'Fake news is deadly': The numbers behind measles cases and immunization in the Philippines

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Metro Manila (CNN Philippines) — "What a Saturday," Perla Cabrera exclaimed as she sprinted to a room full of women in uniform red t-shirts. The pandemonium in that cramped room at the newly refurbished barangay hall of Payatas B. in Quezon City was so intense, the women said it felt like a Monday. They are all barangay health workers who were busy preparing for a door-to-door vaccination drive on the coming Monday.

The Department of Health (DOH) has heightened its immunization drive following a measles outbreak in five regions in the country, including the most densely populated Metro Manila. While the agency has assured adequate supply of vaccines, it admits the number of health workers to administer community vaccination is not enough.

Cabrera has been a health worker in the village for almost a decade now, and she witnessed how the people's confidence in government vaccines has crumbled. Even in villages like those located in highly urbanized Quezon City, she said many Filipinos remain ignorant about the benefits of complete vaccination.

"Meron talaga kaming na-encounter na tamad. Ayaw magpabakuna ng nanay, kasi minsan siguro kulang din sa kaalaman. Meron din kami na-encounter na ayaw magpabakuna nang pinuntahan namin kasi natakot sa Dengvaxia," Cabrera said.

[Translation: We have encountered lazy parents. Some don't want their children to receive vaccines, perhaps because they lack information about its benefits. We also encountered a parent who did not want their children immunized due to the Dengvaxia scare. ]

Health officials blamed the recent measles outbreaks on the growing distrust in vaccination brought by the dengue vaccine mess.

"Nakamamatay ang fake news," [Translation: Fake News is deadly.] Cabrera burst into laughter after she said this when I asked her to expound why she thinks the Dengvaxia controversy scared many residents in her village. She may have said it in jest, but it made sense.

The local health center physician, Dr. Elimira Dizon, said the immunization coverage in the village has particularly dropped since the dengue vaccine or Dengvaxia controversy in 2017.

Dr. Dizon's team of health workers deployed to the community has been regularly confronted with hostile parents. "First hand experience po ng aking [of my] staff na, despite the coordination with the barangay, once they see our team, people really go to their houses, shut their doors, their windows. They decline. They keep quiet, even if we knock on their doors, they don't answer," Dizon said. "They even deny that there are children in their houses when we know there are children there."

On social media, other health workers share a number of more alarming encounters on the field including parents threatening them when they persist in their mission.

Dizon said the Dengvaxia scare has negatively impacted their immunization campaigns in the communities.

Health Secretary Francisco Duque has blamed Public Attorney's Office Chief Persida Acosta for the public's decline in vaccine confidence and compliance causing the spike in measles cases.

Acosta is prosecuting some former and current government officials after some children who received the dengue vaccine from 2016 to 2017 fell ill or died. Acosta's group of forensic personnel concluded that the dengue vaccine caused the death of the children.

The DOH maintained, however, that there is no solid proof to directly associate the vaccine to the fatalities. Acosta still asserted her team has proven this. She also denied she was responsible for the measles outbreak.

"Unfair po 'yan… Sana po bago siya manisi ng iba, tinginan muna niya ang mga pagkukulang sa kanilang kampanya sa mga subok na bakuna," Acosta said, lambasting Duque.

[Translation: That's unfair…before he blames other people, he should look at the misgivings of his agency's campaign on tested vaccines.]

A ten-year decline in vaccine coverage

Following the announcement of a measles outbreak in Metro Manila February 6, dozens of parents have flocked to health centers. On February 8 alone, 400 children received measles vaccines in Quezon City's most populous village of Batasan.

The country's vaccination coverage has been on a steady decline since 2008, according to health officials. However, when requested for actual immunization data, the DOH has provided a data set from 2015 until the 3rd quarter of 2018 only.

The Manager of the National Expanded Program on Immunization Dr. Wilda Silva said, based on their assessment, the consistent decline in immunization coverage is primarily due to the lack of skilled health workers in the regions. Other challenges like the distribution of vaccine supplies nationwide, and the parents' lack of access to and information about vaccines come into play.

Silva said the DOH has implemented programs to address these gaps. "We have hired more nurses since 2011 and the number of manpower has grown since then." She added DOH has also implemented community initiatives as early as 2013 to make vaccination accessible, especially to far-flung areas.

While it admitted that the immunization rate among Filipinos has begun decreasing since 2008, the agency argued that the number of unvaccinated children has grown even bigger since the Dengvaxia mess in 2017.

Coverage of measles-containing vaccines

From 64 percent in 2015, the country's measles vaccination coverage shrunk to nearly half in the third quarter of 2018. Expectedly, the number of unvaccinated children rose from more than half a million in 2015 to nearly a million before 2018 ended.

Dr. Ruby Constantino, DOH Disease Prevention and Control Bureau Director, said the plummeting numbers are alarming. Constantino added, the government targets a 95 percent coverage to achieve a "herd immunity" or the collective resistance of a population to infectious diseases like measles.

"A low immunization coverage increases a community's risk to contagious infections," the health official explained.

The regions of CALABARZON, MIMAROPA, and the Autonomous Region in Muslim Mindanao have the lowest measles vaccine coverage since 2015.

The immunization rate has consistently improved in the National Capital Region from 2015 to 2017. The region even recorded the second highest coverage at 67 percent in 2017. However, the numbers have significantly decreased by a staggering 75 percent in the first three quarters of 2018, which is now among the lowest in the country.

In Western Visayas region, the number of immunized infants has plunged in the last four years. In the third quarter of 2018, the region-composed of the provinces of Aklan, Antique, Capiz, Iloilo, Guimaras, and Negros Occidental- has the most number of unvaccinated infants in the country, with its immunization coverage down by 80 percent before 2018 ended.

Congress launched a probe into the controversial dengue vaccine in November 2016. Its succeeding hearings have been nationally televised. The Public Attorney's Office took on the case in January 2018. On numerous Congress hearings and in dramatic manner, Acosta brought with her hysterical women who claimed their children have died from the vaccine. Later, some of the women admitted that their children were not dead, but remained sick. Emotionally charged stories like this hogged the headlines all-year round.

2018, so far, recorded the lowest immunization coverage in the country in the last decade.

Constantino said there are two doses of Measles-containing Vaccines (MCV). MCV 1 is the first dose given to infants aged 9 months, while MCV 2 is the next dose that an infant should receive at age 12 months. The health official said a baby is fully immunized from measles if he or she receives both doses on schedule.

However, data from the DOH show, there has been a steady downtrend in the number of infants that received the second dose since 2015. "Nakakaligtaan na nila or kulang ang mothers sa information [Mothers either forgot or lack the information]," Constantino said. She added an incomplete vaccine dose still exposes an infant to infection. "We have been aggressive with our campaigns to inform parents. We are also doing supplemental immunization activities to address this."

The DOH survey in 2018 show that the primary reason why children have not received their vaccination is because "mothers are busy." This topped the agency's survey, followed by "child not eligible for vaccination" as the second topmost reason.

However, as far the village of Payatas B. is concerned, which could be the case for most barangays in the country, Dr. Dizon said "busy" has become the mothers' go-to alibi. "It could just be an excuse. You can be very busy, but you can endorse your child to some caregiver." Dizon said it all boils down to the disinformation and unfounded scare surrounding vaccination as the main underlying factor why parents refuse to have their babies immunized.

Rapidly propagating Measles infections

Secretary Duque has declared a measles outbreak in the regions of Western Visayas, National Capital Region (NCR), CALABARZON, Central Visayas, Central Luzon and some provinces of Region 2. From the start of the year until February 9, there has been an exponential spike in the number of measles cases in these regions compared to the same period last year.

In Metro Manila, measles cases in the first month of the year grew fifteenfold, the most number of cases among all regions. From its zero measles casualty record in 2018, CALABARZON-composed of the provinces of Cavite, Laguna, Batangas, Rizal, and Quezon tallied 25 deaths, the highest casualty count.

Rizal province recorded both the highest number of measles cases (693) and deaths (18) among all provinces nationwide.

Data from the DOH reveal, there has been a dynamic trend in the number of measles cases in the country in the last decade. The figures reached an all-time high in 2014 with more than 50,000 cases, and over 300 deaths: the government has declared an outbreak in at least three regions, including Metro Manila.

Measles infection has significantly dropped after 2014, and even reached a ten-year low in 2016 at more than 700 cases and two deaths. However, the numbers began shooting up again since then.

In 2018, the measles infection rate rose tenfold. And this year, the number of cases in the first month of 2019 alone is nearly as much as the sum of cases of the years 2015 to 2017.

Infants aged 4 years and below are the most vulnerable. An overwhelming 85 percent of the deaths belong to this age group. Nearly half of these fatalities are babies born within the last three quarters of 2018.

Ninety-nine percent of the deaths have either not received vaccines and have no records of immunization, or received a single dose only.

On February 19, Duque reported measles cases reached more than 8,000 with 135 deaths.

With the government's ongoing mass immunization campaigns, the secretary believes the spread of infection will slow down by April.

Graphics by Micah Vilano. Maps by Chad de Guzman.