Measles Outbreak Linked to Vaccine Scare in the Philippines

The Department of Health identifies vaccine scare contributes to measles outbreak in 2019. Validated data from different regions of the country by the Epidemiology Bureau of DoH revealed that from 1 January to 9 February 2019, a total of 4,302 measles cases have been reported, with 70 deaths.

Dr Lulu Bravo, Executive Director of the Phil. Foundation for Vaccination and
Atty. Tom Syquia former Executive Director of PS-PhilGEPS

Regions with high reported cases were NCR (1,296 cases and 18 deaths) CALABARZON (1,086 cases and 25 deaths), Central Luzon (481 cases with 3 deaths), Western Visayas (212 cases and 4 deaths) and Northern Mindanao (189 cases and 2 deaths). Eastern Visayas, MIMAROPA, CALABARZON, Central Visayas and Bicol are regions that have shown increasing trend as to reported cases for this week.

In Feb 2019, there were 4,000 cases and 70 deaths reported due to acute measles crisis. It was believed that the refuse for immunization after a scare from a different vaccination program causes increasing number of measles as well as polio.

The government, the DOH Philippines in particular asks parents to have their children immunized quickly and completely. Personally, I don't see anything wrong with vaccination. It is given to see healthcare workers going around the barangays to disseminate information on the importance of vaccination to children. Vaccination helps prevent complications of vaccine-preventable diseases and protects children from serious illnesses such as meningitis and measles.

Competitive Bidding Needed for Largest DOH Vaccine Procurement

Amidst several challenges being faced by the government as well as healthcare providers in pushing the importance of immunization. A competitive bidding is key to regaining public confidence in vaccines, said experts from both the public and private sector during a public health forum held at the Manila Hotel last Wednesday.

“It's always best to have a public bidding, because competition will give you the best price. It is transparent,” noted Tom Syquija, former Executive Director of Procurement Service- Philippine Government Electronic Procurement System (PS-PhilGEPS). “You get the same quality but at the lowest price. It's always best for the public if you have competition,” he added.

Invasive Pneumococcal Diseases (IPDs) is the largest cause of death for Filipino children under age five. Example of IPD is bacteremia, a fatal bacterial infection of the blood. Another example is Septicemia.

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The budget for pneumonia vaccines alone is P4.9 billion, allotted for Pneumococcal Conjugate Vaccines (PCVs) and it helps prevent IPDs. Currently, there are two vaccines available for the government to procure during the next budget allocation, PCV 10 and PCV 13, two vaccines that global health experts claim are comparable in performance.

In February 2019, the World Health Organization (WHO) reaffirmed an earlier position saying that the two available PCVs are equally effective in preventing overall pneumococcal diseases in children. The position paper also states that there is at present insufficient evidence of a difference in the net impact of the two available PCVs on overall disease burden.

“The WHO has already come out saying that there’s really no difference between the two,” said Dr. Lulu Bravo, Executive Director of the Philippine Foundation for Vaccination, when discussing the efficacy of the two PCVs. “Many developing countries have already procured PCV 10.”

Similarly, the Pan-American Health Organization (PAHO) in its own study said that available evidence to date indicates significant impact of both PCV10 and PCV13 in the outcomes studied, with no evidence of the superiority of one vaccine over the other on pneumonia, Invasive Pneumococcal Diseases (IPD), or meningitis hospitalization reduction in children under 5 years old.

In turn, the International Vaccine Access Center (IVAC), in their 2017 PCV product assessment which was based on a comprehensive review of published data, also declared that current evidence does not indicate an added benefit with one vaccine over the other.

Syquija highlighted that the competitive bidding process should be accompanied by the scrutiny and recommendation of legitimate health experts, which would help allay concerns over whether the procured vaccine has carefully been studied or not.

“The first thing to ask is, what is appropriate for the Philippines? How many manufacturers make PCV13? How many PCV10?” said Syquija. “You need a decision on an expert level. What product do we need? Then it will dictate the modality of the procurement.”

Even when the procurement process is transparent, there is a danger in the way it is implemented, claimed Syquija. The bid posted by the government is required to list specifications regarding the item to be procured. It is possible to “tailor-fit” the bid by listing specifications that unnecessarily cut other options out, making it difficult to protect the sanctity of the contract.

Experts are also concern that they might be resurgence of disease like pneumonia and meningitis if the public refrains from getting their children immunized. The vaccine confidence of 93% in 2015 plunged to 30 percent in 2018. Therefore, vaccine confidence is a critical issue, especially since pneumonia is a very common disease in children here and abroad. Of the hundreds of countries in the world, the Philippines is included in the top 15 countries in terms of pneumonia deaths, and those 15 countries are responsible for 75% of all deaths from pneumonia.

In an earlier statement, the DOH pointed to vaccine hesitancy, or the refusal of vaccines despite availability, as one of the reasons for the recent measles outbreak in some regions of the country.

Importance of Vaccination

The trust percentage of immunization in 2015 dropped from 93% to 30% in 2019. According to Dra. Bravo, the Philippines has the highest cases of dengue in Southeast Asia in 2019.

The problem with vaccine scare is everybody's concern. As a blogger and a nurse, I feel responsible to share my knowledge on health and wellness based on study and research. To our dear parents, I understand if you are still hesitant to bring your kids to barangay health center for immunization. I suggest at least listen to the explanations of our healthcare providers and weight the pros and cons of not giving vaccines to children. Also, make sure that you are informed of what's happening in your community. For example, take note of cases of measles or dengue that needed to be reported to your barangay health worker so that they can intervene and provide immediate treatment.

In regards to coronavirus, at the moment there are no known vaccine or treatments approved for coronavirus. It's mostly symptomatic meaning, treatments are given according to the patient's symptoms. For example, pain reliever for pain.

Finally, we are glad that there's still a budget for healthcare such as free vaccination for kids. Let us not put these into waste but take advantage of free immunization. I understand the hesitancy of parents but we should not be scared all the time. Remember, health is wealth. Getting sick is very costly.