EPIDEMIC
OF FE AR
120
FORTUNE.COM // DECEMBER 2019
one tiny mistake, really a single word in the
Nov. 29 press release: “severe.” By saying that
people without previous exposure to dengue
were at higher risk of getting “severe dengue”
if they were given Dengvaxia, Sanofi had
caused unnecessary concern.
Sanofi had taken the word “severe” straight
from the language of its clinical trial design.
But out of that context, it took on a different
meaning.
Ng Su Peing, Sanofi Pasteur’s global medi-
cal head, had the job of fielding questions
at the company’s press conference. “The
general public in the Philippines thinks of
severe dengue as something that’s devastat-
ing, that could lead to death,” she says. “[The
announcement] was conveyed in a way that
really caused alarm.”
“Severe dengue,” by the study’s definition,
covered a broad category of symptoms—from
fever and gum bleeding at one end of the
spectrum to the sometimes fatal hemorrhag-
ing and shock at the other. In the clinical trial,
no participants died of dengue, and reported
cases of “severe dengue” fell at the milder end
of the spectrum. Four out of every 1,000 chil-
dren vaccinated without a previous infection
had a higher risk of developing such disease
over a five-year period. That compared with
1.7 per every 1,000 children without a previ-
ous infection who weren’t given the vaccine.
In the spirit of transparency and scientific
accuracy, Sanofi had crafted its press release
carefully to adhere to the trial’s official termi-
nology. But it had left out both the numbers
and the nuance, leaving the public to interpret
“severe dengue” as they would.
“If you were a lay person and you heard
‘severe,’ what else would you conclude?” says
Anna Ong-Lim, a physician who is currently
president of the Pediatric Disease Society in
the Philippines.
Regulations prevented Sanofi from pro-
moting Dengvaxia to the public directly, so
the company stayed silent on social media.
Instead, it continued to press its data-driven
case with high-level stakeholders in the coun-
try. “Maybe it seemed overly scary, but actually
it’s not scary at all,” says Triomphe, a former
McKinsey consultant, recalling how frustrat-
ing it was to witness the public’s panic build.
“It’s not changing at all the overall benefit/risk
profile of the product.” He says in hindsight,
the situation was more politicized than he
realized: “Probably our voice was not hearable
or understandable,” says Triomphe.
Nor was Sanofi the only one struggling to
cut through the noise. So, too, was the Fili-
pino health department. “Every day we were
getting drowned out,” says Eric Domingo,
undersecretary of health. “It was exhausting.”
In July 2019 I visited Domingo at his office
at DOH’s leafy campus in central Manila. He
was dressed in shirtsleeves and running late.
The department was one week into a dengue
alert, months into a measles outbreak, and
managing occasional reports of diphtheria.
The affable Domingo speaks like a man who
is trying to piece together the past two years,
or maybe like one trying to peel himself off the
pavement after being run down by a truck for
the sixth or seventh time. Worn down, beat
up, but not unable to appreciate the occasional
absurdity of all that has happened.
The Dengvaxia mess began, more or less,
on his first day on the job. He started Dec. 1,
the morning the government suspended the
vaccination program. The timing protected
him from the accusations made against others
in the department, and he became the agency’s
spokesperson and point man on the matter.
“It just snowballed into this gigantic thing,”
says Domingo. “We were thinking we have
to communicate the risk—so sit down, now
that we know this, what are the risks for these
children, what are we going to do, how do we
mitigate that risk, how do we take care of them
and how do we tell them? I guess initially
everybody just expected it to go smoothly.”
What they didn’t anticipate was the spark
that would ignite the furor to come: the
reports of “Dengvaxia deaths” that began bub-
bling up almost immediately. “It was all there
on social media, and then quite a few TV sta-
tions were showing autopsies—death number
one, death number two, like a countdown
every day,” says Domingo. Meanwhile, protests
proliferated.
The country’s health workers, typically
beloved figures in their communities, were
chased away as “child killers.” Parents didn’t
want their vaccinations or even basic medi-
cines like deworming pills.
The Health Department itself was strug-
gling to get information on some of the death
reports. Meanwhile, the public demanded
answers.
It was during this particularly toxic period of
confusion, fear, and outrage, with allegations,
misinformation, and unsubstantiated reports
of Dengvaxia deaths flying around the Internet,
that the Blue Ribbon Senate Committee in the
Philippines conducted a series of hearings on
the vaccine debacle in late 2017 and early 2018.One sanofi
exec caught
up in the
dengva xia
debacle says,
looking
back,
“Probably
our voice
was not
hearable or
understand-
able.”