Staying vigilant

I am sure that some of you have experienced leaving a meeting with a hollow pit in your stomach after learning how other countries have progressed as compared to ours in concerns regarding public health, and sadly, in other key areas as well. We seem to have lost steam or stagnated, and the question that begs to be answered is: why can’t we get our act together? The topic at hand was dengue control and the challenges we face in reaching the 2030 goal of having zero dengue deaths. One panelist beautifully compressed the answer in one sentence, and it was relevant to all of the countries present in the forum: “The gap is not a knowledge problem, it’s a political, economic, and systems problem.”

One of the most enduring messages from the early days of studying public health was the value of primary prevention, which attempts to prevent the onset of the disease through strategies that include health education and health protection via policies or programs. To dissect the current local situation in full is exhausting and will dilute the intention of being battle-ready for the coming months with the resources that we have on hand. We need to capitalize on what we have, rather than what we don’t have, or what we need to understand.

The recent news that cases of dengue are considerably fewer compared to last year needs to be placed in proper context to avoid what we dread most: complacency, born from the assumption that the decrease in numbers is due entirely to the effectiveness of our existing controls. What we are seeing can be attributed to several things. First, dengue infection is cyclical, which means that cases tend to follow a predictable pattern with outbreaks recurring every three to five years. Second, we are just entering the rainy season, and a wetter climate would create more breeding grounds for mosquitoes. The existence of cases represents ongoing transmission; therefore, we need to stay vigilant.

Looking at where the Philippines stands, to our credit, there is no shortage of health education, an existing program is in place, and policies exist. What we currently lack are innovative strategies such as vector control with Wolbachia and a second-generation vaccine, which has been approved in other highly endemic countries and recommended for use in populations that are at risk, but not necessarily as part of the public immunization program. While these are complementary to risk communication, proper clinical management, and robust surveillance and are not stand-alone strategies, don’t they warrant our full attention and thorough consideration in the fight against dengue? There is data available for study and ongoing experience from countries that have licensed use of the vaccine and adopted the Wolbachia method. Listening to their challenges around cost, logistics, and public acceptance was both enlightening and grounding.

I recall a well-known pediatric infectious disease specialist who once said something about antibiotic use but, it applies just as well here: ”Don’t be the first one to try it, but remember not to be the last one either.” It is understandable to have been badly burnt by the Dengvaxia controversy and to still be searching for effective vector control, but can’t we trust that we have an adequate level of expertise and objectivity to weigh their feasibility? While it is true that not everything that is new or innovative is applicable, it still bears opening our minds to possibilities.

Be that as it may, while we wait in anticipation, we must strengthen our efforts in dealing with symptomatic infections and lower our case fatality rates, which, even if in the acceptable range, can be improved. On a community level, let us promote better health-seeking behavior in order that screening and adequate intervention can be instituted earlier. For those who are unaware, rural health centers and city health offices offer free NS1 tests, which detect dengue infection in its early acute phase. Correct and timely diagnosis can be life-saving. Oftentimes, the patients that we lose to the disease are the ones who come in too late—in irreversible shock or with complications.

Dengue can affect all ages, and while the burden of disease has been in the young in recent years, there has been a shift toward older age groups. Mortality has been seen to be greater in the elderly and those with comorbidities, regardless of age.

Within the medical community, we are trying our best to refine clinical management and help spread correct and needed information. We would like to think that we have provided enough reasons why we should make dengue a topmost priority.