The Politics of Measles Outbreaks

Measles outbreak was supposed to be a thing of the past as vaccines became available. In the United States, measles was declared eliminated in 2000. This was due to better vaccination program nationwide and the introduction of a second dose with measles combined with mumps or rubella (MMR) or mumps, rubella and varicella (MMRV). But with global travel, measles was reintroduced back in the country.

There are several states currently having a measles outbreak and the sources of these outbreaks have been identified as persons who traveled abroad (i.e. Israel, Ukraine, etc.) and brought home the disease. The disease thenspread in communities with pockets of unvaccinated people. Some might be surprised why there are still unvaccinated people in the U.S., well not really surprising because some parents don’t want their kids vaccinated for religious or philosophical reasons (i.e. autism) that have been debunked by medical science.

Since its eradication in 2000, there has been gradual reintroduction of the disease. According to the U.S. Center for Disease Control (CDC), between 2000 through 2007 there were 63 reported cases but these numbers accelerated starting in 2008 with reported cases of 131. Between 2008 through 2018, the highest reported cases per year was 667 in 2014. There were 23 outbreaks reported in the U.S. that particular yearand many were traced to travelers to the Philippines who experienced large numbers of outbreaks in 2014.

The main lesson learned from all these resurgent cases is the lack of global of control of the disease from certain countries, the Philippines included where measles are occurring in multiple regions in the country with the largest number in the National Capital Region (NCR).

It will not be surprising then if the reported 101 cases in the U.S. for 2019 to date go up exponentially due to these outbreaks in the Philippines given the frequent travelers between these two countries. But more than that, the deadly Philippine outbreaks have already claimed the lives of seventy people mostly children, albeit from poor families in that country. This is pure neglect on the part of the government, plain and simple. The drastic drop in the vaccination rates from a high of 88% in 2014 to a dismal 55% can be blamed for these alarming outbreaks.

One important lesson I’ve learned working in public health over the years is that while disease ecology is an important framework for studying a disease in the context of human-environment interaction, political and economic factors or influences must be considered whether on a local or global scale. In the Philippine situation, the overheated publicity by the Duterte administration over the so-called Dengvaxia vaccine scandal during the administration of President Noynoy Aquino, influenced greatly the country’s vaccination program overall.

DOH Secretary Francisco Duque put the blame on PAO Chief Persida Acosta for her controversial pursuit of deaths purportedly associated with the Dengvaxia vaccine. Acosta promptly denied responsibility because she thinks that as a lawyer, that is not her cup of tea and implementation of vaccination programs belongs to the DOH. Technically she is right but she cannot escape responsibility because instead of pursuing the legal cases quietly through the courts, she was constantly poisoning the minds of people through her unproven scaremongering that Dengvaxia caused the death of many children in 2014. Her wild accusations scared families of getting their children vaccinated, measles included. At 88% vaccination rate in 2014 (before the Dengvaxia scare became full blown), was close to achieving “herd immunity” if pushed a little bit more towards achieving 90-95%. But that year going into 2015 was the height of the so-called Dengvaxia scandal/publicity. The rate dropped to 73% in 2017 and 55% last year.

Acosta was not alone because competing for publicity was Sen. Dick Gordon who chaired the senate investigation. Everybody was out for blood especially that of Aquino, his budget secretary Florencio Abad and DOH secretary Janette Garin who were all being accused of bribery and dereliction of duty. It was clearly a political hit job because none of the people hounded by Gordon or Acosta landed in jail. But the damage was immense to the government’s vaccination program.

President Rodrigo Duterte failed to reign in these individuals. Duterte’s Johnny came lately approach of trying to convince the Filipino people now to have their children vaccinated is a little too late particularly for those who died from the measles outbreak. Will Sen. Gordon now make the excessive noise that he and Acosta had given to the Dengvaxia cases? Will he start an investigation mutopropio for all these outbreak related deaths? Highly doubtful because fault will fall squarely on the lap of Duterte for command responsibility.

Sec. Duque cannot escape responsibility on this too. But Duterte has gone soft because he too promoted and abetted Acosta’s and Gordon’s scaremongering tactics in an effort to go after the former president and his allies. The health disparities that fall on the poor families because of their economic status is well established. The political theatrics that attended the alleged Dengvaxia related deaths complicated further and exacerbated these disparities.

But what is the Dengvaxia vaccine scandal really all about? It could not have been an honest to goodness effort to exact justice because many of the deaths attributed to the Dengavixia vaccination were not even true. Instead of understanding the “why” it was given, it was a fault finding investigation. True Sanofi returned the dengue vaccine money in the billions of pesos but not because the vaccine was flawed; it was purchased by the Philippines to proactively vaccinate Filipino children without the vaccine being licensed in the Philippines. As a matter of fact, it was a legitimate approach given the serious threat of dengue virus to public health. Dengue is a major public health problem in the Philippines and is endemic in in ALL regions of the country. DengVaxia, was granted marketing authorization by the European Commission in December 2018 and is currently under priority review by the US Food and Drug Administration. It will be awkward now for the Philippines to buy Dengvaxia. How’s that for perspective?

Politics should have no role in public health except for politicians advocating funding for these vaccination programs. Furthermore, they should also allocate additional funding for active disease surveillance. DOH has a passive disease surveillance programthat depends mostly on disease reporting from hospitals, private clinics, rural health units, municipal or city health offices, and human quarantine stations.Passive surveillance is preferred because it is cheap and cover wide areas (nationwide). The system can work and help the health department analyze data collected for disease patterns and identify possible outbreaks. The problem with this approach is that it relies on a vast network of health workers and therein lies the difficulty of ensuring completeness and timeliness of the information. Thus, you see the belated declaration of measles outbreak in the county.