“We are humans. We are more intelligent than bacteria and viruses,” says Health Secretary Janette Garin in a candid reminder to parents about the need to have their children vaccinated against deadly viruses.
Garin, and two other top doctors, led a forum organized by pharmaceutical company Merck Sharpe and Dohme or MSD at Museum Café in Makati City on April 21, which debunked various myths about vaccines. Among such myths are that the measles, mumps and rubella or MMR vaccine causes autism, HPV vaccine leads to infertility and vaccines are no longer necessary.
“Better be safe than sorry,” says Garin.
Garin in the same forum bared the government’s plan to have 300,000 Grade 4 female students receive vaccines against sexually transmitted human papillomavirus or HPV. It is a strong statement from a government agency that tries to remove any stigma associated with sexual activity.
Dr. Benjamin Co, a clinical pharmacologist and associate member of the Pediatric Infectious Disease of the Philippines and Dr. Rosa Maria Nancho, adviser of the Society of Adolescent Medicine of the Philippines, also shared their insights during the “Usapang Bakuna” forum, as a nod to the World Immunization Week which runs from April 24 to 30.
Vaccines contain agents that resemble disease-causing microorganisms that stimulate the body’s immune system by developing antibodies to destroy future similar microorganisms. Vaccines have helped eradicate or reduce incidence of diseases such as smallpox, polio, measles, tetanus, hepatitis, chickenpox, influenza and pneumonia.
Data from the 2013 National Demographic and Health Survey show that 62 percent or only six of ten Filipino children were fully immunized. This means they received the seven basic vaccines before their first birthday.
More than 90 percent of the children received first doses each of vaccines – DPT (diphtheria-pertussis-tetnaus), polio and Hepa B. However, the same children would not complete the succeeding second and third doses required for the full protection and only 78 percent would finish the measles vaccination at nine months old, according to the Health Department.
Doctors say aside from problems on resources and reach, the challenge of completion of such programs is being prevented by myths and speculations surrounding immunization.
“The emerging adversary of vaccination is not effectiveness—it is speculation,” says Co.
“Misguided concerns, which are not grounded on science and research, distract the general public from pressing preventable health threats. This is proving to be a major obstacle in creating a healthier nation.”
“But vaccines have an excellent safety record. As a matter of fact, you could argue that they are as safe, if not or safer than therapeutic medicines.”
Link to autism
Co says a now-retracted study linking MMR (measles, mumps, and rubella vaccine) to autism led by Andrew Wakefield has been discouraging the vaccine’s uptake. The British Medical Journal later described the 1998 study as an ‘elaborate fraud’ that altered the medical histories of all 12 patients that formed its basis.
“Wakefield’s study has done long-lasting damage to health. But we need to remain focused on why vaccines were discovered and balance the benefits and risks of the disease, especially among children and the vulnerable community. As stated by the Measles Rubella Initiative, measles is a leading cause of death among children around the world, with 400 dying every day,” says Co.
The World Health Organization also says there is no scientific evidence to support claims that measles vaccination may be a risk factor for autism.
Meanwhile, Nancho says as HPV is a sexually transmitted disease, some parents do not consider vaccination as a necessity for their kids. “But these vaccinations are recommended at a certain age [9 years old] because that is when they’re most effective,” she says.
HP, a family of viruses, has two strains that are linked to 80 percent of cervical cancer cases. While there are two HPV vaccines (bivalent and quadrivalent) available in the market, their uptake is affected by existing stigma, says Nancho.
“Pre-exposure vaccination, which means vaccination before the child is exposed, is a cornerstone of successful immunization programs against the world’s cluster of preventable diseases,” says Nancho, a former president of the Society of Adolescent Medicine of the Philippines Inc.
Garin says while mercury content has also been raised as a safety concern in vaccines, as some of them are formulated with mercury-containing preservative thiomersal, there is no evidence to suggest that the amount of thiomersal used in vaccines poses any health risks.
She says it is also a mistake to assume that vaccines are no longer necessary, as vaccinable diseases have disappeared in recent decades. Garin says the spike of measles cases in the country quickly refutes this claim.
“The biggest problem here is that decisions on health are being made based on perceived risks, not supported by evidence. We have a responsibility to rid ourselves of all these misconceptions, especially when we are making decisions for our children,” she says.
Cervical cancer is a top killer in the Philippines. About 12 Filipino women die daily because of cervical cancer, according to the Health Department. Globally, cervical cancer, which is known to be caused by HPV in most cases, is also the second most common cancer among women.
In the Philippines, studies show that cervical cancer is the third leading cause of mortality among females. The Filipino Cancer Registry 2005 annual report shows that in 2005, there were 7,277 new cases of cervical cancer with 3,807 reported deaths. This translated into a mortality rate at 1 per 10,000 women.
“We really need to improve our communication. HPV vaccine is presented as optional. Now, we are trying to teach our doctors. They should not say there are other options. It cannot be like that. They have to be very firm,” says Nancho.
“When the doctor is not so sure, or not firm enough to really say your child needs HPV, then you get some doubt about it. But if your doctor is really firm about it, then you will know,” she says.
Nancho says parents, doctors and healthcare providers should help save the lives of children. “When parents express reluctance, [healthcare] providers are also hesitant. Sometimes, it is the parents themselves, and also the doctors. Doctors sometimes want to please their clients. It should not be the case. Doctors have really to be firm,” she says.
She cites the young adult fertility survey showing that a third of the Philippine young population is already sexually active. “Even as young as 12 or 13 years old,” she says. “Are we going to wait for that time they are already exposed? No.”
“Vaccines work best when they are not exposed to the virus. We have to emphasize that it is very important to give it before they are exposed to the virus. Even when your child waits until marriage to have sex, they are not sure of their partners. The partners may transmit it to them. We need high-impact statements like HPV vaccines are devastating to men and women.”
Garin says the government will support the introduction of new vaccines such as HPV vaccine, despite the fears associated with it. “Every time a new vaccine is introduced, there is speculation. We waste a lot of money, we waste a lot of resources, simply because speculation and distrust serve as barriers. Science is evolving. The world is evolving. Many vaccines are discovered, but many diseases are also emerging,” she says.
Garin says the Health Department will provide HPV vaccines to Grade 4 female students in the 20 poorest provinces this year, and only the lack of government funds is the reason why it is not done nationwide.
“It will not be implemented on a nationwide basis because our funds are limited as of the moment. This will cover the 20 poorest provinces. We are correlating HPV vaccination with the socio-economic strata of the province simply because cervical cancer is one of those that have created a huge reduction in terms of upliftment from poverty,” Garin says.
“Once the mother in the family gets cervical cancer, the family will sell properties and belongings for her hospitalization. The children will stop going to school. Patients with cervical cancer are mostly in their mid 40s or early 50s, still a productive age,” she says.
To address the situation, Garin says: “We will be giving free HPV vaccination to all Grade 4 female students in public schools in 20 poorest provinces. We intend to increase that in the coming years, phase by phase. Why Grade 4, because this is the age that is presumed to have had no sexual contact.”
“I have seen many patients with cervical cancer. The psychological impact is quite huge and the smell of the patient with cervical cancer is really bad. The patient has to be psychologically capacitated to bear the discriminatory acts of others who will be sensing the foul odor,” she says.
Garin says that is why the Health Department promotes HPV vaccination. “It is up for the government to make the initiative and the private sector to continue the program. We have to improve vaccine coverage.”
She says from the initial target of 300,000 students, the HPV vaccination cover will be expanded to another 300,000 in other provinces.
The agency will administer two doses of the HPV vaccine within six months on female students, with the consent of their parents.
Aside from HPV vaccines, the agency would also administer anti-tetanus and anti-diphtheria booster vaccines to 2.4 million Grade 1 students in public schools across the country under the national immunization program. The program is supported by proceeds from excise taxes collected from alcoholic products and cigarettes, according to Garin.
Concern for others
Co says parents who believe in myths and refuse to have their children vaccinated help spread viruses to other people.
“In the US, they require parents to show immunization when they enroll in schools. You have to make sure other kids in schools don’t get sick. Sometimes, we only think about our own kids. We don’t take into consideration other people’s children. If our kids get sick, others may be compromised,” he says.