We appreciate that Dans et al are in agreement on a number of our points, but there seems to be a misunderstanding as to what we suggest caused the lack of trust in the Philippines. First of all, the intention of our Comment was not to investigate the sequence of events in a more detailed timeline leading to the outrage and overall loss of public confidence in vaccines, which could be a separate paper on its own. Our comment instead aimed to show the drop in public confidence in overall vaccine importance, safety and effectiveness before and after the events related to Sanofi’s call to re-label the Dengvaxia vaccine given its potential risks to those who have never been previously exposed to dengue virus. There were clearly a mix of factors that converged to trigger the public outrage, and not a clear linear “cause-effect” which resulted in the generalized drop in confidence. Our article points to a number of factors, including Sanofi’s announcement, but related to other underlying political and social factors as well as histories, all of which contributed to the unintended consequence of lowering vaccine confidence and increasing vaccine anxiety more broadly, but again not assuming and particular cause-effect sequence of sub-events.
Many of the arguments provided by Dr. Dans to support his justification of outcry might be true, but best taken up in another venue, as this is not the subject of our Commentary.
Disclosure of potential conflicts of interest
We have no funding from Sanofi as suggested, although they are correct in pointing out that our statement on funding sources should be added: “HL is the Director of The Vaccine Confidence Project. The VCP research group has funding from the EU Innovative Medicine Initiative(IMI), ECDC, NIHR, GSK, and the King Baudouin Foundation.”