Getting to the bottom of childhood immunization: Weighing the good & the bad
MANILA, Philippines — The Philippine National Immunization Program is just coming out of a crisis brought about by combined unfortunate events, misinformation and misleading news that led to the loss of trust and confidence of our people in vaccination and other public health programs.
The childhood vaccine coverage, which used to be as high as 90 to 95 percent in the ‘90s, was down to less than 50 percent — the lowest in our region at the beginning of 2019. In some provinces and barangays, this was even as low as 30 percent. As a result, diseases that have almost disappeared such as measles, which can be fatal for children and adults, came back to wreak havoc not only to the health of our people but also to the economy.
More than 400 children, including some adults, died from measles in the first three months of 2019. It must be recalled that between 2005 and 2009, measles was almost unheard of in our country and almost eliminated. There were many young doctors, in fact, who could not diagnose measles in the early weeks of the outbreak and mistakenly placed measles case among dengue cases. This has caused widespread measles to other patients.
The measles outbreak in the Philippines became the highest in Asia and second in the world after Ukraine, and health officials feared that more outbreaks of other vaccine-preventable diseases such as diphtheria, pertussis, and polio (God forbid!) were inevitable if the trend was to continue.
The emergence of diseases such as dengue, avian flu, and pandemic influenza, would have people avoiding coming to the country for fear of getting the disease, and preventing people from leaving the country to reduce transmission of the disease. Many may consider this as outrageous and absurd but take the example of Brazil when it hosted the Rio de Janeiro Olympics in 2016. Some athletes withdrew from the Games because they feared Zika, another disease brought by mosquitoes, which at that time was reported to be spreading in Brazil.
In the local scenario, this was exemplified by the 2018 outbreak of avian flu in Nueva Ecija and Pampanga that brought considerable economic burden and depression to the local residents. Also in 2004, when the Meningococcal outbreak occurred in Baguio, people will remember the enormous damage to Baguio’s health and economy with the death of more than 30 children and young adults and more than a hundred taken ill. To top it all, some Baguio residents complained of being ostracized and avoided like the plague when they tried to mingle with others or traveled to other places. The intervention consisted of vaccination and administration of prophylactic drugs to control the spread of the disease, which was caused by a Meningococcal Group A and is vaccine-preventable. As a result, all health-care workers in Baguio are now recommended to be given Meningococcal Vaccine, one dose which is highly protective and immunogenic for Group A, C, W, and Y serotypes to protect both health workers and prevent transmission of the disease to other patients.
It was then Health Secretary Juan Flavier who brought about the concept of National Immunization Days, when from 1990 to 1994, the whole month of April was the time for catch-up vaccination against Polio, Diphtheria, Tetanus, pertussis, and measles. Children below eight years old, and about five million of them each year received these vaccines and such program was acknowledged and appreciated worldwide, especially by the World Health Organization (WHO). This was contributory to the Philippines being declared polio-free in 2000, and Dr. Flavier was recognized and given one of the highest awards for Child Health by WHO. It is also noteworthy that the Philippines achieved the WHO-UNICEF Millennium Development Goal 4, which mandates a two-thirds reduction of the number of deaths of Filipino children below five years old from 1990 to 2015 — a 25-year period — with vaccination of young infants as the main strategy for its success.
Although significant gains have been achieved in the two decades, from 1992 to 2012, new vaccines introduced in the NIP, such as Hep B at birth in 2006, Hib, MMR in 2010 and Rotavirus and Pneumococcal Vaccine in 2012, complacency has started to develop among our people when the vaccine-preventable diseases began to disappear. A slow but steady decrease in childhood vaccination was also occurring due to some anti-vaccine misleading news and social media scare.
The vaccination coverage then took a dramatic and significant plunge with the panic and hysteria brought about by the Dengvaxia controversy. Politicians and anti-vaccine groups used the Dengvaxia issue to their advantage without considering the enormous negative impact it will have on vaccine confidence. The occurrence of the measles outbreak in many parts of the country was inevitable and became the disturbing and tragic outcome of a decreased vaccine confidence.
It is in this context that the Philippine Foundation for Vaccination (PFV), in its more than 18 years of existence, has advocated and forged partnerships with government, academe, civil societies, industry, and many other institutions and agencies to raise awareness on the value of vaccination and help to make vaccines accessible to the general public. Through the years, PFV has endeavored to educate, advocate, do research, and engage stakeholders and policymakers to reduce morbidity and mortality of our people from vaccine-preventable diseases and maintain better health for our country.
With the advent of Universal Health Care, which became law in November 2018, a successful Immunization Program is essential and is at the core of preventive health care. This is expected to bring about the equal opportunity, which is most needed by the poor and underserved and provides the most cost-saving and cost-benefit measure to sustain health for our people.
We must call on all sectors of society to join hands and help restore the trust and confidence of our people on vaccines, and renew the campaign to make this happen. We will assist the government, private sectors, and other stakeholders to drive policymakers and decision-makers to make health and disease prevention through vaccination a priority in our country. The children are our future, but they need us now to protect them! — Dr. Lulul Bravo
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Dr. Lulu Bravo is a professor emeritus of the University of the Philippines – Manila, College of Medicine and executive director of the Philippine Foundation for Vaccination.
