Skip to main content

The importance of effective risk communication and transparency: lessons from the dengue vaccine controversy in the Philippines

Abstract

In 2016 the Philippine Department of Health (DOH) introduced a novel dengue vaccine in a mass immunization program to reduce the substantial economic and social burden of the disease on households and the government. The vaccine manufacturer’s announcement regarding new findings on the small but increased risk of severe dengue for vaccinated seronegative patients caused turmoil as various people claimed that the vaccine caused deaths and that health authorities are corrupt. While health department staff split—some having to preserve its reputation and others to monitor over 800,000 children administered the vaccine—communication between the frontline health workers and parents suffered. As a result, public confidence in vaccines dramatically dropped and the repercussions challenge the public health system. We examine factors that contributed to the crisis and argue for strengthening risk communication strategies and increasing transparency on decision making to counter misinformation and protect public health.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Wolfe RM. Anti-vaccinationists past and present. BMJ. 2002;325(7361):430–2.

    Article  Google Scholar 

  2. 2.

    Spooner MH. Measles outbreaks in UK linked to fears about MMR vaccine. Can Med Assoc J. 2002;166(8):1075.

    Google Scholar 

  3. 3.

    Jegede AS. What led to the Nigerian boycott of the polio vaccination campaign? PLoS Med. 2007;4(3):e73.

    Article  Google Scholar 

  4. 4.

    Department of Health, Republic of the Philippines. Disease Surveillance, Dengue Monthly Report. 2014–2018. 2019. https://www.doh.gov.ph/statistics. Accessed 11 Nov 2019.

  5. 5.

    Edillo FE, Halasa YA, Largo FM, Erasmo JN, Amoin NB, Alera MT, et al. Economic cost and burden of dengue in the Philippines. Am J Trop Med Hyg. 2015;92(2):360–6.

    Article  Google Scholar 

  6. 6.

    Hadinegoro SR, Arredondo-García JL, Capeding MR, Deseda C, Chotpitayasunondh T, Dietze R, et al. Efficacy and long-term safety of a dengue vaccine in regions of endemic disease. N Engl J Med. 2015;373(13):1195–206.

    Article  Google Scholar 

  7. 7.

    Lam H, Ku GM, Wu D, Cheng KJG, Rivera A, Tumanan-Mendoza B, et al. Cost-effectiveness analysis of dengue vaccination in the Philippines. Int J Infect Dis. 2016;45:421.

    Article  Google Scholar 

  8. 8.

    World Health Organization. Dengue vaccine: WHO position paper. (2016). https://www.who.int/wer/2016/wer9130.pdf?ua=1. Accessed July 2016.

  9. 9.

    Cruz R. Lawmaker defends lobbying for dengue immunization in district. ABS-CBN News. (2017). https://news.abs-cbn.com/news/12/15/17/lawmaker-defends-lobbying-for-dengue-immunization-in-district. Accessed 20 Feb 2020.

  10. 10.

    Map of the Philippines showing the location of Central Visayas. Wikimedia Commons. (2017). https://upload.wikimedia.org/wikipedia/commons/thumb/a/ad/Philippines_location_map_%28square%29.svg/700px-Philippines_location_map_%28square%29.svg.png. Accessed 27 Apr 2020.

  11. 11.

    Sanofi. Sanofi updates information on dengue vaccine. Sanofi. (2017). https://www.sanofi.com/en/media-room/press-releases/2017/2017-11-29-17-36-30. Accessed 13 Dec 2019.

  12. 12.

    Antonio Dans Facebook post. Facebook. (2019). https://www.facebook.com/antonio.dans/posts/1675124965869264. Accessed 13 Dec 2019.

  13. 13.

    GMA News. Dengvaxia vaccine di angkop sa mga taong di pa nagkakadengue ayon sa manufacturer. GMA News. (2017). https://www.gmanetwork.com/news/video/qrt/436009/dengvaxia-vaccine-di-angkop-sa-mga-taong-di-pa-nagkaka-dengue-ayon-sa-manufacturer/video/. Accessed 11 Nov 2019.

  14. 14.

    ABS-CBN News. Bakuna kontra dengue, maaaring makasama sa ilan: pag-aaral. ABS-CBN News. (2019). https://news.abs-cbn.com/news/11/30/17/bakuna-kontra-dengue-maaaring-makasama-sa-ilan-pag-aaral. Accessed 13 Dec 2019.

  15. 15.

    Department of Health, Republic of the Philippines. Doh puts dengue immunization on hold after new findings from Sanofi-Pasteur. Department of Health. (2019). https://www.doh.gov.ph/node/11831.

  16. 16.

    World Health Organization. GACVS Statement on Dengvaxia ® (CYD-TDV). (2017). https://www.who.int/vaccine_safety/committee/GACVS-StatementonDengvaxia-CYD-TDV/en/. Accessed 20 Feb 2020.

  17. 17.

    University of the Philippines. Executive Summary: Report of the PGH Dengue Investigative Task Force. University of the Philippines. (2018). https://www.up.edu.ph/index.php/executive-summary-report-of-the-pgh-dengue-investigative-task-force/. Accessed 13 Dec 2019.

  18. 18.

    GMA News. QRT: Panayam kay Dr. Erwin Erfe, Director, PAO Forensic Lab. Quick Response Team. Quezon City: GMA Network. (2018). https://www.youtube.com/watch?v=pyvQYzpTZlg. Accessed 11 Nov 2019.

  19. 19.

    ABS-CBN News. PAO forensics expert stands firm on Dengvaxia findings. ABS-CBN. (2018). https://www.youtube.com/watch?time_continue=7&v=noWRxMVmabA&feature=emb_title. Accessed 11 Nov 2019.

  20. 20.

    Inquirer. PAO forensics expert stands firm on Dengvaxia findings. Inquirer.net. (2018). https://newsinfo.inquirer.net/1062920/pao-forensic-expert-stands-firm-on-dengvaxia-findings. Accessed 13 Dec 2019.

  21. 21.

    Ramos M. Palace, DOH say Erwin Erfe is no pathology expert. (2018). https://newsinfo.inquirer.net/967102/palace-doh-say-erwin-erfe-is-no-pathology-expert. Accessed 20 Feb 2020.

  22. 22.

    Ben Tulfo UNFILTERED | Atty. Persida Acosta [Internet]. BITAG Official. IBC 13. (2018). https://www.youtube.com/watch?v=LDE-sSF6Bjc. Accessed 13 Dec 2019.

  23. 23.

    ABS-CBN News Channel. Conflicts of Interest? [Internet]. ABS-CBN News. (2018). https://www.youtube.com/watch?v=1tD5n7lk6Cg. Accessed 13 Dec 2019.

  24. 24.

    Rappler. Dengvaxia victims’ kin file complaint vs DOH, Sanofi, Zuellig execs. Rappler. (2018). https://www.rappler.com/nation/199657-dengvaxia-victims-families-criminal-complaint-doh-sanofi-zuellig. Accessed 13 Dec 2019.

  25. 25.

    Inquirer. Ex-consultant bares ‘mafia-like’ operations at DOH. Inquirer.net. (2018). https://newsinfo.inquirer.net/959942/ex-consultant-bares-mafia-like-operations-at-doh-doh-dengvaxia-ubial-garin-cruz-mafia-corruption-dengue-vaccine. Accessed 30 Dec 2019

  26. 26.

    CNN Philippines. U.S. expert who warned vs. Dengvaxia “astonished” when PH pursued mass vaccination. CNN Philippines. (2018). https://cnnphilippines.com/news/2018/03/13/Dengvaxia-vaccine-Scott-Halstead-Garin-Aquino.html. Accessed 20 Feb 2020.

  27. 27.

    ABS-CBN News. Aquino, “conspirators” should face raps over Dengvaxia: Gordon. ABS-CBN News. (2018). https://news.abs-cbn.com/news/04/11/18/aquino-conspirators-should-face-raps-over-dengvaxia-gordon. Accessed 13 Dec 2019.

  28. 28.

    Manila Bulletin. Moving moments at dengvaxia hearing. Manila Bulletin. (2018). https://news.mb.com.ph/2018/03/13/moving-moments-at-dengvaxia-hearing/. Accessed 13 Dec 2019.

  29. 29.

    Rappler. Gordon report: File criminal charges vs Aquino, Garin, Abad over Dengvaxia mess. Rappler. (2018). https://www.rappler.com/nation/199996-richard-gordon-dengvaxia-draft-committee-report. Accessed 13 Dec 2018.

  30. 30.

    Larson HJ, Hartigan-Go K, de Figueiredo A. Vaccine confidence plummets in the Philippines following dengue vaccine scare: why it matters to pandemic preparedness. Hum Vaccines Immunother. 2019;15(3):625–7.

    Article  Google Scholar 

  31. 31.

    World Health Organization. Questions and answers on the measles outbreak in the Philippines. World Health Organization. (2019). https://www.who.int/philippines/news/feature-stories/detail/questions-and-answers-on-the-measles-outbreak-in-the-philippines. Accessed 13 Dec 2019.

  32. 32.

    UNICEF. #VaccinesWork: UNICEF stresses importance of immunization on World Immunization Week. (2019). https://www.unicef.org/philippines/press-releases/vaccineswork-unicef-stresses-importance-immunization-world-immunization-week. Accessed 13 Dec 2019.

  33. 33.

    Department of Health, Republic of the Philippines. Expanded Program on Immunization Coverage Report.

  34. 34.

    World Health Organization. Questions and Answers on Dengue Vaccines. (2019). https://www.who.int/immunization/research/development/dengue_q_and_a/en/. Accessed 13 Dec 2019.

  35. 35.

    World Health Organization. Executive Summary - The Selection and Use of Essential Medicines: Report of the 22nd WHO Expert Committee on the 2019 Selection and Use of Essential Medicines. (2019). https://apps.who.int/iris/bitstream/handle/10665/325773/WHO-MVP-EMP-IAU-2019.05-eng.pdf?ua=1. Accessed 20 Feb 2020.

  36. 36.

    Rosenbaum L. Trolleyology and the dengue vaccine dilemma. N Engl J Med. 2018;379(4):305–7.

    Article  Google Scholar 

  37. 37.

    Pang T, Gubler D, Goh DYT, Ismail Z. Dengue vaccination: a more balanced approach is needed. Lancet. 2018;391(10121):654.

    Article  Google Scholar 

  38. 38.

    World Health Organization. Risk communication. (2014). https://www.who.int/risk-communication/introduction-to-risk-communication.pdf?ua=1. Accessed 20 Feb 2020.

  39. 39.

    World Health Organization. Updated Questions and Answers related to the dengue vaccine Dengvaxia® and its use. (2017). https://www.who.int/immunization/diseases/dengue/q_and_a_dengue_vaccine_dengvaxia_use/en/. Accessed date 20 Feb 2020.

  40. 40.

    Lasco G, Curato N. Medical populism. Soc Sci Med. 2019;221:1–8.

    Article  Google Scholar 

  41. 41.

    Senate of the Philippines. Stop grandstanding on Dengvaxia issue, De Lima tells Acosta. Press Release. (2019). https://www.senate.gov.ph/press_release/2019/0130_delima1.asp. Accessed 20 Feb 2020.

  42. 42.

    Arkin F. Dengue vaccine fiasco leads to criminal charges for researcher in the Philippines. Science. (2019). https://www.sciencemag.org/news/2019/04/dengue-vaccine-fiasco-leads-criminal-charges-researcher-philippines. Accessed 20 Feb 2020.

  43. 43.

    Valido EM, Laksanawati IS, Utarini A. Acceptability of the dengue vaccination among parents in urban poor communities of Quezon City, Philippines before and after vaccine suspension. BMC Res Notes. 2018;11(1):661.

    Article  Google Scholar 

  44. 44.

    EON. The Philippine Trust Index 2015. (2015). https://www.eon.com.ph/pti/. Accessed 13 Dec 2019.

  45. 45.

    TV Patrol: Batang hinihinalang namatay sa Dengvaxia, “pinag-eksperimentohan”?. Kabayan Special Patrol. ABS CBN News. (2018). https://www.youtube.com/watch?v=pO4KRjunTEo. Accessed 13 Dec 2019.

  46. 46.

    Data from compiled media reports by the authors.

  47. 47.

    Tran BX, Boggiano V, Nguyen LH, Latkin C, Nguyen H, Tran TT, et al. Media representation of vaccine side effects and its impact on utilization of vaccination services in Vietnam. Patient Prefer Adher. 2018;12:1717–28.

    Article  Google Scholar 

  48. 48.

    Chen MF, Wang RH, Schneider JK, Tsai CT, Jiang DDS, Hung MN, et al. Using the health belief model to understand caregiver factors influencing childhood influenza vaccinations. J Community Health Nurs. 2011;28(1):29–40.

    Article  Google Scholar 

  49. 49.

    Keane J. Public life in the era of communicative abundance. Can J Commun. 1999;24(2):43–52.

    Article  Google Scholar 

  50. 50.

    Harsin J. Post-Truth and Critical Communication Studies. In: Oxford Research Encyclopedia of Communication. Oxford University Press. (2018). https://oxfordre.com/communication/view/10.1093/acrefore/9780190228613.001.0001/acrefore-9780190228613-e-757. Accessed 20 Feb 2020.

  51. 51.

    Facebook. Combatting Vaccine Misinformation. (2019). https://about.fb.com/news/2019/03/combatting-vaccine-misinformation/. Accessed 20 Feb 2020.

  52. 52.

    Ampolpittayanant M, Yudha A. Helping you find reliable public health information on Twitter. (2019). https://blog.twitter.com/en_sea/topics/company/2019/Helping-you-find-reliable-public-health-information-on-Twitter.html. Accessed 20 Feb 2020.

  53. 53.

    World Health Organization. Vaccine Safety Communication in the Digital age: 2018 Meeting Report. (2019). https://www10.who.int/vaccine_safety/publications/Vaccine-safety-communication-in-the-digital-age-report.pdf. Accessed 20 Feb 2020.

  54. 54.

    Rödder S. Reassessing the concept of a medialization of science: a story from the “book of life”. Public Underst Sci. 2009;18(4):452–63.

    Article  Google Scholar 

  55. 55.

    Sci-dev.net. Media skills for scientists: Take control when communicating with journalists. Sci-dev.net. https://scidevnet.teachable.com/p/media-skills-scientists.

  56. 56.

    Solinap L. Lawmaker: PH needs an immunization advisory group. Sunstar Iloilo. (2019). https://www.sunstar.com.ph/article/1826622. Accessed 20 Feb 2020.

  57. 57.

    Interaksyon. Garin ‘ignored’ experts’ advice on Dengvaxia; no testing done to find out if children had dengue before vaccination. Interaksyon. (2017). https://www.interaksyon.com/breaking-news/2017/12/11/112478/garin-ignored-experts-advice-on-dengvaxia-no-testing-undertaken-to-find-out-if-children-had-dengue-before-vaccination/. Accessed 20 Feb 2020.

  58. 58.

    Wijesinghe PR, Palihawadana P, Peiris TSR. Participatory decision-making through the Advisory Committee on Communicable Diseases: The Sri Lankan experience. Vaccine. 2010;28:A96–103.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ronald U. Mendoza.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dayrit, M.M., Mendoza, R.U. & Valenzuela, S.A. The importance of effective risk communication and transparency: lessons from the dengue vaccine controversy in the Philippines. J Public Health Pol 41, 252–267 (2020). https://doi.org/10.1057/s41271-020-00232-3

Download citation

Keywords

  • Dengue vaccine
  • Dengvaxia
  • Risk communication
  • Crisis of confidence
  • Vaccine controversy