn’t wake up. The red rashes started to appear when he was no longer breathing. They all came out.”)

At six months, Jackie’s baby was too young to have been vaccinated.

Health workers in Baseco have seen a renewed willingness from parents to get their children vaccinated. Jessica Bartolome

BEFORE THE START OF THE YEAR, the World Health Organization identified vaccine hesitancy as one of the threats to global health for 2019.

Lack of vaccine coverage affects herd immunity, which is achieved when the vaccination of a portion of the population provides protection even to unprotected individuals. When a large number of the population are immune, it is harder for diseases to be passed from one individual to another to maintain a “chain of infection.”

There are infections for which herd immunity is very important: measles, rubella, and varicella, which are directly transmitted from person to person, and polio, an infection for which humans are the reservoir or an important reservoir.

An absence of herd immunity puts at greater risk children who are too young to be vaccinated, such as Jackie Idao’s six-month-old baby.

Health Secretary Duque admits that immunization levels in the country was already problematic even before the onset of the Dengvaxia controversy. The low number of vaccinated patients was already evident especially in geographically-isolated areas, where residents are more difficult to convince and educate about the importance of being immunized.

He clarifies that there is no problem with the supply of vaccines as well as with the capability of health workers. He blames a lack of education for hindering health staff from administering vaccines to children, as mothers need more convincing to let their children get immunized.

There are also cases where health workers are frightened to visit conflict-stricken areas.

Annually, the DOH aims to vaccinate 95 percent of the population. Vaccine coverage in the Philippines reached its peak in 2010 at 90 percent. However, since that period, coverage in the Philippines has continued to drop.

In 2016, the record of fully immunized children was at 69.84 percent. It gradually decreased to 67.47 percent in 2017. As of the third quarter of 2018, vaccine coverage shrinked to 39 percent.

Duque also blames part of the downward trend on immunization coverage to local government units that do not prioritize the implementation of vaccination programs.

Hindi matutukan ng DOH lahat ng local government units dahil napakadami niyan, down to barangay levels ‘yan... ‘yung kakulangan din ng prioritization ng mga local chief executives like mayors and governors among others,” he adds.

(“It is difficult for the DOH to monitor all the local government units as they are numerous. The declining vaccine coverage may also be attributed to some local chief executives who do not prioritize administering vaccines to children in their municipalities.”)

MEDICAL EXPERTS WORRY that the public’s shaken confidence in vaccination will have dire effects for the whole Philippine health care system.

“Good vaccination coverage is a bit like a public health safety net for our communities,” says Weiler, the WHO official. “Once this net is broken… we’re getting very concerned,” he says, because populations, especially children, would be vulnerable to epidemics.

Aside from outbreaks of vaccine-preventable diseases, there is also a risk that polio, a disease that invades the brain and spinal cord and causes paralysis among patients, could re-emerge. This, after the WHO declared the Philippines “polio-free” after its compliance with several conditions imposed by global polio experts in October 2000.

Health facilities will be “overwhelmed” with patients if cases of infectious diseases continue to rise, Duque says, admitting “our hospitals do not have the capacity to manage all the outbreaks” if epidemics broke out.

The DOH has spent “hundreds of millions” to ease the public fright, with tri-media campaigns as well as the distribution of CDs, pamphlets, and brochures, and putting up posters and tarpaulins.

Duque adds: “Social media is very important. We've been uploading all our campaign communications on immunizations and so we have not left any stone unturned in terms of efforts to improve confidence in vaccines and trust in the vaccines.”

Despite all the efforts, it remains an uphill climb. The DOH is set to introduce Japanese Encephalitis Immunization in Regions I, II, III and CAR this March. Duque has already received reports of apprehension to the plan from the ground — still because of the scare, he says, brought on by the Dengvaxia controversy.


“Parents are again flocking to our health center after they saw on television children, even babies, dying due to measles.”

— Nering Gallo, barangay health worker in Baseco, Tondo

THERE ARE SIGNS OF HOPE, and some can be found in one of Baseco’s narrow alleys, where concerned mothers, carrying their infants, surround health workers as they patiently wait for their babies’ turn to receive measles vaccine. Days after the DOH pronounced a measles outbreak, mothers are more than willing to have their children vaccinated.

Most of them also start the day by paying a visit to the health center. Health workers are greeted by a line of mothers wishing to spare their children from the outbreak.

Nering, the health worker, says the scene is a far cry from what happened when the Dengvaxia controversy began.

She is pleased to see parents approach them without the need for house-to-house visits.

Ngayon naman sa awa ng Diyos pumupunta na sila... Nakikita nila sa TV na marami na ang namatay ilang buwan pa lang... Sila na mismo ang pumupunta rito,” Nering says. “Kita n’yo naman po sa umaga, dinadagsa nila kami. Kaninang umaga nung nag-ikot kami, talagang sila ‘yung dumudumog. Hindi na namin kailangang magtawag. Nung nakita nilang mayroong doktor at nars, sila na ‘yung kusang lumalapit.”

(“Thank God, parents are again flocking to our health center after they saw on television children, even babies, dying due to measles. When we went out this morning, we no longer had to call them to have their kids vaccinated. They immediately approach doctors and nurses.”)

Nering believes the measles outbreak has revived the trust, at least of Baseco residents, in the effectiveness of vaccines.

Jackie Idao, the mother who lost her six-month-old to measles, admits she had apprehensions about getting her baby immunized after hearing about Dengvaxia.

Natakot po ako kasi ngayon lang ako [nakarinig] ng ganoong sakit eh,” she says.

(“I got scared of Dengvaxia, because that’s the first time I heard of something like that.”)

Knowing what she knows now, she says she definitely would have. That has now become her appeal to fellow mothers: “Pabakunahan n’yo na ‘yung mga anak niyo habang hindi pa nagkakasakit.”

(“Have your children vaccinated before they get sick.”)