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WHO never endorsed Aquino’s dengue vaccination program

It even violated guidelines
CONTRARY to the claims of former Health Secretary Janette Garin, the mass vaccination program ordered by former President Aquino was neither approved by the World Health Organization (WHO) nor did it comply with its guidelines.

This of course raises the question: Why did Aquino, with a few months left as President in early 2016, rush the P3.5 billion purchase of Sanofi’s imperfect anti-dengue vaccine Dengvaxia?

Garin in a message to her friend broadcast journalist Melo Acuña wrote: “We implemented the dengue vaccination program in accordance with WHO guidance and recommendations. Even before the official release of the SAGE report on Dengvaxia, there were ongoing meetings and consultations among experts, WHO and Department of Health (DoH) officials. We fully cooperated and consulted with WHO prior to the implementation of this program.”

Garin is lying through her teeth, sources in the DoH said. The sources claimed that there were only two or three meetings with WHO officials. The vaccination program threw into the dustbin practically all of the WHO’s guidelines on the use of Dengvaxia.

In the first place, the WHO in July 2015 had withheld its recommendations on Dengvaxia, pointing out that the “WHO Strategic Advisory Group of Experts (SAGE) on immunization is currently reviewing the evidence and will advise WHO (likely in April 2016) on recommended use of the dengue vaccine.”

Aquino order
Still though, Aquino ordered the DoH in December 2015 to procure 1 million units of the Dengvaxia vaccine, and got the budget department to issue the authorization for its P3.5 billion cost as it wasn’t in the department’s budget (and therefore hadn’t been approved by Congress).

In July 2016, the WHO, based on the SAGE’s reports, issued a position paper, which said that “countries should consider introduction of Dengvaxia only in geographic areas where epidemiological data indicate a high burden of disease.” By high burden, it meant infection by the dengue virus of 50 percent to 70 percent of the population.

WHO pointed out that the use of the Dengvaxia in persons not infected with the dengue virus “is not recommended because of low efficacy and potential longer-term risks of severe dengue.”

Photo opp of his P3.5 billion vaccination program. Oops, the vaccine is revealed as having a frightening downside.

It would only be more than a year later, last November 29, that Sanofi itself announced this downside of its own drug: “For those not previously infected by dengue virus, however, more cases of severe disease could occur following (Dengvaxia) vaccination upon a subsequent dengue infection.” In layman’s terms, if a person had not contracted dengue before and is vaccinated with Dengvaxia, he will likely suffer a severe form of dengue, which could even be fatal.

This view wasn’t even an exclusive finding of the WHO. A physician Jacqueline Jobonero-Espina emailed me:

“The first question we asked when there was word around that a vaccine against dengue was being developed was, ‘Will it protect against all 4 serotypes of the virus?” A clear answer was not given. We doctors are all aware that a reinfection of dengue would be a more severe one. An infection can be caused by any of the 4 serotypes of the dengue virus and an infection produces lifetime immunity against that particular serotype. Reinfection with other serotype causes a more severe condition, dengue hemorrhagic fever, as the initial infection only confers partial immunity to the other serotypes. So, when the vaccine was launched most of us did not include it in our routine immunization schedule.”

Aquino’s DoH though made it a practically compulsory immunization program, with the parents of the public-school children left in the dark as to what it was.

Instead of complying with the WHO guidelines, the health department undertook the vaccination of 730,000 mostly nine-year-olds in the National Capital Region, Central Luzon, and Region IV-A (Cavite, Laguna, Batangas, and Quezon), and targeted a total of 1 million. Dengue incidence in these areas though are far from the WHO’s classification of areas in which dengue infection is 50 to 70 percent of the population.

Nationally, in fact, dengue ranks only ninth among diseases most prevalent among Filipinos, making one wonder why the Aquino government chose to spend a huge P3.5 billion to address that disease when only a fraction of that amount has been devoted to counter more widespread diseases like respiratory infections and influenza.

While Central Luzon and Region IV-A have had high rates of dengue incidence, other regions have had much higher rates, notably the Davao provinces. Did the Aquino government think it could also use the vaccination program as an election tool for 2016?

A much worse crime of omission of the health department is that it did not move a finger to follow the WHO’s recommendation that Dengvaxia should be administered only to those who had already contracted dengue before.

The DoH’s guidelines for the vaccination program (still posted in its website) make no mention of this crucial requirement for vaccination, and lists only four kinds of people who may not receive the vaccine: those less than 9 years old and above 45; those who are allergic to the vaccine; immune-compromised individuals such as those with HIV; and pregnant or breastfeeding women.

4 serotypes
In its FAQ section, it had the question: “If the pupil had past dengue infection, can he still avail of the vaccine?” The DoH’s reply: “Yes. Dengue disease is caused by 4 serotypes. Natural infection caused by one of the 4 serotypes confers lifelong immunity from that specific serotype but not from the other serotypes. Dengue vaccination can still provide protection against dengue disease from the other serotypes.” There was not a word on the WHO’s warnings that the vaccine should be administered in fact only to those who have had the dengue disease before.

How many of the 730,000 children were administered the Dengvaxia vaccine even if they had not contracted the disease, and therefore at high risk of getting a severe, even fatal bout of dengue if ever they catch the disease?

Using DoH statistics that dengue incidence in the country is 54 per 100,000 population, only 395 of them had the dengue fever before. That means 729,605 children were administered the Aquino-ordered vaccine for whom the WHO had advised against, and which puts them at risk of contracting severe dengue in the future.

If the P3.5 billion purchase of this problematic Dengvaxia is proven to be tainted with corruption, it would be the worst case of graft in our history, in which every concern for the health of the country’s children was thrown into the dustbin.