Re-examining the measles outbreak in the Philippines: Strengthening the vaccination program through women

KEYWORDS:

• Measles
• vaccination
• outbreak
• Philippines
• women

View responses to this article:

Reply to the letter to the editor concerning reexamining the measles outbreak in the Philippines: Strengthening the vaccination program through women

This article responds to:

Another measles outbreak in the Philippines? The essentiality of a successful vaccination program and public cooperation

I am writing in response to the letter written by Cordero,¹ published in this journal on his opinion regarding the current status of measles and related vaccination programs in the Philippines.¹

The author presented the history of measles outbreaks in the Philippines and discussed how lower vaccination rates, vaccine hesitancy and suspension of immunization services due to the COVID-19 pandemic may have contributed to the ongoing difficulties in eliminating measles in the country.

Indeed, the Philippines has had a long standing problem of low vaccine coverage for measles. Data shows that there has been more than a decade of declining vaccination coverage since 2007, when vaccination with a first dose of measles-containing vaccine (MCV1) coverage peaked at 92%. By 2020 to 2022, the MCV1 coverage has significantly lowered, ranging from 57% to 72%.² The data support the persistent slow decline of vaccination rates for more than a decade, which may have been worsened by the 2018 Dengvaxia controversy and the COVID-19 pandemic.

The Department of Health (DOH) currently implements different vaccination strategies to address this persistent problem through the National Immunization Program (NIP).³ The NIP aims to vaccinate at least 95% of children and includes three strategies: (1) conducting routine immunization for infants, children and women through the Reaching Every Barangay (REB) strategy, (2) conducting Supplemental Immunization Activities (SIA) and (3) Strengthening Vaccine-Preventable Disease Surveillance.

Routine Immunizations for infants and children include provision and administration of vaccines for tuberculosis, hepatitis B, diphtheria, pertussis, tetanus, pneumonia, meningitis, polio (oral polio vaccine and inactivated polivirus vaccine), measles mumps and rubella (measles containing vaccine and measles, mumps and rubella), administered from birth up to 12 months of age.⁴ For pregnant women, tetanus and diphtheria are included in the government’s vaccination program. Additionally, the NIP offers these vaccines at no cost to the patients through the local health centers.

In order to further expand the coverage of the government’s services, the DOH conducts the REB strategy, a systematic program that conducts house to house activities in order to bring vaccination services to high-risk areas and increase vaccine coverage.⁵

Additionally, there are SIAs outside of the routine immunization program. The SIAs aim to reach those who were previously not vaccinated through routine immunizations and are targeted to certain populations. For example, the most recent SIA called “Chikiting Ligtas” was conducted for children 0 to 5 years of age, regardless of previous immunization status.⁶

The DOH also conducts surveillance strategies anchored on the World Health Organization guidelines which provides a framework for the systematic identification of cases and collection of patient samples that are sent out to the Research Institute of Tropical Medicine, which is part of the WHO laboratory network for measles surveillance⁷

Despite these efforts, it seems like the Philippines is still far from realizing the elimination of measles in the country, which makes us wonder, are there any other ways to address this long standing problem in order to prevent impending outbreaks? Is it time to reassess these programs or consider other strategies?

A study conducted by a tertiary hospital in Manila from 2016 to 2019 showed that at least 14.6% of cases are composed of children in the 0–5 months age group and 23% belong to the 6 to 8 months age group⁸ doma. Another pertinent finding presented by the study was that 38.2% of those who have not received any measles vaccine was because the child was age-ineligible, followed by unavailability of mother or caregiver (17%) and sickness of child (17%).

The data supports the need to directly address the gap of protecting children aged 0 to 8 months who are ineligible for measles vaccination. Since the earliest recommended age for measles vaccination is 9 months, those belonging to the 0 to 8 months age group currently relies on protection derived from passive immunity from maternal antibodies.

However, considering that vaccination rates have been declining for over a decade, it is possible that women who are bearing children no longer possess these protective antibodies that can provide passive immunity. Should the government and health sector look into providing recommendations for vaccination of women in the reproductive age group, similar to the US CDC recommendations?⁹

Mothers and caregivers also have other roles to fulfill in increasing vaccination rates since 17% of missed vaccinations are accounted for by lack of a mother or caregiver to bring the child to the health center. Aside from this, the mother’s education and access to maternal healthcare services seem to be associated with their children’s completion of vaccinations.⁴

I hope that the health sector considers employing and strengthening strategies targeting women by undertaking seroepidemiologic studies to understand the role of passive immunity in preventing outbreaks and also aiming to increase vaccination coverage among women of childbearing age. Enhancing prenatal and postnatal care services as well as improving patient education on immunizations may help in preventing future measles outbreaks. By empowering women, the government will also form allies in the community, which will eventually translate into the improvement of child and community health.

Acknowledgment

I would like to acknowledge the DOST S&T Fellows Program and the Philippine Council for Health Research and Development for supporting my endeavors.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.