(Second of two parts)

MANILA, Philippines—As the highly contagious disease pertussis, or whooping cough, killed 40 children, government and health experts are trying to step up the child vaccination campaign hobbled by vaccine hesitancy.

It’s a mostly baseless hesitancy fueled by previous controversies and the COVID-19 pandemic.

Pertussis, according to the US Centers for Disease Control and Prevention (CDC), is a highly contagious respiratory disease caused by Bordetella pertussis bacteria. It causes rapid, violent, and uncontrolled coughing fits, which can go on for up to 10 weeks or more.

It is also called “whooping cough” due to the loud whooping noise made when someone infected with the disease breathes in sharply after coughing a lot.

While pertussis can lead to severe illness in individuals of all ages, particularly the unvaccinated, it poses a heightened, even life-threatening, risk to infants and young children.

READ: Whooping cough: It’s not just a cough

Unlike other infected individuals, CDC noted that infants with pertussis do not cough at all, making it more difficult to diagnose. Instead, they could turn blue or suffer breathing difficulties.

Additionally, their symptoms can resemble those of a common cold not only in the initial stages but throughout their illness, adding to the diagnostic challenge. In some cases, some will exhibit serious complications, which can be fatal.

The World Health Organization (WHO) stressed that the best way to prevent pertussis, especially among the younger population, is through immunization. This message is strongly echoed by the Department of Health (DOH), which continues to remind the public about the critical importance of the safety and effectiveness of vaccines in combating pertussis.

As infection rates escalate in the Philippines, the government and health experts are intensifying efforts to boost routine childhood immunizations, simultaneously addressing and urging the public to overcome prevailing fears and misinformation about vaccines.

Vaccines protect infants, children

Recent data from DOH reveal a concerning trend in pertussis cases in the Philippines, predominantly affecting the youngest and most vulnerable.

As of March 16, DOH data recorded at least 558 cases.

Cases involving infants under 6 months account for 356, or nearly six out of 10 cases. Among the infant cases, 270 (three-fourths of the cases) were either unvaccinated or had unknown vaccination status.

The health department also reported that 40 children have already died from pertussis this year. These figures have spurred health experts to call for increased vaccination efforts as an urgent measure.

READ: DOH: 40 child deaths due to pertussis logged so far this year

In a statement, Health Secretary Teodoro Herbosa reminded the public to get the following shots, which are free at local health centers, for their children: pentavalent diphtheria; pertussis and tetanus; hepatitis B; Haemophilus influenzae type B (DPT-HepB-HiB) and measles, mumps, and rubella (MMR).

READ: DOH pushes vaccines as measles, pertussis cases go up

According to the DOH, pentavalent vaccines include protection against “DPT” (Diphtheria, Pertussis, and Tetanus), in addition to Hepatitis B and Hemophilus influenza type B.

Infants as young as 6 weeks may already be given this vaccine for free at government health centers. A booster dose is also given to children aged 1 to 6 years old. The DOH added that older children and adults are advised to consult a doctor or health center for advice regarding suitable vaccination options.

Meanwhile, CDC recommended whooping cough vaccination for people of all ages. It strongly advised adults who have never received one, as well as pregnant women, to get a TDaP (Tetanus, Diptheria, and Pertussis) shot.

TDaP vaccines, CDC explained, could help pregnant women give their babies the strongest protective antibodies and best protection possible against pertussis.

Philippine Pediatric Society (PPS) Immunization Committee chair Dr. Fatima Ignacio Gimenez expressed that while timely vaccination should always be the aim, “it is almost always better to vaccinate late than never.”

“There are a small number of vaccines for which upper age limits do apply for administration, but for most vaccine-preventable diseases, providing vaccines late will still result in protecting against morbidity and mortality,” she explained, citing WHO guidelines.

READ: Get children jabbed, doctors push parents

Low immunization rates

For former Health Secretary and Iloilo Rep. Janette Garin, the nationwide rise in pertussis cases is attributed to insufficient vaccination.

Data from the United Nations Children’s Fund (UNICEF) showed that, between 2019 and 2022, the Philippines had one million ‘zero-dose’ children — those who did not receive a single routine vaccine, including DPT.

This alarming statistic positioned the Philippines as having the fifth-highest number of unvaccinated children globally during the period.

READ: As 1M PH kids get zero vaxx, LGUs urged to take campaign back on track

A separate dataset detailing the estimates of immunization coverage for the first and third doses of DPT in the Philippines, provided by WHO and UNICEF, further illustrated the decline in immunization coverage among children between 2019 and 2022.

The data indicated that, during this period, the percentage of surviving infants who received the first and third doses of DPT reached its lowest in 2021 at 57 percent.

WHO identified the Philippines as one of the countries recording the highest number of children missing out on one or more doses of DTP through routine immunization services in 2021 alone.

WHO and Unicef attributed the decrease in DPT 1 and 3 coverage in the Philippines to pandemic-related disruptions, including lower demand for routine immunization and diverted routine immunization resources to COVID-19 vaccine rollout.

READ: COVID worsens ‘largest backslide’ in child vaccinations in 30 years

In a report, both organizations attributed what they described as the “largest continued backslide in vaccinations in three decades” to COVID-19-related issues such as:

• service and supply chain disruptions
• resource diversion to response efforts
• containment measures that limited immunization service access and availability

Who’s to blame for vaccine hesitancy?

Garin, however, said the recent decline in vaccine uptake was influenced by “fake news and an infodemic.”

READ: Rising whooping cough cases due to low vaccinations, says Garin

The lawmaker argued that vaccine hesitancy had built up over time due to past administrative failure to address vaccine misinformation, particularly under the tenure of former DOH chiefs Francisco Duque III and Paulyn Ubial.

READ: Garin: Reemergence of pertussis is due to previous admin’s lapses

Duque had faced tough criticism, including from other lawmakers, for handling COVID-19 pandemic response and vaccine distribution.

Several health experts have attributed the low vaccine confidence among Filipinos to controversies surrounding the DOH’s massive anti-dengue immunization program in 2017, where individuals inoculated with Sanofi Pasteur’s Dengvaxia allegedly experienced worse symptoms when they contracted dengue.

At least 800,000 children had already been vaccinated by the time the program was stopped.

The Public Attorney’s Office filed complaints against health officials for the deaths of children allegedly caused by the anti-dengue vaccine. However, in January 2019, DOH said no death was confirmed to have been directly caused by Dengvaxia.

READ: No confirmed death directly caused by Dengvaxia — DOH

Garin, who led the DOH during the Dengvaxia rollout, has defended the vaccine’s safety, noting a contrast with other countries where similar issues did not arise.

Data from WHO and UNICEF explained that declines in reported immunization coverage for DTP 1 and 3 in the Philippines between 2017 and 2018 — 82 and 78 percent and 80 and 75 percent, respectively — “may reflect public perceptions of doubt related to vaccination following the dengue vaccine issue, as well as challenges with service delivery including access issues in hard-to-reach areas.”

The DOH previously admitted that the measles outbreaks in recent years was partly due to the erosion of vaccine confidence following the Dengvaxia issue.

READ: PH confidence on vaccine for kids declines by 25% — Unicef

At the height of the COVID-19 pandemic, then-presidential spokesperson Harry Roque said the Dengvaxia issue contributed to Filipinos’ hesitancy over COVID-19 vaccines.

More vaccine doses coming to PH

Amid the outbreaks and new cases of pertussis, the DOH assured the public that there are three million more pentavalent vaccine doses arriving in the country soon.

Pentavalent vaccines, the DOH explained, “protect not only against pertussis, but also against diphtheria, tetanus, hepatitis B, and Haemophilus influenza type B.”

DOH Spokesperson Eric Tayag also announced recenlty that 800,000 to one million doses of pertussis vaccines are expected to arrive in the country by mid-2024.

“The DOH has also ordered at least 5 million more measles-rubella vaccine doses, further to what is available on hand,” the DOH said.

READ: More pentavalent vaccine doses coming soon – DOH

The public is also urged to get over “vaccine fear” and have children and elderly inoculated.

“This is alarming, but we can prevent the spread of the disease through vaccination and observing proper hygiene,” said Garin.

“Vaccination saves lives, so we need to catch up,” she added.

In an interview with ANC, public health expert Dr. Tony Leachon recommended that the government reintroduce mandatory mask-wearing in public spaces, a measure previously seen during the COVID-19 pandemic, as a strategy to curb the spread of pertussis.

READ: Face masks fastest protection vs pertussis spread, says expert

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