Philippines battles spike in measles cases

baby with measles-main
A baby with measles in the Philippines. Copyright: Copyright: Jim Goodson [CC BY 2.0]. This image has been cropped.

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  • Outbreak causes 189 deaths since January
  • Officials blame spike on ‘vaccine hesitancy’
  • Public trust hit by dengue vaccine controversy

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[MANILA] Authorities in the Philippines are working to counter ‘vaccine hesitancy’ which is being blamed for an outbreak of measles that has claimed 189 lives since the start of the year, out of almost 12,000 people who contracted the disease.

In January, the World Health Organisation (WHO) included vaccine hesitancy — the reluctance or refusal to vaccinate — among the top ten health threats facing the world in 2019. Vaccine hesitancy has contributed to outbreaks of measles in the United States and other countries.

It is also being cited by authorities in the Philippines as one of the causes for the recent spike in measles cases. On 21 February, the Department of Health (DOH) said at a press conference that it recorded 11,459 confirmed cases of the disease and 189 deaths between 1 January and 20 February.
"Loss of public confidence and trust in vaccines — in the immunisation programme — brought about by the Dengvaxia controversy has been documented as one of many factors that contributed to ‘vaccine hesitancy’ in the country,” the DOH stated.

“A lot of children in the region have not received measles shots and we take this as the reason why there was a spike in the number of cases”

Rio Magpantay, Department of Health

According to regional sources trust in immunisation programs in the Philippines declined significantly after Dengvaxia, a vaccine against dengue adopted for use in December 2015, was withdrawn two years later amid controversy after reports of adverse effects. 

The DOH defines vaccine hesitancy as “the delay in acceptance or refusal of vaccines despite availability of vaccination services.” In the Philippines, immunisation against measles, mumps, rubella, and typhoid and other infectious diseases is administered by the government free of charge.

According to the DOH, a vaccine confidence project conducted by the UK’s London School of Hygiene and Tropical Medicine in 2015‒2018 has shown a decline in people’s confidence in vaccination, with public trust dropping from 93 per cent to 32 per cent in the Philippines during the study period. Faith in the safety and productivity of vaccines also dropped from 82 per cent to 21 per cent.

Achyut Shrestha, Medical Officer of the Office of the WHO Representative in the Philippines, told SciDev.Net in an interview that the Philippines “is on the right track”, but its immunization programme needs to be improved to boost herd immunity by targeting key age groups.

“In 2018, government data shows that 70 per cent of measles cases are [in] children under five years of age, while 10 per cent are in the age range of five years to 15 years and 20 per cent are adolescents and adults who are above 15 years of age. This case classification shows the vulnerability that exists in different age cohorts,” he explained.

Shestha says it is important for parents to understand the value of vaccines. “They are empowered to demand vaccines for the protection of their children and for themselves.”

On alert

In Cagayan Valley, in northern Philippines, the number of measles cases shot up by 2,500 per cent since the beginning of the year, according to Rio Magpantay, the regional health director. “A lot of children in the region have not received measles shots and we take this as the reason why there was a spike in the number of cases [of the disease].”

Five other regions — Metro Manila (the National Capital Region), the Cavite-Laguna-Batangas-Rizal-Quezon (CALABARZON) mainland, Central Luzon, Western Visayas, and Northern Mindanao — have reported spikes in the number of measles cases.

At a press conference last week, health secretary Francisco Duque III said that while most of the population has been vaccinated, a large number remains uncovered.

The need to get more people immunised was also underscored by Philippine President Rodrigo Duterte, who appeared on national television this month to urge Filipinos to get their children immunised against measles. The Catholic Church in the Philippines has issued a similar call in a pastoral letter issued by Archbishop Rolando Tirona, which was read in Churches throughout the country on February 17, 2019.

Last week, a massive immunisation drive was launched in Manila and the five provincial regions, with doctors and health workers embarking on a house-to-house campaign. “Aside from the community public health centres, the vaccination drive is being taken to the malls. We immunise even on Sundays and Saturdays since most parents say that they have to go to work on weekdays,” said Duque III.

He added that if the vaccine hesitancy trend continues, the government may compel parents to have their children vaccinated. “We are reviewing the experiences of other countries that have mandatory immunisation programmes.”

The DOH’s efforts must be aggressive, says Daniel Carreon, a physician who practices in several Philippine hospitals. “Anti-vaxxers [must be shown] that the real victims are the children who die of complications such as pneumonia and encephalitis due to the negligence and refusal of the parents to avail of free vaccination.”

Apart from government-mandated immunisation programs, Carreon believes education and stimulating fear of the consequences can also be effective. “Understanding and fear of the actual complications of a preventable disease can be powerful motivators when used properly,” he says.
This piece was produced by SciDev.Net’s Asia & Pacific desk.