MANILA, Philippines — The Department of Health (DOH) maintained that funding for its essential services such as vaccination remained intact.
Iloilo Rep. Janette Garin had earlier flagged a P10-billion cut on the DOH’s budget next year, which the department said on Monday that it was working to restore.
According to Health Undersecretary Rolando Enrique Domingo, the DOH has enough money to buy vaccines and implement its national immunization program next year since its budget of about P7.5 billion was not slashed.
Affected by the reduction in the DOH 2020 budget were such programs as the Health Facilities Enhancement Program (HFEP) and human resources for health, Domingo told reporters.
Performance issues
He said the HFEP cut was mainly due to performance issues, as the DOH was unable to roll out on time projects aimed at improving the infrastructure and equipment of the country’s health care system.
From the current P15 billion, the proposed budget for HFEP next year would stand at just close to P6 billion.
Health Secretary Francisco Duque III had earlier told senators that while the DOH would have wanted a speedier disbursement of funds for HFEP, the department was constrained by various factors such as bid failures, delayed bidding, land ownership problems, lack of technical human resources in the regions, and peace and order issues.
Though funding for the deployment of doctors and nurses was taken out of the DOH budget, Domingo said that the agency was assured by the Department of Budget and Management (DBM) that its requirements would still be funded under the miscellaneous personnel benefit fund.
“That’s what we need to be on the lookout for because we really need to deploy nurses and doctors to be able to deliver the primary care and vaccination programs,” Domingo told reporters.
Currently, Domingo said the DOH was in talks with the DBM and members of Congress to restore the P153 billion sought by Philippine Health Insurance Corp. (PhilHealth) to fund the expansion of the state insurer’s outpatient benefit package.
For 2020, PhilHealth was only allocated P67 billion.
‘Poor surveillance’
The DOH also acknowledged the poor surveillance of cases of acute flaccid paralysis (AFP) over the last four years, which contributed to the polio outbreak.
Domingo said an effective AFP surveillance, along with high immunization coverage rate and good environmental sanitation, could have prevented the emergence of the vaccine-derived poliovirus (VDPV).
“Unfortunately, AFP surveillance was quite poor in the last three or four years. Very few people were reporting. If that’s the case, there’s a possibility that there are undetected cases,” Domingo told reporters.
Sudden paralysis
The World Health Organization (WHO) defined AFP as a sudden onset of paralysis and weakness on any part of the body of a child below 15 years old. Detecting these cases is crucial, even for countries where there are no longer polio cases, as part of the global strategy to eradicate the debilitating disease.
Ideally, countries without poliovirus transmission should have an AFP reporting rate of 1 per 100,000 children below 15 years old.
Data from the DOH’s Epidemiology Bureau, however, showed that as of Sept. 7, only Western Visayas had met this threshold at 1.28.
In the Bangsamoro Autonomous Region in Muslim Mindanao and in Calabarzon, where the confirmed polio cases were recorded, AFP surveillance was 0.3 and 0.19, respectively. Nationwide, the reporting rate was 0.44.
Still polio-free
Domingo said the problem over the last few years was that apart from “passive” surveillance—or just waiting for hospitals to report cases—there was also a lack of “focal persons” to do it.
“That’s why we are now working for AFP surveillance to be more active. We’re getting these cases and hopefully we would be able to detect and confirm if these are polio or not,” he said.
Domingo further pointed out that, although there were already two detected polio cases, the country still retained its polio-free status. This is because the Lanao del Sur and Cavite patients were VDPV cases and not wild polio cases.
By the second week of October, the DOH will be mounting a supplemental oral polio vaccine (OPV) drive in the National Capital Region, Calabarzon, Davao and Lanao del Sur. These areas will also be prioritized in the distribution of the monovalent OPV containing the Type 2 weakened polio strain, which will be provided by the WHO.
Starting 2016, the country did away with using the trivalent OPV to reduce the risks of circulating the VDPV Type 2 strain. Up until 2015, 90 percent of VDPV cases were linked to this strain.
Domingo said that children who received only the bivalent OPV and missed the injectable inactivated polio vaccine (IPV) are recommended to take the Type 2 monovalent vaccine for added protection. He noted that last year, only 30 percent of children below 5 received the IPV, which gave protection against the Type 2 strain.
‘Alarmists’
Garin sarcastically praised “alarmists” and “pseudoexperts” on Monday for bringing back long-gone diseases such as polio as a result of the growing public fear of vaccines.
“You have brought back several diseases that we have managed to eradicate and lessen years ago,” Garin said in a statement.
“May we all learn from what is happening now. Let us not listen to nonexperts and may the media lessen exposures for them. We have real experts who we can tap in times like this. Let us give the proper airtime to them,” added the former health secretary and currently senior deputy minority leader of the House of Representatives.
Two polio cases
The DOH announced on Sept. 19 a confirmed case of polio in Lanao del Sur. Another case was confirmed in Laguna province the next day.
Until the new cases were discovered, the Philippines had been polio-free for 19 years with the last patient reported in 1993.
Garin attributed the resurgence of polio to the spread of “fake news” and said this was “a testament to the new challenges public health is facing.”
Vaccine hesitancy
“Vaccine hesitancy has increased since nonexperts have started talking, claiming they knew everything about the dengue vaccine. They plastered their faces and spewed lies after lies feeding the media. They frightened the people of an effective vaccine, which is now being used in 21 countries, including the US and the EU,” she said.
This, according to Garin, resulted in Filipinos fearing going to their doctors and to the barangay health centers to vaccinate their children.
“We just experienced the measles outbreak, Japanese encephalitis outbreak, and we are still combating the dengue outbreak and now we are faced with polio resurgence all because fake news about vaccines flourished. School-based immunization has also been compromised,” she said.
She said health leaders should have placed measures to prevent resurgence of such diseases.
Experts should have been utilized and mobilized, Garin said. “However, threat of cases being filed for those who speak up the truth made many experts meek and the DOH was filled with demoralization,” she added.
“I would also like to remind everyone that vaccines were invented to save lives. Vaccinate your children,” Garin said.
Davao River
Meanwhile, health authorities in Davao City have confirmed that the Davao River had been found positive of the polio virus, prompting them to order a massive polio vaccination drive covering children in the city.
Josephine Villafuerte, city health officer, said the water samples earlier submitted to the Research Institute for Tropical Medicine confirmed the presence of the polio virus in the river. “In October, there will be an outbreak response vaccination. Every child … is targeted to be covered,” she said.
Villafuerte said there was no confirmed polio case in the city so far.
She said the City Health Office (CHO) would gather barangay officials and resort owners today to discuss the situation.
The CHO cautions the public against swimming in the city’s resorts until the water is declared safe.
“They should always make sure that the water is clean. They should also change swimming clothes. It’s not that they are not allowed to operate but they should effectively disinfect their waters,” Villafuerte said, referring to resort owners.