PHILIPPINES | “Youth Fun Day” Psychosocial Support Activity for Adolescents Vaccinated with Dengvaxia and their Parents | 29 April 2019
In 2015, the Philippine government, under the administration of President Simeon Benigno Aquino III procured PhP 3.5-Billion worth of vaccines against dengue “Dengvaxia” from a French multinational pharmaceutical company Sanofi, the vaccine division of Sanofi Pasteur. The multi-billion purchase could cover 1,000,000 Filipino children from select areas with the highest incidence of Dengue: National Capital Region; Region IV-A (CALABARZON); and Region III (Central Luzon).
Dengue causes child deaths in the Philippines. In fact, the World Health Organization Western Pacific Region reported more than 375,000 suspected cases of dengue in 2016, of which the Philippines reported 176,411. The cumulative number of cases in the country in the first two weeks of 2019 was 36,664 with 140 deaths (WHO, 2019). Despite the alarming scenario, it should be noted that the cost of the said dengue immunization campaign in 2016 was more than that of the national immunization program, which already covered basic and routine vaccines for pneumonia, tuberculosis, polio, diphtheria, tetanus, pertussis, measles, mumps, and rubella.
Current studies show that there is no specific treatment for the mosquito-borne viral infection. The WHO states that for severe dengue, maintenance of the patient’s body fluid volume is critical to severe dengue care and that the main method to control or prevent the transmission of the dengue virus is still to combat vector mosquitoes.
The huge public procurement took place while the clinical trials for the Dengvaxia were still ongoing. Filipino clinical epidemiologists from the University of the Philippines College of Medicine Dr. Antonio Dans and Dr. Leonila Dans examined the data on the efficacy and long-term safety of Dengvaxia from the New England Journal of Medicine. They found that the cases of severe dengue were more than five times more likely among vaccinated children than those who have not been vaccinated. They later explained to the public that the vaccine poses risks to recipients who have no evidence of dengue infection prior to inoculation (called the “sero-negatives” or having a negative result in a blood test for the presence of a virus) as opposed to those who have been exposed to the virus (sero-positives, having positive results in the blood test). The basis of this explanation was the veteran American scientist Scott Halstead’s study published in 1973. He called the occurrence of severe dengue among sero-negatives the “Antibody-Dependent Enhancement (ADE).” An informational video of Dr. Halstead explaining ADE has been uploaded here.
In 2016, Doctors Antonio and Leonila Dans and other health advocates and civil society organizations reached out to the Philippines government and the public through press releases and press conferences to inform them of the safety concerns about the novel vaccine. However, the leadership of the Health Department, then under Secretary Janette Garin, was prepared to roll out the dengue mass vaccination program in April 2016.
As mentioned above, such multi-billion annual spending in a developing country should have reflected the country’s health expenditure prioritization based on prevailing causes of morbidity and mortality.
Recent news articles, easily accessible online, provide various documentation on timelines on the public procurement of the vaccines and the actual implementation of the immunization program. One can assess, as did the Philippine Senate and House of Representatives (HOR) probe Committees, that there were ethical shortcuts committed and that the government procurement, planning, and budget processes were bypassed at the expense of the health and safety of children. In fact, in the 2017 budget approval process in October 2016, a certain Lower House legislator from Cebu City in the Visayas Region threatened to hold the passage of the overall Health Department budget for the succeeding year 2017 if the DOH would not agree to expand the provision of the vaccines to their locality, following the hike in dengue cases in the City. At that time, interim Secretary of Health Paulyn Ubial put the entire dengue immunization program on hold due to the DOH expert panel recommendation. As the budget legislation process in the Philippines is highly political, the legislators’ insistence prevailed and the children from the said city were included in the vaccine recipients. Shortly after, the vaccination program continued.
The children, then, were nine-year-olds.
A few months after the series of public information done through mainstream and social media by Doctors Antonio and Leonila Dans and other civil society organizations, on November 2016, several public investigations and hearings at the Senate and House of Representatives were called for by legislators in both Houses of Congress, participated in by responsible individuals from the Department of Health, Department of Budget and Management, Food and Drug Administration, other relevant national government agencies, and Sanofi Pasteur. In one event in the Senate, the parents of a vaccinated child who died of Dengue gave their testimonies, which highlighted the issues on the vaccination program around proper and informed consent for parents and for the children who would receive the vaccine themselves. It appeared that the prescription drug was casually provided to the children, providing only a “yes, I agree” and “no, I don’t” options for parents in the tick boxes. See the copy of the consent form in this media release.
CRC Asia was among the civil society signatories of a position paper circulated publicly and submitted to both Houses of the Philippine Congress.
After the series of day-long public hearings, investigation, and independent analyses of Sanofi Pasteur’s clinical trial data that took a year, the pharmaceutical company issued a public statement in November 2017, confirming a higher risk of severe disease and hospitalization among sero-negative vaccinated children. With this, Dengvaxia-linked hospitalization and deaths caused even greater trauma among parents and their children. Worse, the fiasco resulted in scare affecting immunization turnout of routine vaccines, which also caused an unanticipated measles outbreak in key Regions in the Philippines.
The 2017 National Demographic and Health Survey reports that the “percentage of children age 12-23 months who received all basic vaccines has fluctuated over time, rising from 72% in 1993 to 80% in 2008 and then decreasing to 70% in 2017. The percentage of children age 12-23 months who did not receive any vaccinations has also fluctuated over time but notably increased from 4% in 2013 to 9% in 2017.” (National Demographic and Health Survey 2017, p. 203)
However shocking, it appears in the narrative that Sanofi Pasteur’s statement was not a new discovery.
While the issues, lessons for efficient, accountable, and equitable government planning and budgeting, and responsible actors in the government had already been threshed out in the Congressional investigations, the culpability of the multinational pharmaceutical company Sanofi Pasteur, aside from its commitment to refund the amount for the unused vaccine, remains unclear.
In March 2018, amidst countering positions of various institutions following Sanofi Pasteur’s announcement, a group of civil society organizations in the Philippines convened a public forum titled “The Dengvaxia Nightmare: Did Anyone Really Care About People’s Health?” Child Rights Coalition Asia was one of the speakers, highlighting the child rights perspectives on the issue, particularly the absence of children’s participation in the public vaccination program and the failure of the government to abide by the principles of public investment in children.
Shared Via CRC Asia Facebook Page in March 2018: At the forum “The Dengvaxia Nightmare: People’s clamor: Did anyone really care for People’s Health?”: Our Regional Executive Director Amihan Abueva shared an analysis of the issue on the Dengue Vaccination Program and highlighted the important principles of child rights in public budgeting. Amihan emphasized the need for citizens to be vigilant of public programs and services, especially for children. She also stressed that citizens and program implementors need to listen to the perspectives of children in planning for and implementing such programs.
At the forum, health, human rights, and child rights advocates and parents of vaccinated children came together and shared their insights, experiences, and call to action. The parent speaker, Rachel Argabioso, who works as a full time at a Business Process Outsourcing company while doing organizing work among her peers, expressed that the new vaccine that showed signals of harm affected not only children’s health but also the psychosocial situation in their families. Argabioso works closely with Sumachen Dominguez, the President of the organization who convened the Facebook Group in 2017 having 39,000-parent/guardian members (Local Organization Name: Samahan ng mga Magulang, Anak Nabakunahan ng Dengvaxia). The controversial immunization program launched in 2016 which affected more than 830,000 Filipino children is said to have caused trauma, stress, fear, anger, regret, conflicts, financial strain, to list some, to the adolescents and their parents and caregivers.
“The foremost concern about the Dengvaxia issue should be the safety of children” said Amihan Abueva of Child Rights Coalition Asia. In her presentation, Abueva highlighted the criteria instituted by the UN Convention on the Rights of the Child on public investments for children; on effectiveness, efficiency, and transparency, which the government failed to uphold when it implemented the Dengvaxia Program. Abueva stressed that the immunization program was “implemented without due diligence, without concern to the highest attainable standard of health; without effective systems for monitoring, without sufficient information to gather informed consent, and exposed dangers to the health of children.” These issues, according to Abueva, were made worse with the hastened use of public funds. READ MORE HERE.
This led the CRC Asia, WomanHealth Philippines, and Dr. Leonila Dans, professor at the University of the Philippines (UP) Manila, volunteer young pediatricians, psychiatrists, and psychologists, in partnership with the organization of parents of vaccinated children and the local government of Binangonan to conduct a psychosocial intervention for parents and adolescents on April 29, 2019 called the “Youth Fun Day.”
The children, now, are 13-year-olds and facing both opportunities and challenges as adolescents.
A total of 39 adolescents participated in the psychosocial activity together with their parents and took part in the forum and small group discussions.
Dr. Leonila Dans Speaking on Dengvaxia and the Dengue Virus
At the start, Dra. Rose Martha C. Ynares, a medical doctor, President of a local women’s group Barkadahan ng Kababaihan sa Binangonan (BKB), and the wife of the local chief executive of the City of Binagonan Engr. Cesar M. Ynares gave an opening message and expressed willingness to continuously engage the parents’ organizations and emphasized on the various health and wellness interventions that can be done in the Municipality to address the health and well-being concerns being faced by the vaccinated children and their families. Subsequently, Dr. Leonila Dans gave an informational talk on the Dengue virus and how Dengvaxia poses both risks and benefits. Dr. Dans made an effort to make an adolescent-friendly updated translation of an info-video she and Doctor Antonio Dans created when they began speaking publicly about the issue in 2016. WomanHealth Philippines’ Ana Maria Nemenzo shared the objectives of the activity and why people’s voices, especially those of the children and their families, should be heard first and foremost. Sheic Sims of CRC Asia explained with the children and adult participants the Child Safeguarding Protocol that the children and adult participants agreed on prior to the activity.
Afterward, the adolescents and their parents, with the help of volunteer pediatricians, psychiatrists, and psychologists facilitators had parallel small group discussions on the individuals’ physical, emotional, and psychological conditions, the challenges, pains, and problems they face being victims of the vaccination program, and their coping mechanisms.
Alternative Budget Initiative Health Clusters’ Mercedes Fabros capped off the small group sessions and affirmed the children and parents’ coping mechanisms: expressing guilt and fear with other people, prayers, engaging in various activities, and drawing strength from their peers in the organization. The organization, however informal, is seen to have a positive impact on the parents, who are mostly the mothers, as they tread the medical, social, and political path towards demanding and claiming justice and rightful social services for the victimized children.
This psychosocial intervention, being among the first ones in the Philippines, is intended to be scaled up to reach more of the 830,000 inoculated adolescents and their parents. The organizers plan to reach out to affected local governments and national government agencies to forge partnerships towards more sustainable and far-reaching health and psychosocial intervention. This plan was affirmed by the participants’ feedback at the end of the small group discussions. Both adolescents and parents expressed their desire for more of the activity, citing that having the opportunity to get informed about the Dengue virus and the Dengue vaccine, to express how they feel, and to share how they cope with the challenges are among the activities that they liked most.
For more information about the case of the Dengue immunization program in the Philippines, an American popular science magazine, Scientific American, published an article in April 2019, which can be read here.
Note: In October 2018, together with the Psychosocial Support and Children’s Rights Resource Center (PST CRRC) and Civil Society Coalition on the Convention on the Rights of the Child, the organizers conducted a psychosocial first aid session with key parent leaders of the Samahan ng mga Magulang, Anak Nabakunahan ng Dengvaxia as there was a need to strengthen and care for the primary caregivers of the vaccinated children who were at the same time political leaders in their claim-making and advocacy work with the various agencies and legislative offices.
