Commentary: The growing challenge of vaccination campaign in Philippines

President Rodrigo Duterte, in his message at the ground breaking of a new hospital in Malabon City, expressed his concern about the decrease in the immunization coverage among children and boldly asked parents not to fear vaccines. 

All other vaccines that have been approved by the government for immunization programs are “good” and “for the health of the person until they grow old,” he said. 

More than a year after the anti-dengue vaccine controversy, this was probably the first time that the president had described as “alarming to government” when people shy away from the vaccination for their children. 

According to the Department of Health, only six out of 10 children were getting their scheduled vaccinations. This makes the scandal a serious public health concern. 

In the last ten years prior to the Dengvaxia issue, the rate of Fully Immunized Child — “infants who received one dose of BCG, three doses each of Oral Polio Vaccine, DPT (diphtheria, pertussis (whooping cough) and tetanus), and Hepatitis B vaccines, and one dose of measles vaccine before reaching one year of age” — has been satisfactory, from a low of 67.47 percent in 2017 to as high as 86 percent in 2010. 

Many health care professionals such as doctors, nurses and midwives, working in the public health sector fear that the previous year might be the lowest rate in a decade. DOH said there is a need to “convince our people anew on the safety and value of vaccines” in order to increase the current immunization coverage. 

This should not be a concern if only RA 10152 or “The Mandatory Infants and Children Health Immunization Act of 2011” has been fully implemented. The law says that the mandatory basic immunization for vaccine-preventable diseases shall be given for free at any government hospital or health center to infant and children up to five years of age. 

Passed under former President Benigno Aquino III, the weak enforcement of the law contributed to the low public awareness that it even exists.

In the presence of the law, why are there still parents who take the liberty not to follow it? What could be the consequences for or liabilities of these parents who opt to compromise their child’s health? 

Obviously, the trust and confidence of the public on immunization continue to diminish due to misinformation and false claims. This might also be because of the lack of guidelines to implement the law. The lack of detailed procedures also prevents concerned government agencies from fully disseminating the law.  

Five years ago, this was the same concern of Senate President Pro-Tempore Ralph Recto when he directed the DOH in a public hearing to come up with the Implementing Rules and Regulations (IRR) for RA 10152. 

Almost eight years and several health secretaries since the law’s enactment, the final IRR has neither been published nor circulated in an official gazette for the information of the public. 

Meanwhile, a few days ago the Food and Drug Administration warned the public against the use of counterfeit anti-rabies vaccine “Verorab,” which pose potential danger or injury to its users. The regulatory agency issued the warning after the DOH endorsed the matter to the FDA’s Regulatory Enforcement Unit and coordinated with all hospitals about its sale. 

The fake drug, originally manufactured by Sanofi Pasteur, does not contain in its label the FDA-licensed importer and distributor, FDA Registration Number (BR-514), Rx symbol, the caution statement on dispensing, and bar code. 

Zuellig Pharma, the vaccine’s registered and exclusive distributor in the country, said the counterfeit vaccine with Lot No. H1833 did not come from them, while a statement from Sanofi Pasteur’s representatives said that the submitted Certificate of Product Registration was also fake. 

According to Director General Nela Charade Puno, “We have also requested all local government units and law enforcement agencies to ensure that this counterfeit product is not sold or made available in their localities or areas of jurisdiction.” 

This was not the first time that the vaccine brand “Verorab” is under the spotlight due to safety issues. In 2016, a public health warning against the same unregistered product has been announced by the FDA. 

Early last year, counterfeits of another anti-rabies vaccine “Rabipur” had been discovered by the agency. That time, the authorized marketing holder, GlaxoSmithKline Philippines Inc., together with FDA reminded the public to be vigilant and released an information campaign for consumers on how to determine fake versions of the vaccine by merely examining the product labels. 

With the proliferation of counterfeit issues, the main question for consumers is how to ensure the quality, safety and efficacy of vaccines. The answer relies with the FDA since they have the regulatory mandate to protect the public. They need to bring back the consumer’s trust in the agency as they have the technical expertise and capacities to determine the safety, quality and efficacy, not only of vaccines, but of all pharmaceutical products that are currently available in the local market.  

Immunization is said to be among the single important public health measure of the 20th century. It accounts for healthier, longer lives for all, most especially among infant and children. It is responsible for improving substantially the number of children who reach their first birthday.

Understanding the fear of some parents as they consider vaccination with scientific evidence, rather than baseless claims and accusations, is a more reasonable approach to improve vaccine coverage. 

Responding to the allegations that DOH paid families in exchange of dropping off Dengvaxia-related charges, Health Secretary Reynaldo Duque said: “As public servants, we must work together in the service of the Filipino people. We must collectively find solutions to the problems before us and not create divisions. We must always work around facts backed by reliable evidence.”

Alvin Manalansan is a health fellow of think tank Stratbase ADR Institute, a partner of Philstar.com.