Tuesday, January 30, 2018

Nagkaalaman na! Doctor from UP finally breaks his silence about Dengvaxia controversy


A doctor from the University of the Philippines finally breaks his silence anent the longtime controversy surrounding Dengvaxia vaccine.
UP Doctor Francisco Pascual Tranquilino | Photo from Facebook

In a Facebook post, Dr. Francisco Pascual Tranquilino shared his thoughts about the said issue.

On the said post, he wrote that together with some of his colleagues, Deans of Colleges of Medicine, former Secretaries of Health, esteemed members of the academe, exemplary clinicians and surgeons, past and present heads of various professional medical associations, NGOs, etc., they wish to add their 'collective voice on this ongoing controversy with the hope of protecting and promoting the health and welfare of our countrymen and to allay the fears and anger of those whose children were given the vaccine'.

Check out his full post below:

I have been silent about the Dengvaxia issue for some time now. However, I am breaking my silence today with the release of our Statement on this controversy. Along with some colleagues, Deans of Colleges of Medicine, former Secretaries of Health, esteemed members of the academe, exemplary clinicians and surgeons, past and present heads of various professional medical associations, NGOs, etc, we wish to add our collective voice on this ongoing controversy with the hope of protecting and promoting the health and welfare of our countrymen and to allay the fears and anger of those whose children were given the vaccine.

Also at this point, I would like to make clear my personal position on this matter. I fully supported the DOH Dengue Vaccine Program when the issue first erupted in 2016. In fact, in January 2016, I urged the Board of Regents of the Philippine College of Physicians (PCP) to facilitate a meeting of the Board with the Philippine Society of Microbiology and Infectious Diseases (PSMID), the Philippine Pediatric Society (PPS), and the Pediatric Infectious Disease Society of the Philippines (PIDSP) in order to fully understand the Dengue Program as well as to evaluate the available evidences supporting its use. I personally acknowledged then that the PPS and/or its recognized subspecialty PIDSP are the primary experts on this matter.
UP Doctor Francisco Pascual Tranquilino | Photo from Facebook

We were also fortunate to have Dr. Rose Capeding in attendance during the meeting. Dr. Capeding was one of the clinical trialists and main author of a well designed and rigorously conducted clinical trial (CYD14) involving 10,275 Asian children including Filipinos, which has shown that the vaccine can reduce the overall risk of dengue by 57% during the first 2 years after the first vaccination. The vaccine was also shown to have an acceptable safety profile during this study period. Further consideration of local priorities, national and sub-national dengue epidemiology, impact and cost-effectiveness data available at that time, I was therefore in agreement with the program’s roll-out. Even the issue of seroprevalence was considered by looking only at geographical settings with high endemicity (indicated by seroprevalence of approx. 70% or more) thus the roll-out only in those provinces/areas in our country with high prevalence of the disease (Regions III, IV-A and Metro Manila). 

So strictly speaking as the program was envisioned, it was not a nationwide mass vaccination. In addition, safety signal of increased risk of hospitalization and severe dengue was mitigated by giving only to children more than 9 years old. Therefore, with all these measures in place, I see nothing wrong with the initiative.
Dengvaxia product photo | Photo from Google

I also believe that should health practitioners decide to give the vaccine to individuals aged 9 years and above, all possible vaccine recipients or their parents or guardians should be apprised of the uncertainties, short-term benefits, and long-term risks. They should also be made aware of alternative options such as pre-vaccination serologic testing, personal protection, and mosquito control.

I was also inclined not to wait for the release of the WHO SAGE Report because it will only be recommendatory and each country would still be allowed to decide on its use after carefully considering the country-specific conditions including dengue epidemiology. Similarly, the National Drug Formulary Committee is only recommendatory, leaving the final decision to the DOH Secretary.

So from a purely scientific and medical standpoint, therefore, the above circumstances supported my decision then in favor of the DOH Dengue Vaccine Program and still is my position now.

Lastly, as a footnote, the label change that Sanofi was supposed to have carried out should have been handled more carefully and in close coordination with the DOH and FDA before any announcement was made to the public.

My photo with my mentor Dr. Antonio Dans below was taken at the height of the debate in 2016 when we had opposing views on this issue yet proving na walang personalan, we can still manage to drink to that! Cheers, sir! 
Dr. Francisco Pascual Tranquilino and Dr. Antonio Dans
Photo from Dr. Francisco Pascual Tranquilino

Dr. Francisco Pascual Tranquilino

Source: Francisco Pascual Tranquilino

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