The Politics of Dengue

We have heard of blood sucking vampire stories during our childhood that scare the living daylights out of us especially when told at night. Imagine vampires having big fangs buried on your neck while sucking your arteries dry - that will definitely strike fear. We are scared of the big vampire bites but not of the little ones from mosquitoes that we could easily swat or smack dead. Well, not until now.

The Philippines is reeling from a dengue epidemic all over the archipelago and there’s no end in sight. While the rainy season disrupts some of the mosquito habitats, they will regroup with a vengeance once the downpour stops because of increased breeding sites. Epidemiologically, the number of dengue cases rises during the rainy season.

Dengue is caused by an infected mosquito (Aedes species) biting a human and releasing the dengue virus. Aedes egypti in particular, is the same mosquito specie that transmits the Zika and Chikungunya virus. Aedes egypti and Aedes albopictus are two species common in the Philippines. Both species bite during the day and the night. A. egypti is mostly a day biter thus it makes it more difficult to eradicate because you can’t spray an entire neighborhood with pesticide to kill mosquitoes during the day.

Mosquitos are one of the most deadly animals in the planet. According to the Philippine Department of Health (DOH), over 600 people had already died with the dengue virus and more than 130,000 dengue cases (with 29,000 involving children 5 to 9 years old) has been reported to the agency. More and more cases are being reported as we speak prompting the DOH to issue a national dengue alert. State of calamity has been declared in several regions or provinces.

So, how did the country get to this point? From being the darling of the world in April 2016 when the Philippines boldly vaccinated 830,000 elementary school children with the world’s first dengue vaccine – Dengvaxia. But politics got in the way of good public health sense. Remember that so-called scandal that Senator Richard Gordon’s blue ribbon committee investigated upon the media blitz scare-mongering by PAO Chief Persida Acosta? Well, their efforts did well to convince President Duterte to ban the vaccine. Consequently, the country’s vaccination rate has plummeted.

Clearly, the Duterte administration was unprepared for this epidemic and they actually made the situation worse with its decision two years ago to ban the Dengvaxia vaccine. The previous administration started a dengue vaccination program for elementary pupils under former Health Secretary and now Iloilo 1st District Representative Janette Garin. The Aquino administration pushed for the ambitious program despite the vaccine still being in the experimental stage because of the endemicity of dengue in the country.

The rushed approval process by the country’s drug and food agency did not help and made it look scandalous especially with allegations of corruption attending the process. But in retrospect, it was a bold public health decision worthy of world acclaim. The fact the vaccine was eventually approved by the World Health Organization (WHO) and is now available worldwide does not undo the damage that Sen. Gordon, PAO Chief Acosta, and the Duterte administration’s rushed judgement to ban the vaccine. Their actions prevented in a significant way, achieving a much higher herd immunity for the pupils thus making them more vulnerable to the virus.

As in anything, restarting the program is of utmost importance now. The vaccine is supposed to “reduce hospitalization by 80 percent and to reduce the severity by 93 percent,” according to Garin. Thus, it is never too late to give the vaccination again especially with the attendant seal of approval by WHO.

Aside from the vaccine though, there are a lot more the Philippine government and the people can do to mitigate this malady. While the government carries most of the burden in having an effective public health policy and implementation, they can only do so much to educate the public and institute public health measures. The public can help in a big way by starting their efforts in their own backyard. Foremost of which is getting rid of mosquito breeding sites like old tires, cans, and unclogging drainage ditches.

Dengue disparately affects the poor in urban or countryside settings due to entrench poverty and political abandonment of the poor. The ruling class should partner with civil society groups and state actors to address poor sanitation, inadequate or clogged drainage ditches and trash build up in areas where the poor live, to help eliminate mosquito breeding places.

Mosquitoes are equal opportunity biters and can inflict their pain regardless of one’s socioeconomic stature. But the usual suspects of who cause dengue outbreaks are often blamed on the poor because of their unhealthy environment – slums, squatters, proximity to landfills, piled trash in the neighborhood, or their lack of healthcare fosters infected individuals to become carriers of the disease.

But the politics of dengue responsibility extends to the rich and the state. After all, it is government responsibility to provide municipal trash removal services as required by the country’s environmental laws. As more and more landfills stinks, people realize that the government has been derelict in complying with these laws that it takes court orders for local officials to finally address the issue.

What about healthcare? Government’s failure to deliver affordable and quality healthcare is fostering unwellness. Despite provision of healthcare being a human right, the government’s failure to make healthcare free to majority of Filipinos that constitute majority of the population contributes to the epidemic nature of this disease or other diseases. Corruption, big or small impacts their health too. From substandard infrastructure, to lack of medicines in public health centers to ghost dialysis patients draining PhilHealth funds, and most of all, expensive treatment and maintenance medications.

With climate change as an individual factor, the dengue situation in the Philippines and other warmer or tropical countries will worsen. The DOH secretary needs to be on the ball and understand the implications of climate change to the rest of the archipelago. As the temperature gets warmer, adult vector survival rates and migration to non-endemic areas gets longer and bigger possibilities, faster viral replication and longer infective periods, and make it easier for the Aedes mosquitoes to establish or reestablish anywhere.

The known social, economic, and disease burden of dengue particularly in the Philippines is alarming and it is evident that the wider impact of this disease is grossly underestimated. Manila’s Mayor Isko Moreno is blazing a trail that his nuance approach to keeping Manila clean could mitigate some of these challenges that complicates eradication of the disease. His efforts show that government can accomplish more with a strident political will.