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Bacolod City, Philippines Tuesday, December 5, 2017
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Come to think of it
with Carlos Antonio L. Leonardia

Vaccine nation


When the news that a vaccine for dengue had been developed and made available to the public, I considered getting my kids inoculated. After all, I am a believer in science and the miracles of modern medicine and the annual threat of dengue fever made vaccination worth mulling.

However, even if I trust science and technology to make life better for humanity, I don't consider myself a beta tester. As with the case of the aging electronic gadgets in our home, I do not automatically update every time I am prompted because while the updates may be good for the latest and greatest models, compatibility with older models could be sketchy and even speed up the planned obsolescence of the product. Since I wasn't sure with the track record of the dengue vaccine upon its much-heralded introduction, and with the health of my kids were at stake, I chose to wait for the reviews before opting in.

It looks like it's a good thing we didn't get our kids the dengue vaccine because recent news from Sanofi Pasteur says clinical analysis has found the vaccine effective for people who already have had dengue. Those who have not are at risk of a “severe” case of dengue. As far as I know, my kids fall under the latter and that means getting them vaccinated could've increased their risk instead of lowering it. It would seem that procrastination has its advantages.

I avoided the stress caused by the revised advisory on Dengvaxia but unfortunately for the Philippine government, the Department of Health uncharacteristically chose to be an early adopter and was among the few countries in the world to implement a dengue vaccination program within months of its release. The DOH spent P3.5 billion on the vaccine and had so far vaccinated more than 700,000 school children for free.

People are now in an uproar because roughly 10 percent or approximately 70,000 of the vaccinated school children who had not been previously infected with dengue are now believed to be at risk of a “severe” case of dengue. Note that the 10 percent figure came from men of science and medicine so unlike politicos who like to make things up from thin air to suit their agenda, there are actual studies and statistics to back up this claim and anyone who wants to dispute it should easily do so if they really wanted to.

Even if no one has actually died yet and the manufacturer's definition of “severe” dengue does not include death, those who are panicking are already throwing out words like “genocide” and calling for heads to roll.

While I agree that heads should roll for putting the lives of approximately 70,000 children at risk of “severe” dengue by having them vaccinated too soon, I also think that people are overreacting. The head of the DOH made the call to proceed with the vaccination program based on the claims of the manufacturer, the guidelines of the World Health Organization, and the clearance of the country's Food and Drug Administration.

They made their decision based on the perennial dengue problem in the country and their trust the rigorous process that medicines have to go through before getting approval for release in the international market. They thought that they were being proactive in addressing the dengue problem but now it seems that they will have to pay for their lapse in judgment. Note that if Sanofi gotten Dengvaxia right from the get go, those officials would've been credited for making the right decision in protecting hundreds of thousands of Filipino children from dengue. But because further clinical trials indicated a problem, they are now in hot water for moving too quickly as far as dengue vaccination was concerned. That is what you call a hazard of the job and explains why many of our government officials would rather play safe and stick to the tried and tested solutions instead of thinking innovatively.

The thing about vaccines is that they are not 100 percent effective but if something goes wrong, they are always blamed. Even now, irresponsible and sensationalistic government officials “investigating” the Dengvaxia fiasco are already linking alleged deaths to the vaccine even without proof. The next thing you know, it will be linked to autism. We need to understand that when a person is vaccinated there is a much smaller chance but no absolute guarantee against the target disease. A vaccine is analogous to the combination of a seatbelt and an airbag. There are no guarantees that you will never die or be seriously injured in a car but those who use seatbelts have a greater chance of survival if they do get in a crash.

If the DOH and DepEd did their job properly when they vaccinated the kids, they should be able to identify the 10 percent who are at risk from “severe” dengue due to Dengvaxia and act accordingly to ensure that an additional layer of protection is ready in case those who have been identified as at risk do get infected. Sanofi Pasteur should also help by developing a test (if it doesn't exist yet) that can be conducted on the vaccinated kids to determine the level of risk and prepare the appropriate countermeasures for affected individuals.

Should the DOH officials have waited before implementing the dengue vaccination program on such a large scale? In hindsight, the answer is always clear. Obviously, they should've waited until all the kinks were ironed out.

More than the 70,000 affected kids who have a chance of contracting a “severe” case of dengue because of the vaccine, what worries me more is what this fiasco does to the perception of vaccines in this country whose people have already proven their vulnerability to fake news and propaganda. This setback is a godsend for the antivax movement and the perception that a vaccine made matters worse, even if it is just for 10 percent of those vaccinated who were not identified properly upon dosage, could encourage more people to shun vaccines in general and this DOH booboo could end up in a problem that is much bigger than dengue.

And that is why heads most roll.*

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