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Measles Outbreak In The Philippines


While the U.S. has been grappling with a surge in measles cases, the Philippines has had one of the worst outbreaks in the world. The disease had almost been eliminated there, but since January, nearly 500 people have died. Behind the outbreak - a distrust of vaccines in a country that already has low rates of immunization. NPR's Jason Beaubien reports from Manila, where health workers and hospitals are overwhelmed.

JASON BEAUBIEN, BYLINE: The San Lazaro Hospital in Manila was getting so many measles patients a few weeks ago that they had to set up tents in the parking lot and the courtyard to house them.

FERDINAND DE GUZMAN: The ward only accommodate 50 patients.

BEAUBIEN: One five - normally?

DE GUZMAN: Five zero.

BEAUBIEN: Five zero.

DE GUZMAN: But at the height of the outbreak, 300 patients per ward.

BEAUBIEN: That's Dr. Ferdinand de Guzman, the head of family medicine at the hospital. He says there were three patients per bed in some measles wards during the peak of the crisis in February.

DE GUZMAN: We had to limit admissions for other diseases and admit measles cases.

BEAUBIEN: The most dangerous complication from measles is a type of pneumonia that, if not treated quickly with antibiotics, can be fatal. In February, the government launched a massive nationwide measles vaccination campaign. Health workers inoculated 5 1/2 million people, mostly kids. The targeted vaccination slowed the outbreak significantly, but the country continues to have hundreds of new measles cases each week.

Standing in one of the current measles wards at San Lazaro, Dr. De Guzman says the hospital is now getting between six to 10 new patients, most of them kids, every day.

DE GUZMAN: It's very typical case of measles. The rashes start from the face, then hairline, then goes down the whole body.

BEAUBIEN: An 8-year-old girl is lying on a hospital bed in a pair of blue jeans shorts and a faded T-shirt. She's so dehydrated that her lips are cracked. The nurses have hooked an IV drip up to her foot, but she rolls constantly from her fever. And they've had to tape the line securely with surgical tape. Her father is sitting in the bed with her.

DE GUZMAN: I ask her where they stayed, where they're living. They live in the cemetery.

BEAUBIEN: The father says his daughter was vaccinated against measles, but Dr. Guzman is skeptical. He says the vaccine is very effective. If she'd been vaccinated, she probably wouldn't be here.

DE GUZMAN: Most of the time, the mothers would tell us that they had their children immunized because they're afraid of being scolded because doctors usually scold the mothers. So they would say we were given the vaccine, but it turns out they didn't have the vaccine.

BEAUBIEN: He says this type of miscommunication has been an ongoing problem in getting vaccination rates up to where they need to be. But he says the bigger problem in the Philippines right now is a botched rollout of a dengue vaccine that has made some parents refuse all vaccines. In 2016, the Philippines launched a nationwide effort to immunize kids against dengue. The French pharmaceutical company Sanofi had just won approval for what health officials hoped would be a game-changing weapon against the brutal tropical disease.

But after almost a million kids were given the new dengue shot, the campaign was suddenly suspended. It had become clear that the vaccine could make some children susceptible to severe, even fatal, dengue. The government revoked the license for the vaccine and brought criminal charges against officials responsible for the campaign.

LEONILA DANS: The impact of that controversy was all over the country. And it's not just in the areas where they received the dengue vaccine.

BEAUBIEN: Professor Leonila Dans is a clinical epidemiologist at the University of the Philippines Manila. She says the dengue scandal undermined Filipinos' confidence in vaccines and has made the measles problem worse.

DANS: The administration of dengue vaccine eroded the vaccine trust, and because of this, a loss in vaccine trust, it exacerbated - I'm not saying it's the only cause - it exacerbated the problem of poor immunizations for measles.

BEAUBIEN: And back at San Lazaro, Dr. De Guzman says some parents aren't just resistant to vaccines now. They're openly hostile towards the community health workers who are trying to immunize their kids.

DE GUZMAN: They would set the dogs free to run after the ones who immunize door to door. The Tagalog term is vacunadores. They would set the dogs. They would slam the doors.

BEAUBIEN: Distrust of vaccines was not the only reason that the Philippines was ripe for a measles outbreak. Immunization rates had been falling even before the dengue fiasco. According to the Department of Health, in 2009, 89% of Filipino kids had gotten all of their childhood vaccinations. Last year, only 66% of them were considered fully immunized. Professor Dans says if there's any silver lining to this current measles outbreak, it's that many Filipinos are once again embracing the need to get their kids vaccinated. Jason Beaubien, NPR News, Manila. Transcript provided by NPR, Copyright NPR.

Jason Beaubien is NPR's Global Health and Development Correspondent on the Science Desk.
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