As health authorities are focusing on averting the spread of the 2019 coronavirus, a health expert however reminded the public not to forget pneumonia, the number 1 killer of Filipino children under five years.
Speaking in yesterday’s “Kapihan sa Manila Hotel,” Philippine Foundation for Vaccination executive director Dr. Lulu Bravo said that as many as 39 Filipino children—or the equivalent of an entire classroom—die every day due to pneumonia.
She said the Philippines is included in the top 15 countries in terms of pneumonia deaths, and those 15 countries are responsible for 75 percent of all deaths from pneumonia.
Because of this, she said the Department of Health should look into the cost-effectiveness between the pneumococcal conjugate vaccine 10 and the PCV13 with the ongoing review of the vaccines.
The DOH has postponed the bidding for P4.9 billion worth of PCV stocks for 2020 pending a review of data raised by pharmaceutical company GlaxoSmithKline.
The deferment was also meant to give the government time to further review the technical specifications of the vaccines. It was likewise an apparent move to heed the clamor of medical experts and the public to review further the call for bidding.
The PCV procurement process was questioned because it specified a single vaccine—PCV13.
Of the total P9 billion FOH budget for vaccines, Bravo said P4.9 billion or 70% was allocated for PCVs under the health department’s Expanded Program for Immunization in children.
When asked which of the two pnemococcal vaccines- PCV10 or PCV13-+ is the most cost effective that should be administered to Filipino children to guard them against pneumonia, Bravo admitted the country is yet to come out with a “study impact” on the matter.
A study impact of the prevalent strains of pneumococcal diseases in the Philippines would help medical authorities determine the suitable type of vaccines needed.
Bravo, however, said that the World Health Organization had already said the two PCVs in the market are equally effective in preventing overall pneumococcal disease in children.
Early this year, WHO said PCV10 and PCV13 have been shown to be safe and effective and to have both direct (in vaccinated individuals) and indirect (in unvaccinated individuals living in communities with vaccinated children) effects against pneumococcal disease caused by vaccine serotypes when used in a 3-dose schedule or in a 4-dose schedule.”
Bravo added that at present, there are 90 strains of pnemococcl diseases, but only 25-40 are active. She further stated that a strain is changing every year.
Reacting to the warning of Dr. Ron Dagan, professor of pediatrics and infectious diseases at Israel’s Ben-Gurion University, that shifting to an “inferior” PCV-10 anti-pneumonia vaccine could increase in the mortality rate among Filipino children who will be afflicted with pneumonia, Bravo questioned the basis of his remark.
She said that with the absence of a study impact on the applicable pneumococcal vaccine in the Philippine setting, they still cannot still cannot establish if its PCV13 or PCV10 that should be given to Filipino children.
Insisting that PCV-13 is “clearly superior, Dagan said there are different additional serotypes that it covers that PCV-10 does not cover.
“PCV -13 covers very well serotype 19A and 6A that are not in PCV-10, and to a certain extent serotype 3,” also said the former chairman of the board of the International Symposia on Pneumococcus and Pneumococcal Diseases.
In the Philippines, the DOH has been using PCV-13 since 2014, but there have been recent efforts to shift to PCV-10 – a move that has been described by former Health Secretary and now Iloilo Rep. Janette Garin as a “step backward.”
But Bravo countered the claim that PCV 10 is a weaker vaccine to PCV 13, noting that apparently it came from the misconception that epidemiology of other countries can also be applied in the Philippines.
She said that the 2017 Dengvaxia scare was mainly a product of misinformation.
“Misinformation had caused confidence in vaccines to plummet from a 2015 high of 93%, to an abysmal 32% in 2018,” Dr. Bravo said. “We should not let another vaccine scare happen again, particularly for pneumonia vaccines because pneumonia is the forgotten killer of children,” she added.
Saying that one vaccine is weaker than the other is misleading and contributes only to misinformation,” cautioned she said.
“We need to rely on what independent global experts say because it is our responsibility as pediatricians, to be updated with the most relevant, and most updated information,” she said.
“Hindi po pare-pareho ang merong mikroboyo sa PIlipinas, kesa sa nasa Israel Amerika, Europa, at China. Hindi porke yun ang ginawa sa ibang bansa, dapat ganon na rin dito,” added Bravo, saying that the presence of certain serotypes differs greatly from country to country.
Bravo and Medicines Transparency Alliance (MeTA) chairman and former Bulacan governor Obet Pagdanganan warned that a monopoly over the government’s procurement of pneumonia vaccines could result in another Dengvaxia scare if the process favors only a single manufacturer.
This warning underscored “The Need for Transparency and Truthfulness in Public Health Amid Misinformation and Fake News,” a panel discussion on fighting the harmful effects of hazardous misinformation on public health.
Pagdanganan said the government’s purchase of PCVs could spark another vaccine scare similar to what followed the 2017 Dengvaxia fiasco.
“We should have learned our lesson and not allow another dengvaxia scare to happen with pneumonia vaccines,” said Pagdanganan.
He said global experts like the WHO have already reported that the available PCVs in the market are comparable in impact so we must make sure that the government procures them through an open, competitive bidding process.
Garin was indicted last March by the Department of Justice (DOJ) along with several others due to reckless imprudence that resulted the deaths of eight children supposedly due to the Dengvaxia vaccine.
Bravo, a former director of the National Institute of Health, strongly reacted to Sen. Mike Defensor and Garin’s statements that pneumococcal vaccine PCV 13 is a superior vaccine to PCV 10.
“Ano ang basehan nila?” said Bravo. “Our basis should be the World Health Organization who, in a more recent study, stated that PCV13 and PCV10 are comparable in performance and impact, especially if you are considering nations where there are so many deaths from pneumonia, like the Philippines.
Bravo was referring to a 2019 WHO position paper that reconfirms an earlier conclusion in 2017, that at present there is insufficient evidence to conclude any difference in the net impact of PCV 10 and PCV 13 on overall disease burden.