Friday, May 14, 2021

Dengvaxia Controversy Haunts Duterte’s COVID Vaccine Deployment | News on the coronavirus pandemic

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Dr Gene Nisperos is Associate Professor at the Faculty of Medicine at the University of the Philippines (UP) in the country’s capital, Manila. As a medical leader, he is on the priority list for coronavirus vaccination when the government releases its first promised vaccines next month.

But Dr Nisperos has serious doubts about President Rodrigo Duterte’s plan.

The doctor is particularly critical of the government’s decision to ban Filipinos from choosing the type of coronavirus vaccine they receive. The government has announced that it will buy millions of doses from Chinese Sinovac despite the lack of “reliable data” and incomplete clinical trials.

These kinds of issues will only discourage people from getting vaccinated, he says.

“People who are reluctant to get vaccinated are health workers themselves,” said Dr Nisperos.

“If you can’t convince your health workers about the immunization program, how are you going to convince ordinary citizens?”

Many Filipinos have not forgotten the failed launch of the dengue vaccine Dengvaxia in 2016 under Duterte’s predecessor Benigno Aquino III.

The vaccine has been touted as the key to the fight against the deadly mosquito-borne disease that is prevalent in many cities in Southeast Asia. But after less than two years of introduction in the Philippines, it was abruptly suspended due to fears of serious side effects. The controversy has been blamed in part on the dramatic drop in Filipino support for immunization – from 90% in 2015 to 60% just before the COVID-19 pandemic struck.

The Philippines is banking on vaccinations to help them escape a pandemic that has killed more than 10,000 people across the archipelago and forced towns and villages into prolonged lockdowns.

But Dr Nisperos and other medics fear that the Duterte administration will repeat Aquino’s mistakes.

Dr Harold Henrison Chiu, an endocrinologist at the Philippine General Hospital in Manila, says he will only consider getting trapped with the Sinovac vaccine if all data is made public, including the cost, given “inconsistent” and poor clinical trial results for drugs in other countries. He says Filipinos should be able to choose which vaccine they receive.

“Our citizens deserve the safest, most efficient and most cost-effective choice.”

Sinovac offer

So far, the Philippine government has granted emergency approval to vaccines developed by Pfizer-BioNTech and AstraZeneca which are both already in use elsewhere in the world.

However, Pfizer-BioNTech has yet to sign a contract with the Philippines, while AstraZeneca, which gained approval on Thursday, has committed 30 million doses to the country, although the actual delivery date has not been confirmed. not been confirmed.

But the country’s deal with Sinovac has proved more controversial with the public.

While the Chinese company has yet to complete the third-stage clinical trials for the vaccine – a requirement for the Emergency Use Authorization (EUA) application – Manila has already signed a contract with Beijing to secure 25 million doses.

Some 50,000 shots are expected to arrive in Manila next month, even before the UEA has been approved.

The government refused to reveal how much it paid for the vaccine, citing Sinovac’s nondisclosure clause.

Filipino health experts raised questions about the efficacy rate of Sinovac vaccine trials in China in Brazil [File: Adriano Machado/Reuters]

Without the go-ahead from Philippine regulators, Dr Paolo Medina, a primary health care physician, says he will not consider taking the Sinovac vaccine and will instead wait for other options.

“But if the emergency use authorization comes out and the process is transparent enough, as a medical professional I will consider it given the urgency of the pandemic,” said Dr Medina, who teaches community medicine at the University of the Philippines.

Growing skepticism

Manila City Hall employee takes part in mock vaccination in mid-January ahead of scheduled COVID-19 vaccine arrival in February [File: Ted Aljibe/AFP]

The concerns raised by medical professionals reflect the views of the Filipino public, which is becoming increasingly skeptical about vaccinations.

A December 2020 survey conducted by OCTA Research, which analyzes health statistics from the Philippines, found that only 25% of people surveyed in metro Manila were willing to get vaccinated against COVID.

About 28% of those polled said they would refuse any type of vaccine, while 47% were undecided and said it depended on the brands available.

A separate survey conducted between November and December by Manila-based public opinion poll Pulse Asia showed that only 32% of Filipinos in the country wanted to be vaccinated against the coronavirus and 47% said they did not. at all get vaccinated. due to security concerns.

Betray the public

The situation is a clear reversal from previous years. As of 2015, about nine in 10 Filipinos said they believed in the importance of vaccines, according to the Global Vaccine Confidence Index.

The reluctance can be attributed to the controversy surrounding Dengvaxia, which was administered to school children starting in 2016.

“Many of the safeguards that had been in place the longest were violated, and were not intentionally followed, in order to push for a vaccine that was still at the research level,” said Dr Nisperos, of University of the Philippines. effort to endorse Dengvaxia.

“The entire vaccination program was carried out under very questionable and non-medical conditions which put the children’s lives at risk. The health ministry has betrayed people’s trust.

A health expert from the University of the Philippines said that the Dengvaxis controversy in 2016 and 2017 increased the negative public perception of vaccination in general. [File: Noel Celis/AFP]

For 19 months from April 2016, more than 800,000 schoolchildren in pilot areas of Metro Manila and five provinces received injections of the world’s first dengue vaccine, developed by French pharmaceutical company Sanofi Pastor.

But in December 2017, the program was abruptly suspended by the Duterte administration, after a follow-up study by Sanofi found that the vaccine posed a higher risk for people who had not previously been infected with the. virus.

It reflected a warning from the World Health Organization, which Filipino health officials ignored before the vaccination program began. WHO has found that dengvaxia “may be ineffective or even increase this risk” in those who were not yet infected at the time of the first vaccination.

Act in haste

The deaths of several pre-teen students, who received the vaccine, have raised alarm bells again, with widespread media coverage and partisan political statements sparking public fear and anger.

Experts from the Philippine General Hospital later discovered that three of the children had died of “dengue shock syndrome”, two of which were “probably due to vaccine failure.” But no conclusive conclusion was reached. Sanofi-Pasteur also says its vaccine remains safe and has received regulatory approval for use, with restrictions, by the United States and the European Union.

Another investigation by the Philippine Congress concluded that Aquino administration officials acted in haste in approving the vaccine.

Although the vaccination completed the three trials required by the Philippine Food and Drug Administration, it continued despite unfinished clinical trials conducted by medical researchers nationwide, which was recommended practice to ensure safety and efficacy. .

The Philippines is now grappling with one of the largest coronavirus outbreaks in Southeast Asia and is eager to find a way out of a pandemic that has forced extended lockdowns of many parts of the country, including Manila .

But experts say the “lack of transparency” on the purchase of the Sinovac vaccine will make the government’s job to fight the pandemic even more difficult.

“How can you get many people to use Sinovac when you haven’t yet reviewed the regulatory documents?” Dr Tony Leachon, former senior advisor to the Duterte government’s Covid response team, told Al Jazeera.

Leachon notes that none of the major city mayors in the Philippines have expressed willingness to purchase the Chinese-made drug.

“What are you going to do with the Sinovac vaccine if the people in the local government don’t actually accept it for use,” Dr Leachon said.

If the government still insisted on pushing for Sinovac’s shot on the priority list, then it should “show leadership” by inoculating cabinet officials and influential figures first, he said.

In Indonesia, which participated in advanced trials for Sinovac, President Joko Widodo was the first to be shot. It has now been deployed to Brazil, Indonesia and Turkey. Trials have shown widely varying efficacy rates ranging from only 50 percent in Brazil to 65 percent in Indonesia and a maximum of 91 percent in Turkey.

No responsibility?

Dr Medina, professor of community medicine at the University of the Philippines, says apart from transparency, it is just as important for the government to be accountable if it is to ensure public confidence in its immunization program .

He says recent controversy over Duterte’s security service vaccination using contraband vaccines from China, only served to further erode people’s confidence in the process.

“The fact that there is no accountability sends the message that we are not serious.”

Dr Medina says the government must lead by example by following all the necessary procedures.

“It will really forever erode all confidence in the vaccine, if we shorten the processes now,” said Dr Medina.

Duterte has long relied on the military to lead his administration’s response to the coronavirus.

But with the loss of public confidence and the need to convince a skeptical public of the need for vaccination, some say the president must put scientists and public health experts rather than generals at the forefront of the campaign.

“Once we do that, we can use a better lens to decide on a ‘science-based’ national COVID-19 action plan,” said Dr Nisperos, who also heads Second Opinion PH, a voice alternative in public health.

“The militarist response to the pandemic has proven to be unnecessary and counterproductive.”



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