Dengue fever vaccine: what you need to know
ACCORDING to the World Health Organization, dengue is the fastest-growing infectious disease with its incidence growing 30-fold in 50 years from 1965 to 2015. Half of the world is at risk of getting the virus with a yearly estimate of 96 million symptomatic cases and 500,000 hospitalisations globally.
In Myanmar, incidents of the virus have been on the rise. The Ministry of Health recorded a 300 percent increase over the previous year in 2015, and in the first half of 2016, more than 600 cases were reported in the Yangon Region alone.
There is, however, reason for hope. The world’s firstever dengue vaccine, which has been available for use since last year, has become the light at the end of the tunnel, especially for tropical countries like Myanmar where many fall prey to the disease annually. Mexico is the world’s first nation to have allowed the sale and use of the vaccine, followed by the Philippines and Brazil. According to Usa Thrisyakorn, professor of paediatrics at Thailand’s Chulalongkorn University and chair of the Asian Dengue Vaccination Advocacy (ADVA) group, the dengue vaccine has been licensed in 13 countries, while approval for sale is soon to follow.
Myanmar isn’t on that list yet, but it can look to its neighbours to see how implementation of the vaccine can best be carried out. In Thailand, studies and research in relation to the dengue vaccine have been consistently carried out for more than 30 years, especially by Mahidol University. The government and related public agencies are considering how the vaccine should be made available.
“Thailand’s healthcare system is quite efficient in terms of dengue treatment,” added Usa. “But it is the responsibility of decision-makers to see if the vaccine is worthwhile. As an assistive tool, mathematical modelling might come into play to help calculate if it is worth it.”
Earlier this year, the Philippines launched the world’s first public immunisation program for dengue. The mass vaccination program is designed to administer the vaccine to 1 million nine-year-old schoolchildren. The Philippine government spent 3.5 billion pesos (US$170 million) to administer the free vaccines.
Tikki Pang, visiting professor at Lee Kuan Yew School of Public Policy, the National University of Singapore, and former director of research policy and co-operation at the WHO, considers the Philippines a country that has achieved in managing the implementation the vaccine quickly.
“The then-president of the Philippines [Benigno Aquino III] understood there was a serious problem with dengue,” said Pang. “And this is the first time ever there is a vaccine. He believed this would help the country in reducing the number of cases. So it’s a strong political commitment right from a president.”
But will State Counsellor Daw Aung San Suu Kyi be willing to make the same commitment? If so, Myanmar may do well to observe the protocols implemented by Thailand, where the vaccine has been licensed and is expected to be available for use early next year. Usa wonders how the vaccine will be made accessible – be it through private hospitals or a state program. According to Pang, should Thailand introduce the vaccine to immunise its population, an equitable access should be the first thing to underline.
“Everyone should get the vaccine, not just those who can afford to pay,” he said. “So that means it probably is going to be up to the government to provide the funding for public health immunisation. If it’s available only from private doctors, then many people cannot afford to be vaccinated. There has to be a policy to make the vaccine accessible to everybody regardless of rich or poor.”
“If the Thai government is not certain about the [vaccine’s] cost-effectiveness and only allows private hospitals to sell it, the foreseeable issue here is in terms of inequality,” added Usa.
Despite the WHO’s position paper recommending the use of the vaccine in countries or areas where the infection is widespread, Pang said it’s up to each country to make a decision for themselves.
“The WHO’s main function is to set global standards. So they have published their position in a paper where they recommend the use of the vaccine in countries or areas where there is a lot of disease. All countries of the world are members of the WHO so they pay attention to what the WHO recommends.
“However, the final decision to use the vaccine is the decision of the country itself,” he added. “They can get guidance from the WHO but it is the country’s own experts, scientists and doctors who know the situation of the country best. The final decision to introduce the vaccine should be a national decision guided by the WHO.”
By 2020, the WHO aims to reduce the mortality rate from dengue infection by 50pc. To achieve this, Usa said it is paramount for countries at risk to follow recommended protocols.
“There are mainly five protocols to follow,” Usa said. “First, diagnosis and treatments must be fast. Second is mosquito control. Then we also need a good database and disease surveillance.
The fourth protocol is with regard to continuous research to adjust dengue care and treatments. The last one is vaccination.” – The Bangkok Post, additional reporting by The Myanmar Times
Mosquitoes transmit the virus at alarming rates in Yangon Region: More than 600 cases were reported in the first half of this year.
An Indian medic collects a blood sample of a patient suspected to be infected in New Delhi, India, on September 2. The dengue virus is the fastest-growing infectious disease in the world.
A pest-control worker fumigates an area against Aedes mosquitoes which carry the dengue virus at a public residential estate in Singapore on November 15.