04 December 2023 | Monday | News
In this exclusive interview, BioPharma APAC engage with two distinguished experts in the field of infectious diseases and immunization: Prof. Tikki Pangestu, Co-Chair of the Asia Pacific Immunization Coalition (APIC) and Visiting Professor at the National University of Singapore, and Prof. Lulu Bravo, Paediatrician and Infectious Diseases Specialist, Professor Emeritus at the University of the Philippines Manila. Together, they shed light on the current dengue situation in Southeast Asia, factors contributing to dengue outbreaks, and comprehensive approaches to combat the rising public health threat. The interview covers topics ranging from integrated management strategies discussed at the 1st APIC Summit to the role of vaccines in dengue prevention, addressing vaccine hesitancy, and the impact of climate change on dengue transmission. The experts also share key takeaways and immediate recommendations for Southeast Asian countries to enhance their dengue management efforts. Join us in exploring the multifaceted aspects of dengue and the collaborative measures needed for a dengue-free future in the Asia-Pacific region.
Prof Lulu
Despite measures such as vector control and personal protection: The WHO states that from 2015 to 2019, dengue cases in Southeast Asia increased by 46%. In our region, key factors contributing to dengue outbreaks include:
Prof Tikki
A holistic perspective is needed to address dengue effectively. This includes vector management, communication, education and awareness, clinical management and vaccination. Most, Southeast Asian countries already have dengue management measures in place, such as disposal of all containers capable of holding water, spraying insecticide indoors, and fuming. Some countries have also successfully deployed the Wolbachia Method, which involves releasing mosquitos carrying the Wolbachia bacterium, into high-risk areas. Wolbachia bacteria in Aedes aegypti mosquitos reduce the risk of dengue transmission, as the bacteria make it more difficult for the dengue virus to replicate. In addition, the WHO also recommends personal protection measures such as wearing long sleeves and using mosquito repellent.
However, these measures are only partly effective – we need a holistic approach that starts with better surveillance of dengue areas to support potential strategies on the communication of the benefits of dengue vaccination. We should not underestimate the role of vaccination in dengue management.
Prof Lulu
Most Southeast Asian countries employ similar dengue management measures. In the Philippines, for example, the Metropolitan Manila Development Authority recommends the public to cover and clean water containers, wear protective clothing, drain and clean roof gutters, apply mosquito repllent, etc.
In Indonesia, the Ministry of Health recommends similar measures like covering and cleaning water storages, recycling unused items and wearing more clothing to minimize risk of exposure to mosquitos. In Vietnam, prevention efforts include community education campaigns, that aim to reduce mosquito breeding sites, and spraying insecticide. Proper waste management in the streets is also encouraged to eliminate mosquito breed sites.
Simple measures like education and disease awareness are very effective to ensure success in holistic dengue management. Educating around symptoms allows family members and doctors to quickly identify dengue symptoms and refer patients to hospitals for treatment. This also leads to increased surveillance in the community, as an Indonesian project has successfully shown. In addition, raising awareness of the risk factors of dengue can help to sensitize the community and enable them to support dengue prevention.
Prof Tikki
In October, the World Health Organization’s (WHO) Strategic Advisory Group of Experts (SAGE) on Immunization recommended that vaccination should be considered for introduction in settings with high dengue disease burden and high transmission intensity to maximize the public health impact and minimize any potential risk in persons who had previously not had dengue. SAGE also recommended that an introduction of the dengue vaccine should be accompanied by a well-designed communication strategy and engage the community.
This is an important signal for the region, as it underscores that vaccines are an important part of managing dengue in a holistic way to achieve zero-mortality by 2030.
In Asia, the APIC Summit on Infectious Diseases & Immunization highlighted the key intersections between science, policy and effective communications to overcome vaccine hesitancy. Vaccine development has benefitted, and will continue to benefit, from unprecedented advances in the science of vaccinology and the key role of partnerships between the public sector, industry and academia.
But at the end of the day, it is still ‘vaccination and not vaccines which saves lives’. The impact of new vaccines in the future, including much improved versions of vaccines to combat dengue globally, is closely dependent on the development of effective and sustainable public policies and strategies or implementation of these vaccines. The success of these policies will also depend on vaccine acceptance among the people. This entails overcoming fear and uncertainty surrounding ‘vaccine hesitancy’ in the age of misinformation and conspiracy theories. People’s confidence and acceptance of the overall value and benefits of vaccination underpins the ultimate success of these new vaccines as an important public health tool to reduce dengue prevalence, morbidity and mortality at the global level.
For instance, the introduction of new dengue vaccine in Indonesia and Thailand has increased discussions of dengue prevention. While the uptake of the vaccine is picking up pace, with ongoing education campaigns, we are one step closer to zero dengue deaths by 2030.
Prof Tikki
Vaccines are essential to the sustainable management of dengue. With the ongoing surge of dengue cases despite preventative measures, such as fuming, covering water containers or using mosquito repellent, it is important to take a holistic approach:
However, vaccination must be complemented with thought-through, transparent communication strategies to address and alleviate any public concerns. Trust can only be achieved through education, culturally appropriate content, and stakeholder collaboration.
Prof Lulu
Higher temperatures, increased precipitation and frequent flooding has provided an ideal breeding environment for the Aedes aegypti mosquito, the main carrier of dengue. Such changes not only increased the speed of multiplying of the Aedes aegypti mosquito, but also enables the virus to replicate faster,. As a result, if no measures are implemented dengue will impact 60 percent of the world’s population by 2080.
While there is no treatment against the dengue virus itself, many common prevention methods have been adopted to reduce the risk of dengue transmission. In the Philippines, the National Dengue Prevention and Control Program has been in place since 1993 to manage vector management, outbreak response and case diagnosis, and health promotion. Wearing long pants and long-sleeved shirts, using mosquito repellent, empty water containers and dispose of any containers that can hold water are some of the most common methods for the public to prevent dengue,.
While all preventative measures are essential, they do have limitations. Recent research has revealed that mosquitoes in several Asian countries have undergone mutations that makes them impervious to chemicals commonly used to eradicate them. Other challenges in the region include the eradication of breeding sites in areas with unreliable water supply, as residents rely on open water containers to store water. It is therefore crucial to adopt a holistic approach to that includes tailored communication strategies, vector management, and vaccination. Recently in the Philippines, many doctors, including paediatricians, have emphasized on the role of vaccines alongside other dengue management measures such as vector control and diagnosis, to achieve zero mortality by 2030.
Prof Lulu
While effective dengue management requires vector control, surveillance, education and vaccination, collaboration is essential to address the threat of dengue. The healthcare ecosystem, comprising of public and private sectors, media and the public should collaborate on disease prevention and management together. In the Philippines, the nationwide Dengue Prevention and Control Program covers surveillance, case management, diagnosis, integrated vector management, outbreak response, health promotion, advocacy, and research. In Thailand, the ING-MA campaign, which uses a virtual avatar to tell the dengue victim story, gained much public attention and increased awareness towards dengue prevention. With integrated initiatives, we are confident that we could reach zero mortality by 2030.
Prof Tikki
While collaboration is important, we should also focus on education, via proactive public communication. To complement vaccine innovation, communication on the benefits of dengue vaccines is crucial to dispel vaccine hesitancy, misconceptions, and fears. Lessons can be learned from the COVID-19 pandemic and applied to the introduction of the dengue vaccine. Evidence-based educational content is key to promote trust.
To address the threat of dengue in Indonesia, campaigns like KOBAR Lawan Dengue, National Vector Ayo3MPlus Vaksin DBD and Langkah Bersama Cegah DBD programme were launched to educate the public about the dangers of dengue and the importance of prevention, including via vaccines. In Malaysia, the Dengue Prevention Advocacy Malaysia initiated active involvement from the government, civil society, academia, private sector, media, and the community to mobilise ‘whole-of-society’ action against dengue. We are confident that zero dengue mortality by 2030 is possible through joint efforts across vector control, surveillance, education and vaccination.
Ref-
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