- by Gary Finnegan

World’s first dengue vaccine program begins in the Philippines

student getting the fist dengue vaccine

Janette Garin gives a Filipino student the world’s fist dengue vaccine. Image via Sanofi Pasteur.

Dengue becomes a vaccine preventable disease

In the Philippines, dengue fever has claimed thousands of lives and incapacitated many since the first known cases were reported in 1953, and the world’s first dengue vaccine couldn’t have arrived sooner. And so, last Monday, with much festivity and good cheer, top officials from the Department of Health, headed by Secretary Janette Garin and local government officials, launched a first-of-its-kind, school-based dengue mass vaccination program at the Parang Elementary School in Marikina, a suburb in Metro Manila. More than 600 students from Grade 4 received the first of three doses of Dengvaxia, Sanofi Pasteur’s breakthrough dengue vaccine. The vaccine is registered for use for those between the ages of 9 and 45 years old and has been approved in Mexico, the Philippines, El Salvador, and Brazil.

For school principal Marcia de Guzman and many school officials desperately pinning their hopes on it to end dengue’s long reign of terror, the dengue fever vaccine is perceived as nothing short of a miracle.  De Guzman says that only in January this year, a student at the school died from the mosquito-borne viral illness, while 45 others were hospitalized by it, despite the school taking vector control measures like putting treated nets over the windows of the classrooms.  Data from Marikina’s Public Information Office says there were 487 confirmed cases last year, with six deaths.

Parang Elementary is first to get the free vaccine

A fourth-grade student named Wanda Beatrice (seen at top) made history as the first child in the country’s public health program to be inoculated, with Sec. Garin herself hunkering down to administer the first dose.  Doses will be given to the students in six-month intervals. The government’s health office aims to finish first dose vaccinations this June. The second dose is expected to follow the in October to December, with the last dose to be given from April to June 2017.

With Marikina a dengue hotspot in recent years (many of its communities are identified as high-risk areas), the government couldn’t have chosen a better city to kick-start its ambitious public health program of immediately vaccinating 1 million grade school children in the country.

image of children dancing for VIPs during dengue vaccine launch in Philippines

Parang Elementary School fourth graders perform a song for attendees at the dengue vaccination program kickoff.

The Department of Health has been aggressive in combating dengue as the problem continued to escalate in recent years:  The Philippines has the unfortunate bragging rights of having registered the highest dengue incidence in the Western Pacific region for the years between 2013 and 2015. Last year, the country had 200, 415 confirmed cases.  As of February 20, 2016, a total of 18,790 suspected dengue cases were reported nationwide. A figure 13.2 percent higher compared to the same time period last year.

Most of the cases come from Southern Tagalog with 3,182 cases (16.9 percent); Central Luzon with 2,596 cases (13.8 percent), and Metro Manila with 1,479 cases (7.9 percent).

It is with these figures in mind that the DOH is carefully appropriating its limited resources.  The three regions have been selected according to burden of diseases, prevalence, and high mortality rates, based on statistics gathered from the DOH’s Epidemiology Bureau.

The Philippines Department of Health officials at the press conference. From left: Dr. Lyndon Lee Suy, DOH spokesperson; Sec. Janette Garin; Vicente Belizario, Undersecretary of Health; Dr. Rose Capeding, head of Microbiology, Research Institute for Tropical Medicine; Dr. Rontgene Solante, Philippine Society for Microbiology and Infectious Diseases chairman

The Philippines DOH and heath officials from left: Dr. Lyndon Lee Suy, DOH spokesperson; Sec. Janette Garin; Vicente Belizario, Undersecretary of Health; Dr. Rose Capeding, head of Microbiology, Research Institute for Tropical Medicine; Dr. Rontgene Solante, Philippine Society for Microbiology and Infectious Diseases chairman

 A historic milestone in dengue prevention

At the press conference, Sec. Janette Garin called the program’s launch “a historic milestone”. “We are the first country to introduce, adopt, and implement the first-ever dengue vaccine through (the) public health system and under a public school setting,” she said.

The Philippine government has earmarked P3.5 billion pesos (roughly $76 million) for the administration of the vaccine. Sec. Garin says that this amount also includes “monitoring, surveillance, the whole totality.”

And yet despite the deep urgency for a dengue vaccine, especially in the Philippines, the arrival of the vaccine—and the administration to the 600 school children here in Parang—is not without controversy.

The Philippine government decided to start its vaccination program and has allowed the use of the vaccine in private clinics, ahead of the World Health Organization’s official recommendation, which is expected to be published in May.

Social media posts are circulating online warning parents of allowing their children to be vaccinated.  Some doctors, led by Dr. Anthony Dans of the National Academy of Science and Technology, have questioned its safety and efficacy, strongly calling out the government for its implementation without the WHO Strategic Advisory Group of Experts’ recommendations.

Sanofi Pasteur visits a school for dengue vaccine program launch

But in a press briefing, four days before the mass vaccination, WHO country representative Dr. Gundo Weiler said the organization is supportive of the program. Clarifying the issues surrounding the DOH rollout, Weiler said, “It is the prerogative of a country to license the product, determine its use based on the internal scientific appraisal of the clinical research underpinning the product.”

The group only meets twice a year, he explained, which has delayed the publication of the recommendation. Weiler further stressed, “It is not the WHO’s mandate to license a medical product, to determine whether or not a product should be used in a country. This is the prerogative of the national regulatory authority in the country.”

Many agree that the Philippines’ fast approval is necessary.  A new analysis published in the New England Journal of Medicine in March reported that the Philippines had the highest incidence of confirmed dengue in the 10 endemic countries that participated in the clinical efficacy studies for Dengvaxia. The analysis also reported that up to 15 percent, or about one in six children who has fever, can be attributed to dengue.

More than 40,000 individuals in 15 countries have undergone clinical trials (29,000 of them received the vaccine). In the pooled efficacy analysis in this age group, the vaccine was shown to reduce dengue due to all four serotypes in two-thirds of the participants and prevent 8 out of 10 hospitalizations and up to 93 percent of severe dengue cases.