No trust in vaccines: the Philippines measles outbreak

No trust in vaccines: the Philippines measles outbreak

Misplaced concerns stemming from the Dengvaxia scandal are putting thousands of children at risk.

WHAT’S HAPPENING?

Authorities in the Philippines declared a measles outbreak in February 2019. Five regions have already been affected.

KEY INSIGHTS

– The measles outbreak has the potential to affect over 2.6 million children
– Filipino parents lack trust in government vaccine programs after the disastrous dengue fever vaccine controversy
– The measles virus could to spread to mainland Southeast Asia

Measles cases have spiked globally over the last year. In the Philippines alone there has been a 266% increase in measles cases. The Southeast Asian country first declared an outbreak in Metro Manila, which reported 196 cases, in January. The disease has now spread to five regions in the Philippines, causing 203 deaths since the beginning of the year. This is not the first time that the Philippines has suffered from a measles outbreak, with large-scale outbreaks also occurring in 2011 and 2014.

Measles is a highly contagious disease that spreads easily to unimmunised children and adults. Clinically, measles presents as a fever and a rash with a cough, runny nose or conjunctivitis. Measles is very dangerous as it can make children susceptible to contracting pneumonia, which often leads to death. Children under five are at the greatest risk of contracting the disease and they make up 70% of measles cases. Non-government organisations (NGOs) in the Philippines are currently focused on assisting unvaccinated children.

The United Nations International Children’s Emergency Fund (UNICEF) and World Health Organization (WHO) are working with the Filipino Department of Health (DoH) to provide financial, technical and logistic support to control the outbreak. The Measles, Mumps and Rubella (MMR) vaccine provides almost 100% protection from contracting measles and has proven to be extremely safe. This vaccine offers continued protection from contradicting the measles and is supplied to children and families for free by the Filipino government.

However, parents are refusing these services, causing immunisation rates to drop to as low as 30% in some communities. The DoH has attributed the current measles outbreak to ‘vaccine hesitancy’, a delay or refusal of the vaccine service despite it being readily accessible.

INVESTIGATIONS AND INSURGENCY

Philippines measles

Distrust of vaccines stems from the promotion and administration of Dengvaxia, a vaccine aimed at preventing dengue fever that was rolled out to tens of thousands of Filipino children in 2016-2017. The vaccination campaign came to a dramatic halt in late 2017 over concerns voiced by the Attorney-General’s Office that it could lead to severe dengue infections if the person had not previously contracted dengue.

The Office’s investigation into Dengvaxia resulted in criminal charges against over 30 health officials. However, the conclusion has been challenged, as external health professionals have stated that the Attorney General’s Office was not qualified to issue this opinion. The deaths attributed to the vaccine have also been contested by the DoH.

The media coverage about Dengvaxia has created mass distrust of vaccines, leading parents to avoid vaccinating their children. The DoH estimates that over the last year over 2.5 million children under five have missed their vaccines. Since the investigation, the DoH has also been struggling to gain support for their public health initiatives from local communities. It is still unclear how the political climate will shift in response to the outbreak. The government is actively responding by providing accurate information about vaccines and strengthening routine immunisations to improve community coverage against the disease.

The political insurgency in the southern Philippines has also contributed to low immunisation rates. The WHO estimates that in some conflict regions only 7% of eligible children were immunised against measles in 2018. Rates were particularly low following the five-month battle between government forces and insurgent groups affiliated with ISIS over the city of Marawi in 2017. The conflict significantly affected the availability of health facilities available in Marawi, with buildings either caught in the crossfire or seized as temporary housing for internally displaced people. While health care facilities have been mostly repaired with support from the WHO, compatibilities and training for disease surveillance and immunisation are still taking place.

REPERCUSSIONS OF A REGIONAL OUTBREAK

Philippines measles

Photo: Leonard Ortiz/Digital First Media/Orange County Register

Regional neighbours have expressed interest in contributing to response efforts to the Philippines measles outbreak. The WHO has stated that there is a moderate risk that measles will spread internationally, especially to countries in Southeast Asia — there have already been several cases of measles in the region because of travel to the Philippines.

The risk of spread varies by country. For example, in 2017 both Bhutan and the Maldives eliminated endemic measles. This was achieved through the Regional Strategic Plan for Measles Elimination by 2020, which was developed by the Regional Office for South-East Asia (WHO). The strategy involved increasing immunisation coverage in each country to above 95%, effective surveillance networks, laboratory testing, and forming linkages to public health programs in each country. However, some Southeast Asia nations will struggle to eliminate measles by 2020. Vietnam, Thailand, and Myanmar have all had outbreaks since 2014, largely due to low immunisation rates — they are particularly vulnerable to infection from the Philippines outbreak.

UNICEF states that globally cases of the measles have increased by 48.4% in the 2017-2018 period. This has increased demand for the MMR vaccine worldwide, leading to delays in procuring new batches. In the Philippines, NGOs are assisting to generate the requested 6 million doses of the MMR vaccine. But if the outbreak continues to spread in Southeast Asia, the demand for vaccines may go unfilled.

Meanwhile, the rate of measles in the Philippines is increasing, particularly among the large population of unimmunised children who are acutely at risk of contracting the virus. The government is working actively to make more vaccines available but their efforts are hampered by the current public perception of vaccines.  If the outbreak in the Philippines is not controlled, it has the potential to spread to other countries in Southeast Asia with low immunisation rates, causing public health scares, draining government resources, and leading to tragic outcomes for sufferers.