“[Measles] is a preventable disease. It seems to be that no one should die from a preventable disease, and yet people die from this,” Dr. Bien Nillos, a professor of the Behavioral Science Department, states in Filipino as he speaks with The LaSallian on the measles outbreak recently declared by the Department of Health (DOH) in several regions nationwide.
Measles is a highly contagious disease characterized by high fever and a red rash originating from the face and spreading across the body. Transmission is airborne, with nine out of 10 unvaccinated persons contracting the disease if exposed to an infected person.
Complications from the disease, such as pneumonia and brain inflammation, may lead to death. The spread of the disease can be prevented by readily available vaccines. However, people have been more reluctant to use these vaccines, and the DOH has cited this reluctance as a possible cause of the recent outbreak.
Nillos, who also previously served as Doctor to the Barrios with distinction, also expresses deep concern as more than 11,000 cases were recorded in January to February alone, with 189 reported deaths. Alarmingly, as much as 79 percent of the measles-related deaths are of people with no prior vaccinations.
Public health mobilization
In November 2018, the World Health Organization reported a 367 percent increase in measles cases in the Philippines over a one-year period. Last February 9, Health Secretary Francisco Duque III declared an outbreak in the National Capital Region (NCR) and Central Luzon, with several other regions under tight watch. The disease continues to spread as increasing cases are being reported in Visayas and Zamboanga City.
The DOH has estimated an additional 4,302 measles cases and 70 deaths last January, concentrated in NCR, Region IV-A, and Region III. The most common age groups affected are that of young children from one to four years old and nine months and below.
The health department, in cooperation with multiple government agencies, is implementing a mass vaccination program scheduled to run until March, targeting around 12 million individuals, especially children, who are most at risk. This will be implemented in public schools and daycares where workers will ensure that the children under their charge are vaccinated.
Many factors can be blamed as to why vaccination rates remain low in the country even in previous years. According to Nillos, the Expanded Program on Immunization—which ensures that recommended childhood vaccines are available to infants, children, and mothers—has not performed as well as other public health programs. Poverty, infrastructure, and supply problems are just some of the common issues he lists. “Many far-flung areas still find themselves inaccessible. They still don’t get the vaccines because they live very far from the health center,” he adds.
Nillos recounts from his experience the difficulty of explaining to ordinary folk the concept of vaccination, saying that many people still fail to understand its benefits. “Immunization is painful. We don’t want anything that’s perceived as [physically] painful or difficult [to understand]. In public health, mahalaga ‘yung perception. ‘Yun ‘yung laro,” he explains.
(In public health, perception is important. It’s the name of the game.)
Fears over vaccination
Nillos points out that the vaccination programs of the DOH are one of the hardest programs to implement in the country, especially in far-flung areas. The science behind vaccination is not as simple to explain compared to the other programs offered.
“There’s a very low understanding of the concept, and that influences their behavior so [there are] very low [vaccination rates], because immunization [has] to be voluntary,” he laments. A report by DOH also points out the recent Dengvaxia controversy as a possible reason of vaccine hesitancy, which has also complicated the department’s efforts in halting the spread of measles, as issues with the dengue vaccine further eroded public confidence on vaccines in general.
Nillos casts doubts on the methodology employed by the Public Attorney’s Office (PAO) and explains that autopsies conducted on the alleged victims have limited usefulness in establishing cause and effect. Many factors need to be controlled, something he doubts that PAO was able to do.
“Unless the PAO becomes transparent in their methodology, there will always be that doubt in the way they arrived at their conclusion. For me, the way I’ve read in the news, it’s not scientific; therefore, if it’s not scientific, it’s not really definite. You cannot really say that those deaths were due to the vaccine [because] we have to establish other evidence,” he elaborates.
Dr. Lily Cabuling, Director of the University’s Health Services Office (HSO), shares that vaccinating children has become even more difficult. She relates being held back by worried parents, delaying vaccination during the “golden period” of at around nine months old. “[The parents say] kasi, ‘Paano kung mamatay anak ko?’ There are a lot of mothers who verbalised that to me,”
(Their parents would ask me, ‘What if my child dies?’ There are a lot of mothers who verbalised that to me.)
Cabuling also believes that the Dengvaxia controversy may have heavily impacted overall vaccine production, with companies slowing down their overall production and affecting the availability of other vaccines.
Nillos, however, believes that the controversy is only part of the bigger issue that a lack of attention was given to immunization, stating, “It’s not a far-out idea to say the least that the resurgence of measles worldwide is probably due to the fact that globally, our vaccination programs have not really picked up.” He warns against singling out Dengvaxia as the sole factor in the low rates of vaccination, calling such an analysis “myopic”.
Controlling the spread
Bianca Daez (III, AB-CAM) is aware of the current outbreak. She says she has had her first measles vaccine, but failed to get the second one. While she has never been stricken by it before, she still fears that she might contract the virus. “I’ve never gotten it, but I am scared because I can’t afford to be sick right now,” she expresses.
On the other hand, Santiago Alvarez (IV, BS-CS) has availed of all his vaccines. He knows of the measles outbreak, but is not quite sure how far it has gotten. “I’ve never contracted measles before, and since I’m well protected, I think I’m safe,” he claims.
Enzo Panlilio (III, AB-CAM), meanwhile, says that he has contracted measles before during his second year of high school, but is unsure if he had managed to get vaccinated in his childhood. Although, he admits he has not been vaccinated recently.
Cabuling clarifies that a vaccination for measles does not guarantee non-infection, but that any resulting sickness after being vaccinated would only be mild. “The severity is lower, and the dreaded fatal complications [are] very low compared to the population na hindi binigyan ng bakuna,” she explains.
(The severity is lower, and the dreaded fatal complications [are] very low compared to the population who are unvaccinated.)
For the University students and staff, procedures are in place to help contain infectious diseases like measles. Students that show up with characteristic symptoms, such as red eyes, high fever, and rashes, are immediately sent home with their IDs regulated.
Help desk announcements and posters on contagious diseases are regularly published by the HSO and include facts on the diseases, preventative measures, and treatments. Students or staff may also opt to receive a vaccination from the University Clinic for a fee.
Nillos explains how fast the disease could spread, warranting a quick response. “If one classmate comes to class with measles, you really expect [it will spread very fast], especially if the class had no immunity against measles,” he cites. However, he believes that the length of the outbreak will ultimately be determined by how fast everyone concerned can control the current situation.