So how many children died as a result of Dengvaxia? That remains a
controversial question. Sanofi’s answer: “There is no clinical evidence that
any reported fatalities were causally related to vaccination.”
While the PAO has been publicizing every “Dengvaxia” death and
autopsy, a DOH-sanctioned task force has been quietly reviewing cases
of Dengvaxia recipients who have died. Of the 891,295 individuals vacci-
nated in the government program, there had been 315 deaths as of Oct. 25,
according to the DOH. And 41 of those cases were due to dengue. (There
have been a total of 6,171 cases of dengue and 124 severe dengue among
those vaccinated.) While the work is ongoing, DOH says that at present it
has not directly linked any deaths to Dengvaxia itself, as the PAO asserts,
or to “severe” cases of dengue precipitated by the vaccine, as Sanofi warned
about. As for the 41 deaths due to dengue, there is currently no clear way to
determine if they were related to the immune-enhancement effect accord-
ing to the DOH and the WHO.
As for the number of people who may die from dengue without the pro-
tection of a vaccine, well, that too is unknowable for now—but the number
is likely to be many, many times larger.
“You’ve got a vaccine against this disease, which has an enormous public
health burden. The population benefit is clear, but there are a small num-
ber of people who would be exposed to more severe disease,” says Jeremy
Farrar, the director of the Wellcome Trust, who cochaired the SAGE com-
mittee that recommended Dengvaxia’s use in 2016.
“There are people that argue the public health benefits are the most im-
portant issue, and the numbers are hugely in favor of vaccination,” he adds.
That said, many people, Farrar included, believe there is an obligation
to test prior to vaccination if it’s possible to identify those at risk. To not,
many point out, is a violation of medicine’s do-no-harm principle.
The seemingly easy answer is to give Dengvaxia only to those who are
not at risk of harm, as in those who have suffered a previous dengue infec-
tion. This is not an easy thing to do, though.
An estimated three-fourths of dengue infections are asymptomatic—mean-
ing the majority of people who get dengue will never know they had it. There
are tests that can tell you, but they are relatively expensive, not sufficiently
accurate (they can’t reliably distinguish Zika from dengue, for instance), and
can take labs days or weeks to process. That’s not a feasible solution for a
government that hopes to protect its population against an epidemic.
And that’s precisely what the Philippines’ dengue outbreak became
this August. The escalation forced a short-lived and somewhat awkward
national conversation: Was it time to bring Dengvaxia back?
Many in the medical community thought so; the vaccine could be used
responsibly and benefit many in the private market. There also seemed to
be demand—a smattering of Filipino celebrities and politicians had made
news by visiting Singapore and Thailand for dengue inoculations.
Despite the cases the government had filed over Dengvaxia-related
deaths, President Rodrigo Duterte expressed openness to the possibility.
Though he had been silent on most Dengvaxia matters, he told reporters
he trusted that local experts knew what to do.
The Health Department didn’t reinstate Dengvaxia’s license, but in mid-
August it said Sanofi Pasteur could reapply, which the company is in the pro-
cess of doing. Jean-Antoine Zinsou, Sanofi Pasteur’s general manager in the
Philippines, expresses confidence that the product will be back eventually.
This year’s epidemic, meanwhile, has proved worse than any before in
the country, with some 360,000 cases and 1,373 deaths through Septem-
ber. Among the infected was Duterte’s teenage daughter Kitty, who had
reportedly received Dengvaxia. She was hospitalized in October but made a
full recovery.
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