A plea for sanity: Public health and safety above all

MANKIND has been plagued by epidemics and numerous infectious diseases ever since. These epidemics have killed millions of people through the centuries. Vaccination has dramatically increased human lifespans by preventing or eliminating diseases that once were deadly to many. Many of us would not even be here if our ancestors had not survived these feared diseases and some of our children may not even be around now if we were not ourselves vaccinated against many communicable diseases. Smallpox has been eradicated and polio is almost gone, except in a few areas.

Yet, even as these developments were marked as valuable and significant, there have been many movements through the centuries that opposed vaccination on many grounds from religious to economic to just plain ignorance. Even today, opposition runs high mainly in Third World countries out of sheer ignorance and fear-mongering but also in economically and scientifically advanced countries like the USA and United Kingdom. As late as 1998, Dr. Andrew Wakefield (UK) fanned the flames of the anti-vaccination movement by claiming in a Lancet article that autism was caused by the MMR vaccine, which was proven to be invalid and that Wakefield falsified data. Lancet retracted the article in 2014 and Wakefield’s license to practice medicine was revoked. This is the same study being cited by the opponents of dengue vaccination even today on social media.

What are the consequences of these controversies? With the Wakefield affair that reduced vaccination rates in Europe and the USA, there were many outbreaks of measles, with Europe reporting 14,732 cases and 57 deaths in the past three years. In the USA, outbreaks were reported in many states, mainly among unvaccinated individuals with hundreds of cases and many deaths. Interestingly, the measles virus was typed as that imported from the Philippines during its past outbreaks.

At most risk are infants below one year of age who are not yet eligible for MMR vaccination but are or should have been protected from measles, mumps, and rubella by herd immunity when vaccination rates reach 95%. When vaccination rates fall below that threshold, outbreaks will occur and these young children are then highly susceptible to the complications of these diseases and the risk of death increases.

Any movement that opposes vaccination, none of which claims has been proven to be valid at this point in time, will lead to mass hysteria, especially among the poorly educated and misinformed. The fears of vaccination will be amplified to the point that parents will refuse to have their children vaccinated. Outbreaks and epidemics will follow leading to a big increase in hospitalizations and deaths among both unvaccinated and vaccinated or willing to be vaccinated but too young. It is the general public that suffers and health costs soar with the epidemics filling hospital beds all over the country. Everyone loses.

With the current Dengvaxia controversy, we are seeing measles outbreaks in many parts of the country and deaths have been reported (https://news.mb.com. ph/2018/11/27/measles-outbreakkills-20-in-sarangani/.) This unfortunate side effect of the controversy is too real to ignore. In a more direct way, dengue cases have soared past the previous year’s tally many of which could have been prevented had the vaccine not been pulled from use prematurely (https:// news.mb.com.ph/2018/11/21/cordillera-dengue-cases-up-100/.). The vaccine is now in use in over 20 countries and recommended for use in the EU. The US FDA is now considering its use in the country.

The dengue mass vaccination program relied on the recommendations made by the Pediatric Infectious Disease Society of the Philippines (PIDSP) which found that 88.5-93% of children ages 9-16 years old had previous exposure to the dengue virus; thus this age group was recommended for vaccination since they stand the most to gain in terms of dengue immunity and less likely to have complications. Even more convincing was a Cebu City study which showed >98.3% previous dengue infection in a population age 15 and above. Vaccine recommendations are not made lightly and have basis in studies like this (www. pidsphil.org).

A study (https://.www.ncbi.nlm. nih.gov/m/pubmed/30309284/.) showed the massive drop in public confidence in vaccinations. From 93% of 1500 persons surveyed who agreed that vaccines are important, it is down to 32%. Similarly, 82% strongly agreed that vaccines are safe three years ago and that figure is down to 21%. Measles cases are up 350%, rubella is up more than 1,000% and diphtheria and pertussis cases are also on the rise ((WHO vaccinepreventable diseases: monitoring system 2018).

We are facing a very real crisis of multiple disease epidemics that will kill thousands of Filipinos. Is this risk worth the overblown issues of dengue vaccine safety?

When do we say, “Stop to all the rumor-mongering and playing to public fears?” Let reason and science resolve the issue. Let us restore sanity to the public discourse and save lives instead.