Controversial doses

From defective dengue vaccine to antismoking campaign, DoH lives through its highs and lows

THE lifting of a TRO, or temporary restraining order, as well as a political stir caused by a defective dengue vaccine gave the Department of Health (DoH) its own share of highs and lows in 2017, which also marked a more intensified antismoking and tobacco campaign.

Led by former Secretary Paulyn Jean Rosell-Ubial, the DoH embarked on a nationwide campaign to encourage smokers to quit and nonsmokers to never try it, even electronic cigarettes, or e-cigs, called “vapes.”

“They say that [vapes] are a safer alternative, but we in the health sector say there is no safe level of exposure to tobacco smoke,” Rosell-Ubial said in June. “So even if it has a small amount of tobacco, it is still not safe.”

Vapes contain 7,000 dangerous chemicals that are almost the same as those used in cigarettes, she added, citing an advisory released by the FDA, or Food and Drug Administration, which is under the DoH. In other words, vaping leads to more serious addiction to tobacco.

Smoking ban

Also in June, the DoH launched a national “Quitline,” where smokers can call and be helped by support representatives or receive motivational messages to help them quit smoking or vaping. On the following month, President Rodrigo Duterte signed Executive Order (EO) 26, which bans smoking in public places like schools, workplaces, sidewalks, and public vehicles. (The sale of tobacco to minors is also banned.) This prompted the DoH to advise the LGUs to create a smoke-free taskforce in their own communities to help in the implementation of the nationwide smoking ban. But since the government has not yet released its IRR, or Implementing Rules and Regulations, local governments were left to form their own rules, leading to a strict implementation of the ban in some areas and lenient in others. The DoH emphasized, however, that the EO is enforceable even without the IRR.

The inclusion of e-cigs in the smoking ban, meanwhile, is still being studied by the DoH based on a recommendation by the WHO, or World Health Organization.

TRO on contraceptives

This year also saw the DoH move toward the full implementation of the Responsible Parenthood and Reproductive Health (RPRH) Law, which was hampered by a TRO issued by the Supreme Court to a couple of contraceptives—Implanon and Implanon NXT—on June 17, 2015, in the case of Alliance for the Family Foundation Philippines, Inc. v. former health secretary Janette Garin, et al. In an April 26 (2017) resolution, the SC said the FDA should conduct a summary hearing and amend the IRR of the RPRH Law, to make it compliant with the court’s mandates. Four months after, the FDA held the first-round of hearings to finalize the certification and recertification of disputed contraceptive products under the amended rules. In November, Juan Antonio Perez, executive director of the Commission on Population (PopCom), said the RPRH Law was “on track” as the FDA was expected to release the results of its review in the same month. Weeks later, the FDA announced the approval of all 51 contraceptives up for certification and recertification, including Implanon and Implanon NXT, in effect lifting the 29-month TRO by the high court.

“The lifting of the TRO will allow the DoH to start procuring commodities from its 2017 budget,” Perez said. “All Filipinos working for women’s health should rejoice in this development.”

‘31 a day’

With the latest figures revealing 31 HIV cases per day, 2017 saw the rise of cases of human immunodeficiency virus, which causes AIDS, or acquired immunodeficiency syndrome, in the country. From January to September, 936 new HIV cases had been reported to the HARP, or HIV and AIDS Registry of the Philippines, bringing to 47,921 the total cases in the country since 1984. Various studies pointed out the country having the fastest increasing population of PLHIV, or People Living with HIV, making the Philippines one of eight countries in the Asia-Pacific region where the virus continues to rampage.

The DoH provides free antiretroviral medicines to anyone who tests positive for HIV, as well as other outpatient services to a maximum of P30,000 a year per person. Government funding—P900 million for 2017—has increased over the past years to help boost the HIV program.

The Commission on Appointments rejected Rosell-Ubial on Oct. 10. She was the fifth official in the Duterte Cabinet whose appointment was rejected by the CA, after Perfecto Yasay as foreign secretary, Regina Lopez (environment secretary), Judy Taguiwalo (social welfare and development), and Rafael Mariano (agrarian reform). She was briefly replaced by Health Undersecretary Hermingildo Valle as OIC while awaiting the appointment of a new secretary. By endOctober, Duterte named Francisco Duque 3rd as the new Health chief.

Dengvaxia fiasco

After Sanofi Pasteur revealed that its vaccine may cause a more severe case of dengue fever, the DoH suspended its immunization pro- gram in November. Sanofi’s announcement sparked massive health panic, as there were about 830,000 schoolchildren inoculated with Dengvaxia in Metro Manila, Central Luzon, and the CALABARZON provinces of Cavite, Laguna, Batangas, Rizal, and Quezon.

While Sanofi had allayed fears on the effects of Dengvaxia, saying it was not deadly, the FDA recalled the vaccine from the market on Dec. 4. Sanofi was also directed to conduct an information dissemination campaign through advisories, “Dear Doctor” letters, and patient forums. The FDA also said it was closely coordinating with the DoH in monitoring cases or reports of adverse events or reactions from those who had been administered with the vaccine.

Duque said they would sue Sanofi over the fiasco, adding the government may also ask for an indemnity fund from the company for future cases of severe dengue in the previously vaccinated children. The pharmaceutical giant, he added, may also be held liable if it was found to have withheld crucial information “that would have changed the outcome of all of these problems” and the [decisions made by the] previous administration. “We will demand the refund of the P3.5 billion paid for the Dengvaxia, and that Sanofi set up an indemnification fund to cover the hospitalization and medical treatment for all children who might have severe dengue,” he stressed.

The DoH also announced the formation of a task force to monitor children inoculated with Dengvaxia and to review the government’s dengue vaccination program. Recently, the department said it would seek the assistance of experts from the University of the Philippines-Philippine General Hospital to validate alleged deaths due to Dengvaxia. With at least two deaths reported, both 10-year-old children in Bataan and Quezon City, Duque said the DoH is transparent “to erase doubts from other sectors that the DoH may be concealing information relevant to the Dengvaxia vaccination.”