The Dengvaxia Debacle: The Volatile Mix of Politics, Medicine and Failed Science
by Luis Adrian Hidalgo
Media was slow to ask probing questions. When reports about deaths attributed to Dengvaxia came by the third week of December, media merely carried the assumptions of forensic experts from the Public Attorney’s Office (PAO) of a correlation between the vaccine and the death of its recipients. Reports failed to clarify whether the PAO is a qualified authority to speak on the matter when its function is to provide legal assistance to the claimants as directed by the Department of Justice.
FRANCE-BASED pharmaceutical company Sanofi Pasteur on November 29, 2017 posted on their website a warning about the risks of their anti-dengue vaccine Dengvaxia. Citing new findings, the company said: “For those not previously infected by dengue virus, however, the analysis found that in the longer term, more cases of severe disease could occur following vaccination upon a subsequent dengue infection.”
Primetime newscasts 24 Oras and TV Patrol included the advisory in their November 30 rundown, quoting the statement above along with a brief backgrounder on the Philippine dengue immunization program, recalling the concerns raised by studies and health experts.
Given more lead time, the newspapers failed to make an effort to expand on Sanofi’s advisory. This sort of announcement would have raised all kinds of questions for a layman. Isn’t a vaccine supposed to be received by those not yet infected? What then was the purpose of the vaccine being made available for protection against dengue? Most importantly, what is meant by “severe disease?” A different disease other than dengue? What kind of life-threatening condition would result from post-vaccination but first dengue infection?
Reporters were clearly without any kind of familiarity with the issues, which would have helped to figure out what exactly the advisory meant. The issue was covered as breaking news with reports piecing together the information as these were made or issued by public officials, representatives of agencies and companies.
This is the kind of news that needs to be explained. It is media’s responsibility to do the explaining — first, by interviewing someone in Sanofi to explain exactly what it meant, and then by getting other expert opinion to weigh in on various aspects of the issue.
Media reports two days after Sanofi’s notice featured anxious parents wondering about their children’s health and wellbeing. Current Health Secretary Francisco Duque III acted promptly to announce on December 1 the immediate suspension of the vaccination program. Unfortunately, the Department of Health (DOH) did not provide any more information to answer the questions listed above. The press conference showed that the department was taking immediate action to stop further vaccinations. But it did little to explain the level of danger for those most concerned as even the DOH did not have any more information than what Sanofi released.
Following the issue
Given the public’s susceptibility to panic and fear about disease and epidemic warnings, the press is obliged to get as much information about the dangers early in the coverage. DOH should have concentrated on what the public should do in light of the advisory.
With media’s dependence on talking heads, it took some time for issues to unfold.
For instance, it took days before media reports carried Sanofi’s description of possible negative outcomes — referring to symptoms of severe dengue infection such as two-day fever, drop in platelet count and hematoma. This point was made only during a December 4 press conference by Sanofi officials. At the same press conference, Sanofi also pointed out that the vaccine does not cause dengue. The disease is caused by the bite of a dengue-infected female Aedes aegypti mosquito. DOH Secretary Duque made the same point during the December 1 press briefing, but this was not given emphasis in media reports.
Former Health Secretary Janette Garin, who was in office when the immunization program was launched by the DOH, pointed out that the DOH followed the World Health Organization’s (WHO) recommendation to include Dengvaxia in the country’s immunization program. But WHO issued a statement on December 5, which said it only “outlined a series of considerations” that national governments must take into account.
A more proactive media would have gone to WHO sources as soon as the story broke as its institutional voice would have helped reflect the many perspectives in the complex issue. Instead, it took a whole week for the WHO clarification to make news.
Given the advisory, health reporters should have sought out sources such as health experts and other officials involved in the country’s national dengue immunization program in order to provide a substantial discussion about the safety issues involved in the new vaccine.
The exchange among sources sidelined the most important issues that should have drawn media’s primary attention: What is the level of risk and what should be done for those who are at risk of “severe dengue?”
Duque announced that the DOH would strengthen surveillance to monitor the condition of vaccine recipients. He said that DOH would coordinate with the healthcare providers, hospitals and DOH regional offices in the affected areas. Duque also clarified, among other things, that the so-called severe disease warned in the advisory will not happen in all cases, and that the vaccine still offers 30-month protective period. A helpline for dengue vaccine queries was set up by DOH on December 6.
Media did not follow up with news reports on the implementation, which would have helped to evaluate the effectivity of the effort. Close media attention would have forced the DOH to make sure that the remedial process was reaching out to the people.
Missing Details, Alarming Assumptions
Media was slow to ask probing questions. In the third week of December, media merely reported the assumptions of forensic experts from the Public Attorney’s Office (PAO), correlating the vaccine and the death of its recipients. Reports failed to clarify whether the PAO is a qualified authority to speak on the matter.
Confusion and doubts about Dengvaxia also stemmed from the limited understanding of the vaccine, the medical nature of which wasn’t explained more clearly in reports.
The haphazard coverage only contributed to the public’s doubts and fears, increasing the people’s mistrust, not only of Dengvaxia but of vaccines in general.
Politics and Health
Politics and health are not a good mix. The discourse shifted to the blame game instead of searching out helpful information.
Hearings in the Senate and in the House of Representatives investigated the procurement process for undue haste in the purchase of the vaccine from Sanofi. Garin and two other former DOH secretaries, Enrique Ona and Paulyn Ubial, all had to say something about who bears and shares the blame.
Live coverage is useful, but media cannot presume that everyone catches the important points. Neither the Senate nor the House touched on the gaps in health policy-making that could help avoid unnecessary haste in the inclusion of new vaccines. As with many important issues, the public could do with less politics in the discussion of controversial matters.
TV news and print coverage were limited to simply quoting what everyone said. As nothing that was said was really helpful, the public would not have missed anything if the media simply ignored the hearings for what they were — just more politics which did not promote public health.
Public health issues are among the most important concerns to be reported by media. These are of wide interest and, more often than not, touch on public issues relevant to everyone. These are difficult to report. Health reporters need to be equipped with background information to be able to draw out from public officials information that is useful for everyone.