Secretary Duque issues directives to regions and hospitals to prioritize the needs of vaccinated children

To formulate policy and set guidelines on addressing the issues surrounding the rollout of Dengvaxia vaccine, the Department of Health under the leadership of Secretary Francisco T. Duque III held a command conference bringing together the Department’s Executive Committee, Regional Directors, Hospital Chiefs and program managers, experts from the Research Institute for Tropical Medicine and the Food and Drug Administration, members of the Expert Panel on Dengvaxia, and the World Health Organization Representative Office in the Philippines.

Chaired by DOH Chief-of-Staff Undersecretary Mario Villaverde, the high-level conference provided a valuable opportunity for the top DOH officials from all over the country to update themselves on the issues and concerns associated with Dengvaxia, share the best practices and challenges faced by affected regions, and discuss guidelines prepared by the Task Force convened by the Secretary of Health in December of last year.

Secretary Duque closed the conference by issuing a set of directives to be immediately pursued and enforced by the entire DOH which will be subject to amendments as the need arises during their implementation.

 

SECRETARY’S DIRECTIVES

 

“Considering all the discussions, resolutions, and other outputs of this Joint Executive Committee Meeting and Command Conference on Dengvaxia, I, the Secretary of Health, hereby direct the following:

The Dengue Task Force:
(a) has approved in principle three interim guidelines to address the issues and concerns as a result of the Dengue vaccination initiative subject to the final review of the Expert Panel:

1. Surveillance – instituting a mechanism of enhanced surveillance over the next five years initially covering admitted cases following immunization, and then expanding to a reporting system covering outpatient settings through health centers, clinics, LGUs, and regional offices.
2. Dengue case management and patient referral – emphasizing on the early diagnosis and proper case management of Dengue; and, establishing a network of both public and private hospitals which can provide services to patients.
3. Risk communication – giving correct information to allay unfounded fears based on misconceptions; provide basic information on Dengue and the 4S approach to prevent infection; constantly updating the public on DOH’s efforts in addressing the concerns of vaccinees; and, designating public health advocates at the regional offices and hospitals who can help patients navigate through the health system so that their health needs are adequately and expeditiously addressed.

These interim guidelines are immediately effective once approved subject to specific period of implementation and revisions as we learn more from our experience.

(b) shall review the policy and processes on the introduction of new antigens in our national immunization program;

(c) shall study other proposed guidelines to enhance the delivery of public health vaccination programs;

1. Financing and reimbursement of hospitalized cases of adverse events following immunization using PhilHealth, the Medical Assistance Program, and other possible financing sources. For the regional offices to negotiate with private providers not to charge beyond the PhilHealth case rates.
2. Vaccine Injury Compensation;
3. Autopsy of alleged deaths following Dengvaxia immunization; and,
4. Laboratory diagnosis and confirmatory test.

(d) shall pursue possible legislative reforms that emerged from this issue by:

1. Strengthening the mandate of RITM to be an independent research arm on infectious diseases, not influenced by the industry; and,
2. Strengthening the independence of FDA in exercising its mandate to protect the public in regulating health products.

(e) shall be constantly vigilant about possible/emerging concerns that may arise from this issue.

In relation to this, I would also like to reiterate my request to the Expert Panel to give guidance to the DOH on determining the causality of adverse events specifically following Dengue vaccine immunization.

The Regional Directors are to do the following:

(a) give a human face to the efforts of the DOH by reaching out to the parents and patients, and to show compassion particularly to the bereaved parents and relatives;

(b) document, sustain, and institutionalize best practices that have been developed in the course of addressing the crisis in their respective areas; and,

(c) lead the operationalization of policies in their covered provinces/cities and provide feedback.

The Concerned DOH Hospitals are to:

1. extend their utmost service to appropriately manage the health and psychosocial concerns of Dengvaxia vaccinees;
2. raise the level of scientific and administrative discussion among personnel and officials to further enhance the capabilities of their respective units in dealing with such crisis.

For the future directions of the Department on public health programs:

1. The design and implementation of public health programs should consider the universal principles of respect for persons, beneficence, nonmaleficence, and justice. (b) Exercise of prudence in introducing new health technologies, noting that they should be based on rigorous scientific and economic evaluation, considering other factors when implementing the program in the real world.

I would like to extend my heartfelt gratitude to everyone present today. Your participation and cooperation are vital in addressing these issues on Dengvaxia. I anticipate with optimism the same degree of participation and cooperation in operationalizing these directives in the days to come. With this, I give my full trust and confidence in the decisions you will make as well as the execution of such directives in your own respective offices.”