How The Philippines Is Fighting One Of The World's Worst Measles Outbreaks : Goats and Soda As health workers in the Philippines continue to try to contain the outbreak, a botched vaccination campaign against dengue is making their job harder.

The Philippines Is Fighting One Of The World's Worst Measles Outbreaks

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STEVE INSKEEP, HOST:

We've heard a lot about measles in the United States. And it's getting even worse in some other countries, including the Philippines. Over the last year and a half, the Philippines has had almost 60,000 measles cases and more than 650 people have died from a disease that is preventable by a vaccine.

NPR's Jason Beaubien reports from Manila that the outbreak is driven by several factors, but one of the most significant is fallout from a botched dengue a vaccine campaign in 2017.

JASON BEAUBIEN, BYLINE: Amelia Apang has a tough job. And two years ago, that job got a lot harder.

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BEAUBIEN: Apang is a community health worker in a remote, indigenous community two hours northwest of Manila. Cicadas buzz in the mango trees as she goes house to house in the village of Nabuklod trying to make sure that kids get all their childhood immunizations.

AMELIA APANG: (Foreign language spoken).

BEAUBIEN: She says before the 1980s, no one around here was immunized for anything. But slowly, two health workers like her, knocking on doors, badgering mothers and bringing vaccines directly to kids, vaccination rates in the community had been steadily increasing.

Then in 2017, the government suspended a high-profile dengue vaccination campaign when it became clear that the vaccine could make the disease worse in some kids. Dengue is a common mosquito borne disease in the Philippines.

The problem was that by that point, nearly a million children had already been injected with Dengvaxia. The abrupt withdrawal of Dengvaxia became a national scandal.

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SOFIA TOMACRUZ: Days after admitting risks in its dengue vaccine, French pharmaceutical companies...

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TOMACRUZ: ....Whether or not Dengvaxia causes children to develop other symptoms or worse, death due to Dengue.

Lawmakers are also set to investigate the DOH's purchase of the vaccine.

BEAUBIEN: The government filed suit against the vaccine manufacturer, blaming it for the deaths of at least 10 kids. Parents were terrified about what might happen to their kids. And Apang says, in Nabuklod, there's a local belief that any harm that comes to your children, including from a vaccine, will also come to you.

APANG: (Through interpreter) Because of the culture - because their culture means that when your child died because of vaccination, the parents will also die.

BEAUBIEN: Even though no one in this village reported any problems from the dengue vaccine, some parents pulled their children out of school and lashed out at the teachers who had organized the dengue vaccination campaign.

JOCELYN ATUN: They were threatening our teachers. Maybe because out of anger or out of emotional stress.

BEAUBIEN: Jocelyn Atun, the principal of the elementary school in the village, says she had to call in a doctor from the regional health office to meet with the irate parents.

ATUN: They are now afraid to accept any vaccine for their children. But I think, eventually, in the end, issues about this Dengvaxia will be eliminated. And eventually, they will let their children be vaccinated again.

BEAUBIEN: But in the meantime, this fear is now complicating efforts to reign in the measles outbreak. The way to contain a measles outbreak is to vaccinate, vaccinate, vaccinate. Health workers try to reach everyone who hasn't yet been immunized, particularly young kids. And revaccinate people in areas where there are large numbers of cases. Even before the Dengvaxia scandal, childhood immunization rates had been in a steady decline, dropping from 89% of kids being fully immunized a decade ago to just about 70% in 2016.

Dr. Anna Ong-Lim, who's a practicing physician and the head of the Pediatric Infectious Disease Society of the Philippines, says she's heard lots of excuses over the years from parents about why they hadn't gotten their kids vaccinated. They're too busy, they can't get off work, they can't afford transportation to the clinic.

ANNA ONG-LIM: I had never heard people say, because I was scared. I'd never encountered that in the past.

BEAUBIEN: The dengue vaccine scandal undermined trust not just in vaccines, she says, but in the Department of Health overall. In some villages, people are now rejecting deworming pills that are part of a national blitz against parasites that happens every summer.

Restoring confidence in the health system is now something the Philippines has to grapple with, and Ong-Lim says it's not exactly clear how to do that.

ONG-LIM: This measles outbreak is sad because kids have gotten sick. Lots of kids have died.

BEAUBIEN: But it also funneled millions of Filipinos back into the health system, either to get vaccinated against measles or to treat their loved ones who'd come down with the disease.

ONG-LIM: Hopefully, that becomes the first of many other positive experiences that they have. That will be the key to rebuilding trust.

BEAUBIEN: And, at least in part, that trust is starting to be rebuilt. Health workers in the Philippines have already vaccinated 5 1/2 million people against measles over the past three months. And the government has a goal of getting 20 million, or one-fifth of the entire population, inoculated by the end of September.

Jason Beaubien, NPR News, Manila.

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