Vaccination program needs massive, vigorous information campaign

A recent survey of the Octa Research Group indicated that only 46% of adult Filipinos are willing to be inoculated with a vaccine that would protect them against serious illnesses caused by the coronavirus. Octa is a polling and research group of experienced experts and academics with interdisciplinary backgrounds.

The resistance to anti-coronavirus vaccine has tremendous implications on the Department of Health’s objective of inoculating at least 70% of the population to achieve herd immunity — when the great majority of the people have been immunized to the coronavirus, thus preventing its further spread. With only 46% immunized to COVID-19 (coronavirus disease 2019), the other half of the population remains vulnerable to the coronavirus, the number of deaths is likely to rise.

This resistance to vaccination can be traced to the controversy arising out of the Department of Health’s program of inoculating schoolchildren with Dengvaxia, a vaccine developed by the Paris-based pharmaceutical giant Sanofi Pasteur. The company had high hopes for Dengvaxia, the development of which had taken 20 years and cost around $1.8 billion.

Officials predicted that the vaccine would bring down infection rates by 24% within five years. According to the World Health Organization, there are 390 million dengue fever cases worldwide each year, of which 96 million have clinical manifestations, and another 20,000 people die each year. Early diagnosis and effective care can control mortality rates below 1%.

In the Philippines, severe dengue fever is a major cause of severe illness and death in children. The health department spent $67 million on Dengvaxia and got underway a mass immunization program with the aim of vaccinating a million students by the end of 2016.

After more than 830,000 children had received at least one dose of the vaccine (Dengvaxia is administered as three injections, with six-month intervals), Sanofi Pasteur learned from the results of its trials that people who had never been infected with dengue before but received the vaccine could be vulnerable to a more severe case of dengue fever.

In November 2017, Sanofi Pasteur disclosed this finding to the public, prompting the Department of Health (DoH) to suspend the vaccination program in schools. Soon after, the potential implications of the vaccination program became a national scandal.

In February 2018, Attorney Persida Acosta of the Philippines Public Attorney’s Office filed a suit in melodramatic fashion against government officials and executives of Sanofi Pasteur and its Philippine distributor Zuellig Pharma. She sought damages on behalf of the parents of a 10-year-old girl who allegedly died after receiving the vaccine despite the fact that she had a pre-existing condition.

ABS-CBN news anchors Noli de Castro, Ted Failon, Anthony Taberna, and Gerry Baja, ever ready to sensationalize a developing controversy to rouse their large audience, picked up Acosta’s wild story. They fanned the controversy in their bombastic style in their respective daily programs, scaring their nationwide audience not only from Dengvaxia but other vaccines as well.

However, several medical societies in the Philippines said there is no credible evidence that links Dengvaxia to the deaths of the recipients. They questioned the validity of the reports of Dr. Erwin Erfe, which are the basis of Acosta’s lawsuits. The doctor’s field of expertise is forensic science, also known as criminalistics, which is the application of scientific methods and techniques to the investigation of crime.

If dengue-infected people who had been inoculated with Dengvaxia died, experts of infectious disease maintained it was the virus that had actually caused the death of recipients of Dengvaxia, not Dengvaxia itself. The vaccine merely failed to protect the patient from the virus, it had not caused the person’s death.

The Philippine General Hospital, the teaching hospital of the College of Medicine of University of the Philippines, Manila issued a report stating that three out of 14 children who died after receiving Dengvaxia indicated dengue, despite immunization, was the cause of death. Also, a group of doctors, including former DoH Secretary Esperanza Cabral, urged the Public Attorney’s Office to stop conducting autopsies.

But the clarification of eminent medical professionals were drowned out by the wild claims of the screaming, media-exposure seeking Public Attorney Acosta and the bombast of the four ABS-CBN broadcasters with enormous following.

During an investigation by the House of Representatives, mothers of children who took part in a mass vaccination program confronted then-Health Secretary Janet Garin, accusing her of killing their children. The women would later admit to the media that none of their children died after vaccination.

But the politicians saw in the controversy sensationalized by broadcasters an opportunity for greater media exposure. By February 2019, the Dengvaxia scandal had become the subject of two congressional inquiries and a criminal investigation. In the Senate, Senator Richard Gordon released his draft report that states former president “Benigno Aquino III is guilty of “malfeasance, misfeasance, and nonfeasance” in connection with his administration’s mass immunization program using Dengvaxia. Signatories of the report were Senators Ralph Recto, Manny Pacquiao, Win Gatchalian, Tito Sotto, Gregorio Honasan, Juan Miguel Zubiri, JV Ejercito, Nancy Binay, and Grace Poe.

In March, the Department of Justice, apparently succumbing to the “cry for justice” of many members of Congress and of high-rating broadcasters, filed charges against Sanofi Pasteur and DoH officials, claiming the officials had ignored “the identified risks and adverse effects of the vaccine and were therefore responsible for the subsequent deaths of several children.

Two advocacy groups with links to the Duterte Administration — the Volunteers Against Crime and Corruption and Vanguard of the Philippine Constitution, Incorporated — filed with the Department of Justice criminal complaints against former president Benigno Aquino and other officials of his administration over their alleged liability in the government purchase of Dengvaxia. They accused the respondents of committing multiple homicide and physical injuries through criminal negligence, graft, technical malversation, and violation of the procurement law for the purchase of Dengvaxia.

The baseless claims of Acosta, De Castro, Failon, Taberna, and Baja that Dengvaxia has harmful effects had serious implications on other vaccines. Now, many parents refuse to have their children vaccinated against preventable diseases like measles, even if the vaccines have long been proven safe and efficacious by the World Health Organizations and the Food and Drug administrations of many Western countries. With anti-COVID-19 vaccines just developed in the last 12 months, it is no surprise that fear of them is widespread and pronounced.

If the Duterte Administration is to contain the spread of the coronavirus, it has to wage a lavishly funded massive and vigorous information campaign to dispel the fear of vaccines that the screaming Acosta and the pompous ABS-CBN news anchors had instilled in the minds of countless Filipinos. The Presidential Communications Operations Office should allot its huge budget to the campaign. But it should not be given the tasks of formulating the campaign strategy and of implementing it. Its many booboos in the past have shown it to be incompetent for communications operations. A public relations firm or an advertising agency should be hired to design and execute the campaign.

The information must be delivered by highly credible and articulate specialists in the fields of infectious disease, epidemiology, public health, and other related fields. Health Secretary Francisco Duque, who had lost his credibility as a public health official when he acceded to President Duterte’s order to allow entry into the country of tourists from China in February last year, should be eliminated from the roster of endorsers of vaccination.

I am inclined to suggest that Dr. Lulu Bravo, Professor Emeritus at the College of Medicine, University of the Philippines, Manila, and founding president of the Philippine Foundation for Vaccination, be among the principal endorsers of vaccination. Her emotional plea in broadcast media to health frontliners to accept the first available vaccine against COVID-19, be it Sinovac, was persuasive. It would be effective in convincing the people who had been misled by Acosta and her accomplices in broadcast media.

She said the highly contagious coronavirus might infect the health workers before their preferred vaccine becomes available. She cited the cases of eminent doctors who had died of COVID-19 because no vaccine against it had been developed.

Her impassioned appeal to accept the first available vaccine against COVID-19 jibes with the advice of infectious disease experts in America, including Dr. Anthony Fauci, a physician-scientist and immunologist and the director of the National Institute of Infectious Diseases and Allergy since 1984, to get inoculated with the first vaccine one can lay his hands on. At least it would deter hospitalization and death.

My involvement in public health programs in the past may qualify me to suggest Dr. Eric Tayag, director of the Bureau of Health Development and director of the National Epidemiological Center of the DoH, and Dr. Susie Mercado, former Undersecretary and Chief of Staff of the DoH and formerly of the World Health Organization, as endorsers of vaccination. Both are familiar faces to TV audiences. Dr. Tayag’s style is perfect for convincing the masa — the vast audience of Kabayan Noli de Castro and his ABS-CBN colleagues — more than 70% of whom are not willing to be vaccinated.

The high-profile Red Cross Chairman Richard Gordon, who as senator politicized the Dengvaxia controversy, should also be eliminated from the roster of endorsers. Another doctor who should not be considered as an endorser is former Philippine Medical Association President Leo Olarte. His justification — to save the life of President Duterte — for the vaccination of the Presidential Security Group personnel with the smuggled COVID-19 vaccine was shameful. 

Oscar P. Lagman, Jr. was at one time Head of Healthcare Consulting at the largest consulting firm in the country. He had also been consultant on a number of USAID-sponsored health programs.