登革热疫苗接种：成为第一个是个坏主意

Crispin Maslog说，登革热疫苗使菲律宾人持持警告的态度。

When the Philippines launched its dengue vaccination programme on 4 April 2016, using Sanofi Pasteur’s newly approved ‘Dengvaxia’, there was great fanfare and optimism.

本周，公共律师办公室有对公司提起诉讼, seeking compensation for the death of a 10-year old girl it says has died as a result of the vaccine.

这是在对菲律宾参议院停止计划的调查之后。同时，针对赛诺菲的更多集体诉讼的威胁仍在继续，卫生部本身威胁要起诉该公司拒绝退还PH35亿菲尔（7,000万美元）。

而且，参议院蓝丝带委员会主席理查德·戈登（Richard Gordon）在本周的广播采访中说，该委员会正在考虑针对前总统贝尼尼奥·阿基诺三世（Benigno Aquino III），预算秘书弗洛伦西奥·阿巴德（Florencio Abad）和卫生部长珍妮特·加林（Janette Garin）提起反贪食案件。

Some scientists are pitching in, explaining what Sanofi Pasteur and the former health department officials have done. On the other hand, a group of 58 medical doctors and scientists, headed by former Health Ministers Esperanza Cabral and Manuel Dayrit, have issued a statement calling for calm.

但是，随着菲律宾的科学家和政客争夺亚洲首次大规模登革热疫苗接种计划的失败，最大的伤亡可能是人们对疫苗接种和其他政府领导的公共卫生计划的信任和信心，这是对抗疾病的有效方式。

Public trust in vaccination has taken a beating, helped by the media’s sensational coverage of suspected dengue-vaccine related child deaths. Unfortunately, the mistrust has extended to other public health programmes: news stories report that families in poor communities are now refusing to take part in free, basic child care programmes such as deworming.

愤怒began on 29 November 2017当赛诺菲巴斯德警告时在声明中that people inoculated with the dengue vaccine would be at “severe risk” if they had not been previously infected with the virus. Dengvaxia, according to the manufacturer, gives “persistent protective benefit against dengue,” but only for those who have been previously infected with the disease.

消息发布后几乎立即，许多父母挺身而出，声称他们的孩子因疫苗接种而生病或死亡。

事实

Let us review the facts, briefly.

登革热是菲律宾高度流行的疾病，平均病例数量in the region of 175,000 in recent years。

2015年12月22日，菲律宾成为第一个亚洲国家，第二位是墨西哥旁边的第二个国家，获得了赛诺菲巴斯德疫苗Dengvaxia的许可。

On 4 April 2016, just four months later, the Philippines launched its school-based mass vaccination programme. It went ahead with the programme without the WHO pre-qualification that is normally required. However, I am told that this decision was based on the advice of the Strategic Advisory Group of Experts (SAGE), a 15-member panel of independent experts, which provides recommendations to the WHO on global vaccine policies.

On 24 April 2016, or 20 days later, a total of 204,397 vaccinations were completed, 362 of which had adverse reactions. By the following year, a total of 837,000 people, mostly children, had been vaccinated, all of whom come from regions where dengue is endemic.

But on 29 November 2017, Sanofi Pasteur issued a statement warning that people who got vaccinated with Dengvaxia would be at “severe risk” if they had not been previously infected with the virus. The warning was based on a new analysis of six years’ worth of data from clinical studies done by the company.

Immediately after that, the Philippine health secretary Francisco Duque said in a press conference that the dengue vaccination programme was being halted, and a review had been ordered.He toldscidev.net在采访中没有计划恢复该计划的计划。杜克补充说，卫生部门还研究了24例可能与大规模疫苗接种有关的死亡。

政治后果

The Philippine media has kept the Dengvaxia issue in the headlines ever since Sanofi Pasteur made its announcement. Both broadcast and social media have sensationalised the story, airing pictures of mothers crying over the deaths of children they say are attributed to dengue.

Views on social media are especially critical of Sanofi Pasteur and some health officials, often voicing negative opinions about vaccination itself.

The Philippine Senate, through its investigative and anti-corruption Blue Ribbon Committee, has conducted several hearings on the scandal, with no less than former Philippine President Benigno Aquino III among those who have testified and stand to face charges.

Lessons learned

我们从这场惨败中学到了什么？
First, we are reminded again that haste makes waste. I confess to being gung-howhen I wrote about the launchof the vaccination programme in 2016. It seemed a bold and pioneering move, considering the number of cases in the Philippines.

很容易忽略一个新科技的危险logy being introduced — dangers which should be heeded especially when the technology involves the human body. The Philippine government could have been more conservative in adopting the new vaccine, especially in this case, since it involves children.

为什么要从如此庞大的规模开始？在临床试验的扩展中测试疫苗的样本量较小，而Sanofi Pasteur完成了自己的测试，这是理想的选择。

Now, the public is wary of other health programmes — and the scepticism could extend to scientists who will be talking of new technologies that could affect health, like GM foods. On January 31st, a group of leading Filipino physicians and scientists发表声明在领先的报纸上表达了对登瓦克西争议引起的错误信息的担忧，他们说“这已经侵蚀了公众对该国的疫苗接种计划和其他公共医疗保健的信心”。

“If this trend continues, then we may find ourselves faced with outbreaks of debilitating and life-threatening diseases that we have already been able to control through our vaccination programmes,” the statement emphasised.

Indeed, the Philippines has the distinction of being the first country in the world to introduce Dengvaxia in a mass vaccination programme — but it is now paying the price for this. In hindsight, it looks like Filipino children became unwitting guinea pigs in the rush to roll out a new dengue vaccine, with the scientific and health community’s reputation taking a hit as well.

法国阿肯斯·普雷斯（Agence France-Presse）的前记者克里斯平·马斯格格（Crispin Maslog）是环保主义者，也是beplay足球体育的微博前科学教授Silliman菲律宾大学洛杉矶大学ñ操作系统。他是亚洲媒体信息和传播中心董事会主席的创始成员和主席。

这件作品由Scidev.net的亚太桌子制作。