MANILA – Even while lawmakers are conducting separate inquiries into the P3.5-billion Dengvaxia fiasco, officials should move quickly to stop “an ongoing cover-up” among Department of Health officials involved in the Aquino-era dengue immunization program who could prevent the incumbent DOH secretary from getting to the bottom of the scandal, a public health expert warned at the weekend.
“Imperfect science cannot conceal what is perfectly clear: people got greedy. Sanofi Pasteur is the manufacturer and supplier of Dengvaxia. DOH is the contracting party. Even without the ‘bad science’ issue, there were apparent red flags in the procurement and delivery of the new vaccination services,” Dr. Francisco Salcedo Cruz, who had testified in two hearings of the joint Senate Blue Ribbon and Health committees, said in a statement sent to media outlets Saturday.
By “bad science,” he was referring to remarks made at the last (Dec. 14) hearing by Dr. Antonio Dans of the National Academy of Science and Technology (NAST), that local and international scientists had alluded to the risks from a vaccine that had not yet been perfected owing to questions raised about its different impacts on different sets of vaccinees.
Cruz is a former DOH consultant on good governance, and is an expert on Vaccine Preventable Diseases (VPD) and the DOH Expanded Program on Immunization (EPI). He appeared at the December 11 and 14 hearings as the VACC expert person on the dengue vaccination debacle sparked by big pharma Sanofi Pasteur’s November 27 advisory about the risks of “severe disease (dengue)” for zero-negative people — or those who never had dengue before they were injected with Dengvaxia — once they subsequently contract dengue. Sanofi said further review of its clinical studies showed the vaccine effective in preventing further infections among those who had previously been stricken with dengue; but those who never had infections prior to injection could be vulnerable to more severe strains.
The advisory, coming after the Aquino-era officials of budget and health rushed the P3.5-billion mass immunization of schoolchildren 9 years old and above, has sparked widespread anxiety and accusations from some parents that their children died from severe complications when they contracted dengue after having been injected with Dengvaxia. The DOH has said none of the deaths earlier blamed on Dengvaxia have been proven so, but investigations continue.
Over 400,000 of the children were immunized during the time of Aquino’s Health Secretary, Dr. Janette Garin, just weeks before the May 2016 elections, giving rise to speculation it was rushed for political reasons.
“Observing the events unfold and hearing the sentiment of the people, I think I share a burning question with many others: Was this a well-designed, planned and implemented mass vaccination campaign during the 2016 national elections? Or was this a well-designed, planned and implemented mass campaign using immunization during the 2016 national elections?” Cruz asked in his statement at the weekend.
WHAT SHOULD HAVE HAPPENED
Describing himself as a mere “public health advocate” he said he cannot comment on whether or not mass vaccination was a good election campaign strategy. However, it if it were the case of the former, added Cruz, the following should have happened:
- First, the designated subnational program manager would have the experience and expertise in running a new vaccination initiative which includes major components like vaccine services and sessions, vaccine cold chain logistics, behavior change communication and health promotion, social mobilization and community participation, disease surveillance, and monitoring and evaluation with coverage surveys.”
He noted the Philippine Children’s Medical Center (PCMC) had none of these competences. The choice of PCMC was “directly attributable to the late issuance of the Special Allotment Release Order (SARO) authority to incur obligations, and the DOH practice of sub-allotting funds to government medical centers to procure items for the department’s central office.”
- Second, when one plans for a new, big health project, the primary consideration is its “highest chance of success.” If the target vaccinees were Grade 4 school children and the vaccination sites will be their public schools, “the highest chance of success” would be to conduct the event when the students, teachers and even parents are all around–when there are classes, Cruz said.
- Third, vaccination and health promotion are twin interventions in immunization programs. “The most effective prevention in any public health program which targets disease reduction is improving health literacy among mothers, families and communities. After all, they are the primary producers of health–not the DOH, nor LGUs and international agencies. Disclosing pertinent information to the mothers and children is particularly mandatory in routine immunization.”
On whether the decision-makers then got bad advice and thus proceeded to rush the Dengvaxia program, Cruz stressed that “experts sounded the alarm as early as March 2016. The DOH then did not care to listen. It was full steam ahead.”
For whatever reason, he added, “DOH found the time and urgency to implement the ‘mass vaccination campaign’ during the 2016 national elections.”
Cruz then reiterated the warning he made in the December 11, 2017 Senate hearing about “an ongoing wide-scale cover-up of senior DOH officials.” He said the DOJ and NBI should investigate DOH fast, though there’s hope in the fact that incumbent DOH secretary Francisco Duque “is not involved in the cover-up.” Still, Cruz warned, “those giving him advice on this issue are complicit to this Dengvaxia mess.”
Cruz said he has been in touch with two DOH insiders willing to “come out, tell the truth and show documents of collusion and corruption among undersecretaries (retired, resigned and incumbent), assistant secretaries, central office and regional directors.” He said he advised them to first seek clearance from Duque.
THERE ARE MORE, BIGGER FUND SCANDALS
According to Cruz, the P3.55-billion Dengvaxia mess “is just the tip of the iceberg. A quick, comprehensive, and evidence-based investigation by DOJ and NBI will reveal that the P23-billion Health Facility Enhancement Program and the P12-billion Procurement of Medicines projects are of a similar nature.”
He said the Dengvaxia fiasco was driven not just by graft and greed, but also about the overriding ambition of some officials, in a thinly veiled allusion to Aquino-era Secretary Janette Garin, who was at the center of the scandal.
“Yet this is not only about graft and corruption. It is also about honoring or defiling a great tradition among DOH secretaries. Almost all are well-respected, highly competent, educated coming from the best universities. The great tradition is the respect of the outgoing secretary to the incoming secretary, sincerely wishing the latter success. The outgoing secretary cuts cleanly. From Azurin (the last secretary of President Marcos), Bengzon and Periquet (President Aquino), Flavier, Galvez-Tan, Ramiro, Reodica (President Ramos), Estrella, Romualdez (President Estrada), Dayrit, Duque, Cabral (President Macapagal-Arroyo), Ona (President Aquino), Ubial and Duque (President Duterte).”
Cruz said “certain past DOH secretaries can be considered to be “hulog ng langit” for the Department and for all Filipinos. Alran Bengzon and Johnny Flavier lead the way. There were also Chit Reodica, Cuasi Romauldez, Manolet Dayrit and Espy Cabral.
“Certainly Secretary Duque, Enrique Ona and Paulyn Ubial are among them. Among these giants, I cannot help but consider one who broke tradition and fell from grace. Nahulog sa hagdanan sa pagmamadali [That one fell down the stairs in the rush to reach the top].”
Cruz ended his statement by saying that while corruption may seem bad enough, the spectacle of a doctor possibly doing harm to children in the inordinate rush to push a program may be “the worst sin of ambition.”