EPIDEMIC
OF FE AR
115
FORTUNE.COM // DECEMBER 2019
Dengvaxia.
The global health and dengue research
communities were, for all the right reasons,
rooting for it. For decades, they had watched
the virus creep around the world; they had
seen old-school methods of mosquito control
fail; they had seen the body count grow. The
Dengue Vaccine Initiative (DVI), a collabo-
ration of scientists, had worked to identify
clinical trial sites and develop surveillance
programs for viral outbreaks. Any vaccine,
the DVI estimated, would require up to an
eye-popping 3.5 billion doses in the first five
years to meet demand. The WHO, meanwhile,
wrote guidelines on how to design a dengue
vaccine trial. And together the WHO and DVI
hosted regulators from seven dengue-prone
countries (the Philippines among them) for a
technical consultation on the Dengvaxia data.
When Thomas Triomphe arrived as Sanofi
Pasteur’s new head of Asia-Pacific in January
2015, one of his top concerns about Dengvaxia
was simple: Would there be enough? His
territory was vast, 19 countries from India to
Australia, and just about every one of them
was a potential market for the company’s new
dengue vaccine.
The Philippines was an obvious place to
launch the vaccine. The virus had become a
year-round killer there and was an estimated
$345 million annual drag on the economy.
That year, 2015, was an especially costly one,
with 200,000 reported cases of the disease
and 600 deaths. And Filipinos were frustrated
that the government seemed to do little to
stop it—with each epidemic “viewed by the
public as a symbol of how the government is
really taking care of its people,” says Julius
Lecciones, the executive director of the Philip-
pine Children’s Medical Center, which gets the
country’s most severe cases involving children.
Beyond warning the public to stay vigilant,
however, there wasn’t a lot the government
could do. Local officials could make a show
of spraying against mosquitoes, but that was
merely “political fogging,” as some dengue
experts call it.
As 2015 came to a close, the Filipino
government saw its chance to act. There were
unused funds in the budget that needed to
be spent by year’s end. Some $70 million was
quickly allocated for Dengvaxia in December.
That same month, the Philippines joined Bra-
zil and Mexico in approving the drug.
The government moved fast to imple-
ment its mass vaccination program—a pilot
targeting 9-year-olds in three regions of the
Philippines. The nation’s school-based dengue
immunization effort began on April 4, 2016,
the first day of summer break.
That struck some as odd timing. But the
campaign’s launch at a grade school in Manila
drew a large crowd and some VIP attendees.
The president of Sanofi Pasteur’s Dengue
Company, Guillaume LeRoy, was there as was
Janette Garin, then the Philippine’s health
secretary and a trained physician, who jabbed
one of the first little arms with an inaugural
syringe. Later that day, Garin, who is now a
congresswoman, showed up at another launch
event in a province outside Manila, this time
with then-President Benigno Aquino III. They
wore yellow shirts, the color of the Liberal
Party, and before a large, cheering crowd, Garin
administered a shot, and Aquino gave a speech.
The optics led some to other questions about
timing: A general election was a month away.
Aquino had served his maximum term and was
not up for reelection, but some read the staging
as a campaign event—the Liberal Party saving
the nation from a miserable disease.“You’ve got to monitor this closely”
THOUGH DENGVAXIA was now on the market in
the Philippines, a debate continued among
researchers about the effectiveness of the vac-
cine and how it should be administered.
In July 2015, a study had been published
in the New England Journal of Medicine that
caused dengue experts to reconsider the results
of Dengvaxia’s clinical trials. Drawing on three
years of follow-up data from Phase IIb and III
trials, the analysis validated much of Sanofi’s
optimism. But it also raised a red flag.
The banner headline: The vaccine worked—
not for everyone, but for many. It appeared to
work to some degree against all four strains
of dengue (though more effectively against
types 3 and 4), and it seemed to work both
in children who had previously been infected
with dengue and those who had not (though
poorly in the latter).
Among children ages 2 to 16, there was a
60% reduction in dengue cases during the
first 25 months following vaccination. That
rate was higher—nearly 66%—for children
age 9 and above. Incidents of hospitalization
and cases of severe dengue were significantly
reduced in the vaccinated population, though
the data did indicate a curious, if clear,
trend—one, moreover, that only emerged in
the third year of the study: Very young kids
who had been vaccinated and did get dengue“half of the
world lives
at daily risk
of being
infec ted
with dengue,”
says one
expert. “But
we don’t
know why
some people
get sick and
some people
don’ t.”