A moment of silence for our public health workers

A moment of silence for our public health workers

- in Health, Philippines
A woman carrying a measles infected infant. Outbreaks of the highly contagious disease have been declared in NCR and other regions. Image from GMA News.

If you or anyone you know works in public health, just know I’m praying for you.

The Department of Health has confirmed that there are measles outbreaks in Metro Manila, Central Luzon, CALABARZON, MIMAROPA and the Bicol Region. A further number of regions are under “tight watch” for potential outbreaks, specifically: Ilocos, Cagayan Valley, Cordillera Administrative Region, and Caraga.

According to Health Secretary Francisco Duque III, the number of  reported cases within Metro Manila alone has seen a 550% increase from January 1 to February 6. A total of 169 cases have been recorded in the region. The same period last year recorded only 26 cases.

In Manila’s San Lazaro Hospital alone, 55 deaths from measles have been recorded. Most of the deceased were children aged three months to four years old. As of Tuesday morning, the hospital was treating 248 children for measles.

Nationwide, the DOH recorded around 18,000 measles cases in 2018. For 2017, there were only 3,804 cases.

Measles, locally known as tigdas, is a viral, highly-contagious respiratory disease. The virus may remain active or contagious in the air or infected surfaces for up to 2 hours. Infected people exhibit a variety of symptoms besides the telltale rashes associated with the illness. These including a high fever, red eyes, a runny nose, and cough. Since the rash beings to spread only after several days, noticing these other symptoms can lead to an early diagnosis and treatment intervention. It can also mean an early quarantine and a decreased change of the disease spreading. People are infections from 4 days prior to onset of the rash to 4 days after the rash erupts.

Measles are spread through cough or other direct contact with the body secretions of an infected person. One infected person can pass the disease on to as many as 18 others.

Most deaths are caused by complications associated with the disease. Children under the age of 5 or adults over the age of 30 are especially vulnerable to developing serious complications.

It should also be mentioned that for persons with healthy immune systems, this disease is entirely preventable.

A vaccine against the very contagious and very serious disease was introduced in 1963. Before this, major epidemics would occur every 2-3 years, causing around 2.6 million deaths per year worldwide.

Thanks to vaccines, incidence of measles have dropped worldwide by 80% between 2000 and 2017. This represents and estimated 21.1 million deaths prevented. In 2017, only 110,000 people died from the disease. Though this is a fraction of the deaths recorded pre-vaccine, this is still a high number considering the availability of a safe and effective treatment to present the disease from spreading at all.

The prescribed age for vaccinating children is 9 to 11 months old. Children aged 6 months old may be vaccinated if there is an outbreak in their locale. If a child is vaccinated at 6 months, they should still get the vaccine at 9 to 11 months, and then a booster shot at 15 months old. The first vaccine is 90% effective, while the booster increases resistance to 100% effective.

In 2014, the Philippines declared its  intention to be a measles-free country by 2017. In line with this, the Department of Health launched mass immunization programs to bring down the number of cases.

And yet, here we are. Epidemics don’t happen overnight. The DOH has been diligently monitoring the resurgence of measles cases for . In April 2018, the health agency was already reporting that the incidence of the disease had increased by 3,671%.

So, nation, how did this happen?

Well, we’ve stopped vaccinating.

The government programs are still there. The measles vaccine can be availed of for free. It’s one of the mandatory basic immunizations all children must receive, listed alongside tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, mumps, rubella, hepatitis-B, and H. influenza type B (HIB). Public health clinics still hold immunization drives that allow the community to access these life-saving medicines.

But more and more, parents are opting out of vaccinating their kids. In February 2018, children’s vaccination rates decreased to 60%.. The annual vaccination target of the DOH is 85-90%, which was previously achieved in some areas (like Central Luzon, which is now sadly the site of an active outbreak). Some regions in the Philippine see even lower vaccination rates.

A large part of the blame rests on the shoulders of the Dengvaxia controversy. Now, whether the people who designed, approved, and implemented it should be treated as criminals is something that will be decided in Congress and in the eyes of the law. But there’s no denying that the taste left in the mouth of many people is bitter and the word association with ‘vaccine’ is now ‘danger’.

Here is where we take a breath and think about the poor people working in public health. As with any branch of science, one of the greater challenges is communicating information and the reason why this information is important. In many fields, this leads to frustration over dinner tables while talking to distant relatives with a vague curiosity into ‘what exactly is it that you do with your degree?’. In others, this leads to a failure to properly motivate the public or legislators to push for measures that would protect the environment. For public health workers, this can mean death for many people.

The anti-vaccine movement has been gaining traction worldwide, thanks to pseudoscience. But the Philippines’ measles problem is not largely due to parents who think they know better than all of modern medicine, its due to parents who don’t know nearly enough about modern medicine. If the first time you heard vaccines discussed at length was during Dengvaxia, it’d be hard to believe you’d bother getting any other vaccine.

What vaccines do, how they work, and why people need them individually and as a population is not something many people fully understand. This isn’t just limited to measles – it’s true for most diseases (let’s not get into antibiotics and why you have to finish your complete treatment even after you feel better). Information, paired with medication, is the best treatment.

The public health sector is facing a huge challenge. In hospitals, they will be flooded with sick children and many times will have to deliver terrible news to worried parents. In rural health centers, they will face the difficult task of reaching infected people and delivering treatment to them. Nationwide, they will have to try and educate people over the fear they’ve already embraced.



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