Health & Life Sciences Update: Philippines Dengue Vaccine Scandal

January 30-31:  2018 Health & Life Sciences Industry Mission to the Philippines

The Council is now registering executives for our Health & Life Sciences Industry Mission to Manila, the Philippines on January 30-31. The mission aims to support the national health agenda and identify opportunities for collaboration with the Department of Health and its new Secretary, Dr. Francisco Duque III. Please contact Ying Hui Tng at yhtng@usasean.org or Hai Pham at hpham@usasean.org with any questions or to express interest.

Philippines’ Dengue Vaccine Scandal

In 2016, the Philippines Department of Health (DOH) began the world’s first dengue immunization drive. The program has been suspended as of November 2017 after Sanofi Pasteur released a long-term follow-up study of dengue vaccine (Dengvaxia) that showed benefits for those who had a previous dengue infection, but an increased risk of a severe case and hospitalization for those who did not have a previous infection before inoculation. Former Health Secretary Janette Garin claims she was not warned by Sanofi that the dengue vaccine carried significant health risks for those who had not been previous infected. However, it appears recommendations urging a slow roll out for the program made by the Formulary Executive Council (FEC), an advisory group to the DOH, were not headed before the mass vaccination program was rolled out.

President Duterte stated that the Philippines will demand a refund of the 3 billion pesos paid for the vaccine and for Sanofi to set up an indemnification fund to cover the hospitalization and medical treatment for children who may have severe dengue. He also stated that a government legal team will investigate Sanofi’s accountability. Former Health Secretary Garin will face a Senate investigation in mid-December. Former Philippines President Benigno Aquino III received an invitation from the Senate blue ribbon committee to attend the next hearing on the dengue vaccine program. There is great concern that the dengue vaccine scandal will damage the population’s confidence in vaccination. As vaccine-preventable diseases are making a recurrence in Southeast Asia in part due to reduced immunization rates from consumer doubts over vaccine safety, the Philippines must allay the public’s fears over vaccination to ensure immunization rates remain high to prevent future disease outbreaks.

Diphtheria Outbreaks Spark Immunization Campaigns

On December 11, health authorities in Jakarta launched an immunization campaign against the “extraordinary” outbreak of diphtheria. Diphtheria cases have increased 42% since last year, with at least 32 deaths and over 590 cases recorded across the country. The Ministry of Health believes that declining immunity of the population due to reduced immunization levels is responsible for the outbreak. Indonesia successfully eliminated diphtheria in 1990 with a mass government-promoted immunization program that included newborn inoculation. The program was eliminated in 1998, and subsequent rumors that vaccines are dangerous or violate Islamic law have further reduced immunization rates in some communities.

On December 12, public health authorities in Bangladesh began vaccinating Rohingya children against diphtheria after a suspected outbreak killed nine refugees and infected over 700 in overcrowded camps on the Bangladesh-Myanmar border. Bangladesh authorities said they had not been anticipating an outbreak of diphtheria, as the disease was virtually eradicated in Bangladesh due to immunization programs.

ASEAN Member States Commemorate World Aids Day

In July this year, a new report by the Joint United Nations Programme on HIV/AIDS (UNAids) listed 6 ASEAN member states among the 10 countries with the most infections. Malaysia, Indonesia, the Philippines, Vietnam, Myanmar and Thailand, together with 4 other countries, accounted for more than 95 percent of all new HIV infections in the Asia-Pacific region last year. At the 28th ASEAN Summit in 2016, the 10 member states adopted the ASEAN Declaration of Commitment on HIV and AIDS, re-affirming the regional commitment to end the AIDS epidemic in ASEAN by 2030. Several ASEAN states have recently followed up on that declaration and commitment, especially as the global community commemorated World AIDS Day on December 1.

Some states have launched new regulations and initiatives, such as the Philippines, where the House of Representatives unanimously approved the Philippine HIV and AIDS Policy Act. The bill seeks to streamline the delivery of treatment, care and support services through the delineation of responsibilities in HIV/AIDS response between national and local agencies. In Vietnam, Deputy Prime Minister Vu Duc Dam launched the methadone treatment management system to provide easier access to addiction treatment. Other member states have expressed the need for non-discrimination in AIDS treatment, such as Brunei, Malaysia, Myanmar and Thailand, in conjunction with the World AIDS Day theme of “My Health, My Right”. While most ASEAN member states have successfully reduced the incidence of new HIV cases, progress varies between countries. The Philippines has even experienced a 140% surge in new HIV cases from 2010 to 2016. Thus, regional cooperation, knowledge-sharing and capacity-building remain critical in “getting to zero” - zero new HIV infections, zero discrimination and zero AIDS-related deaths.

Singapore’s Healthcare Expenditures Continues to Rise

Finance Minister Heng Swee Keat expects government expenditures on healthcare to “rise quite sharply” in the next three to five years and beyond. He predicted that there will be a steep increase to the tune of “at least $3 billion” by 2020. This is a continuation of the trend of rising expenditures over the past few years, with total spending having almost tripled since 2011. The budget allocation to health has also accordingly increased from $4 billion in 2010 to $10 billion this year. Healthcare expenditures are expected to further increase by 9.6% in 2017 because of quality enhancement for healthcare professionals and growth in patient subsidies. The latter is a main contributor to costs given that MediShield was replaced in 2015 by MediShield Life in order to extend universal medical coverage to all Singaporean citizens and Permanent Residents. In addition, ElderShield, which provides basic financial protection for long-term care, is expected to drive increases in healthcare costs in the near future, especially in 2030, when the effects of a rapidly ageing population begin to set in. Notably, while 450,000 senior citizens in Singapore benefit from a raft of subsidies under the Pioneer Generation Package, there will be 1 million Singaporeans who will reach retirement age in 10 to 20 years.

The impact of an ageing population has long been on the government’s agenda. Deputy Prime Minister Tharman Shanmugaratnam, as Finance Minister in 2015, had projected healthcare spending to triple to $12 billion in 2020, which is not far off from Minister Heng’s predictions. As such, cost-effectiveness has become a buzzword in healthcare in Singapore as the government seeks to prevent costs from spiralling upwards. In 2016, the government established the Agency for Care Effectiveness (Ace), which seeks to ensure that high-cost treatments and technologies deliver outcomes commensurate with their costs. Its mandate also includes the promotion of cost management while maintaining quality care. The Ministry of Health is also adopting a focus on community care in order to reduce burdens on acute hospitals. This is all part of the Government’s efforts to “do all it can” to keep costs low, in the words of Minister of State for Health Chee Hong Tat.

In early November, Singapore's Parliament passed amendments to the Sale of Food Act (more from the Council here), which allows the Agri-Food and Veterinary Authority (AVA) to specify what can or must be contained in food labels. The AVA is now gathering feedback for its proposed amendments to the Food Regulations, namely to ban certain health and nutrition ("premiumisation") claims, as well as images that idealize formula over breast milk on formula labels. It is also seeking to mandate the inclusion of a statement on the importance of breastfeeding in alignment with the "Whole of Government" efforts to promote breast milk. These rules would only apply to stage one and two formulas for infants up to 12 months old, as children over a year old do not require formula. The draft amendments are available here. The Council responded to the public consultation on the amendments by submitting a letter to the AVA, explaining concerns that the amendments might stifle market entry without increasing consumer awareness or price competition. We recommend AVA to partner with industry to develop appropriate guidelines and avoid blanket restrictions. Please contact Ying Hui Tng at yhtng@usasean.org if you have questions. 

Call to realise AIDS-free generation in Brunei Borneo Bulletin Online 4th Dec 2017
A MESSAGE from Minister of Health Dato Paduka Dr Haji Md Isham bin Jaafar in conjunction with World Aids Day 2017 World AIDS Day is commemorated every December 1, and this year it is an opportunity for us to take stock of our progress in reaching the United Nations (UN) Sustainable Development Goal of ending the AIDS epidemic as a public health threat and help us move closer to the goal of an AIDS-free generation.

Brunei hosts special meeting of Asean PPWG Borneo Bulletin Online 1st Dec 2017
THE Ministry of Health of Brunei Darussalam hosted the Special Meeting of the Heads of Delegation of the Asean Pharmaceutical Product Working Group (PPWG) this year. The meeting was held for from November 29-30, at Al-‘Afiah Hall, MoH, Bandar Seri Begawan.

Gains made in fight against TB Phnom Penh Post 6th Dec 2017
Cambodian health officials in a statement on Monday lauded the country’s success in cutting back the tuberculosis mortality rate by 55 percent in 16 years – a triumph highlighted in a recent WHO report, which also found a $19 million funding gap for TB in the country this year. While the Ministry of Health’s National Center for Tuberculosis and Leprosy Control, in a statement, attributed the gains mainly to the commitment of the Cambodian government, the report shows that the government only contributed $3.5 million to the national TB budget for 2017, less than 10 percent of the total $37 million budget. International donors put forward $14 million, leaving the rest unfunded.

Diphtheria deaths in Indonesia spark immunization campaign ABC News 11th Dec 2017
Indonesia is immunizing millions of children and teenagers against diphtheria after the disease killed 38 people, mostly children, since January. Children in school uniforms and toddlers clinging to their parents received shots at a high school in Indonesia's capital, Jakarta, on the first day of the campaign Monday. Diphtheria is a bacterial disease that can cause breathing difficulties, heart failure and paralysis. It was more or less eradicated in Indonesia in the 1990s but health officials say it has re-emerged in the past four years because immunization rates have dropped, partly reflecting fears about vaccines.

Public health guaranteed by state Jakarta Post 9th Dec 2017
As the National Health Insurance-Healthy Indonesia Card (JKN-KIS) program nears the end of its fourth year, Indonesians are beginning to notice the presence of the state more. The implementation of the JKN-KIS program has had a number of positive impacts including easy access to health services, economic growth, job creation and preventing people falling into debt because of high medical costs. “People’s expense for the JKN-KIS premium can be considered an investment because the JKN-KIS is proven able to protect families from the throes of poverty because of the high cost of medicine and health services,” said President Director of the Healthcare and Social Security Agency (BPJS Kesehatan), Fachmi Idris during a discussion at the FMB9 gathering held at the Communications and Information Ministry office on Dec. 7.

Indonesia fights 'extraordinary' diphtheria outbreak that has killed 32 Reuters 7th Dec 2017
Indonesian health authorities will launch an immunization drive next week to contain a sharp rise in cases of diphtheria, which has killed at least 32 people, including many children, in the world’s fourth most populous country this year. The health ministry said at least 591 cases had been reported since January, a 42 percent increase from last year, and called the outbreak an “extraordinary event”. “We have seen an acceleration in cases compared to last year ... We are implementing an immunization program to prevent a pandemic,” said Dr Mohamad Subuh, director general of disease prevention and control, at the ministry.

Tobacco tax to cover public healthcare deficit: Ministry The Jakarta Post 8th Dec 2017
Finance Deputy Minister Mardiasmo has said the government would start setting aside revenues from the tobacco excise duty next year to fund the Healthcare and Social Security Agency (BPJS Kesehatan), which has suffered a deficit since the program kicked off in 2013.

The Elders Urge Indonesia To Take Bold Steps To Accelerate Progress Towards UHC Look to the Stars 6th Dec 2017
The Elders concluded a two-day visit to Indonesia with a call for the government to take bolder fiscal, political and social measures to accelerate progress towards Universal Health Coverage (UHC), building on impressive achievements in recent years. Gro Harlem Brundtland and Ernesto Zedillo visited the Indonesian capital Jakarta on 28-29 November for meetings with President Joko Widodo (Jokowi) at the Presidential Palace, accompanied by Foreign Minister Retno Marsudi, Health Minister Nila Moeloek and Finance Minister Sri Mulyani.

Malaysia’s child malnutrition crisis needs urgent action Malaysiakini 2nd Dec 2017
“Child under-nutrition” and “in a country like Malaysia” are words that shouldn’t belong in a sentence. And so evidence of childhood stunting due to chronic undernutrition is a worrisome piece of news in our country, which claims to enjoy rapid economic growth, development and improvements in socioeconomic status and health care system. More so as just days back we were shocked by a poll, which indicated that 15 percent of Malaysians were forced to skip meals to ensure their survival.

42 per cent drop in new HIV cases - Health Ministry NST Online 1st Dec 2017
The Health ministry recorded 95,470 cases of HIV in the country from 1986 to September this year with the number of new cases showing a decrease of 42 per cent, from 5,830 cases in 2006 to 3,397 cases last year. This year, 3,014 new cases were reported until September. Health Minister Datuk Seri Dr S. Subramaniam said Malaysia has shown great progress in combating HIV/ AIDS since it was first detected in the country 31 years ago with new cases and AIDS-related deaths showing a downward trend.

Pharmaceutical Sector in Malaysia under Market Review Global Compliance News 12th Dec 2017
The Malaysian Competition Commission (“MyCC“) has commissioned Third World Network (“TWN“), an independent non-profit international research and advocacy organisation, to conduct a market review on the pharmaceutical sector in Malaysia (the “Review“). The market review is being conducted by the MyCC pursuant to powers under Chapter 3 of the Competition Act 2010 (“MCA“). Pharmaceutical companies and other relevant stakeholders should take this opportunity to provide feedback especially if there are any discrepancies or inaccuracies in the draft report. MyCC has set a deadline of 9 am on 7 December 2017 for the submission of feedback. The finalised report, which will be issued after the public feedback sessions, may ultimately be used by the MyCC as the basis for its analysis and findings of anti-competitive practices by pharmaceutical companies in Malaysia.

Discovery of fake baby formula in Johor triggers widespread concern NST Online 11th Dec 2017
The discovery of fake baby formula being sold in Johor has sparked consternation among various quarters. Concerns have since been raised on whether the problem is limited to just the southern state, and how to best tackle it. The scandal came to light last Thursday when the Johor Domestic Trade, Cooperatives and Consumerism Ministry seized 210 boxes of fake baby milk formula, worth about RM42,000, from five supermarkets and pharmacies in the state. The five premises were located in Iskandar Puteri, Mutiara Rini, Taman Orkid, Nusa Bestari and Taman Daya. The raids were conducted after the ministry's enforcement unit had conducted surveillance for the past four months.

Ministry must oversee organ transplants, doctors told Malay Mail Online 7th Dec 2017
Health Minister Datuk Seri Dr S.Subramaniam said the number of pledged organs is high but the supply does not meet demand because of weaknesses in the current system. — Bernama picPUTRAJAYA, Dec 7 — Doctors who facilitate organ transplants with their overseas counterparts without Health Ministry knowledge are committing an illegal act, the minister, Datuk Seri Dr S. Subramaniam, said. He said the ministry is looking into ways to strengthen the laws, including the Human Tissue Act 1974, to prevent such abuses.

Pharmaniaga invests RM100m on halal, affordable vaccines NST Online 5th Dec 2017
KUALA LUMPUR: Pharmaniaga Bhd is investing RM100 million in the next five years to make halal and affordable vaccines for local use and export.

Myanmar Pledges to Fight Discrimination in HIV Prevention The Irrawaddy 1st Dec 2017
Myanmar has pledged to implement policies to fight discriminations in HIV prevention as it aims to end AIDS as a public health threat by 2030. At a commemorating ceremony for World AIDS Day at the University of Nursing in Yangon on Friday, Dr. Kyaw Zin Thant, director-general of the Ministry of Health and Sports’ department of medical research, told the audience that the ministry believes it will achieve the goal of ending the epidemic by 2030. “To be able to do [HIV] prevention activities more effectively, we will set and supplement procedures and policies to eliminate major obstacles such as discriminations,” the director-general said.

Japanese encephalitis vaccination campaign begins in communities The Myanmar Times 12th Dec 2017
The Ministry of Health and Sports on Monday launched the nationwide community-based Japanese encephalitis vaccination programme aimed at immunising millions of children from the debilitating mosquito-borne disease.

Philippines to probe dengue vaccine scare BBC News 4th Dec 2017
The Philippines has launched an investigation into the immunisation of 730,000 children with a dengue vaccine that could pose health risks. Last week French drug company Sanofi announced its vaccine could worsen the potentially deadly disease in people not previously infected. The public immunisation programme was suspended on Friday. Dengue fever affects more than 400 million people each year around the world.

House OKs bill on HIV/AIDS policy PhilStar 4th Dec 2017
The House of Representatives has approved on third and final reading the bill seeking to strengthen the fight against human immunodeficiency virus and acquired immune deficiency syndrome in the country. Voting 188-0, members of the House unanimously approved House Bill 6617 or the "Philippine HIV and AIDS Policy Act." The proposed measure seeks to deliver treatment, care and support services to persons living with HIV in accordance with approaches upholding principles of human rights, gender-responsiveness and age-appropriateness.

SingHealth and A*Star tie up to tackle prevalent diseases in Asia The Straits Times 8th Dec 2017
Diabetes patients may not have to go to the clinic to have their blood sugar levels checked in future, as they could get this done at home through remote technology - another arsenal in the war against diabetes. Such is the concept of the diabetes clinic of the future, an approach which will be adopted at SingHealth's Diabetes and Metabolism Centre at Singapore General Hospital. (SGH)

Fee guide helps treat health costs The Straits Times 7th Dec 2017
How much should an orthopaedic surgeon charge for a simple knee replacement? In the private sector today, one in four charges more than $13,215, and a similar number peg fees at less than $7,747. This is just the surgeon's fee and does not include the cost of the artificial knee, use of the facility or what the anaesthetist is paid. Is a surgeon whose fee is double that of another doubly good? Is he charging what the market can bear? Or does his fee depend on whether a patient has an "insurance rider", which means the patient's insurance pays his full medical bill with no co-payment on his part?

Calls for stronger partnership between public, private healthcare providers Channel NewsAsia 12th Dec 2017
The Ministry of Health is looking for more opportunities for public and private healthcare providers to work together as Singapore's healthcare needs are set to grow.

Move to rein in hype over formula milk The Straits Times 10th Dec 2017
Infant milk powder labels often tout a host of ingredients that ostensibly boost brain and eye development as well as a myriad of other benefits. But they may have to become much plainer if such claims, and even more innocuous ones, like "Calcium helps to build strong bones", are outlawed. Ms Seah Peik Ching, the Agri-Food and Veterinary Authority's (AVA) regulatory administration group deputy director, told The Sunday Times: "Under our regulations, there's a list of nutrient composition requirements where all the products need to contain these basic nutrients, so there's no reason for (brands) to highlight them." The AVA is gathering feedback for its proposal to ban health and certain nutrition claims, as well as images that idealise formula over breast milk on labels.

Govt spending on healthcare to rise sharply in next 3-5 years: Heng Swee Keat The Straits Times 6th Dec 2017
Finance Minister Heng Swee Keat expects government expenditure on healthcare to "rise quite sharply" in the next three to five years and beyond. Speaking to the media after a tour of Changi General Hospital and Saint Andrew's Community Hospital on Wednesday (Dec 6), Mr Heng said he predicts that by 2020, government spending will go up by "at least $3 billion". In this year's Budget, the Ministry of Health (MOH) received $10 billion, up from the $4 billion health received in 2010.

Thailand's 'war on sugar' aims to slim people and fatten coffers- Nikkei Asian Review 11th Dec 2017
Faced with rising obesity rates, as well as health care costs that are ballooning nearly as fast as people's waistlines, the Thai government has introduced an excise tax aimed at nudging beverage makers into making less sugary drinks.

Govt urged to permit needle exchanges Bangkok Post 5th Dec 2017
The Aids Access Foundation has urged public health authorities to stand firm on a plan to curb spiralling HIV contraction rates by giving out clean needles and syringes to drug addicts despite the Council of State considering it a violation of the law. Foundation director Nimit Thien-udom said Monday he was worried after learning the Public Health Ministry's Bureau of Aids, Tuberculosis and Sexual Transmitted Infections had said the programme might encourage drug-taking and therefore violate drugs laws. "The bureau should not let this view [on law violation] sway it off track," Mr Nimit said, insisting that making sure intravenous drug users receive sterile needles has long been regarded as sensible public policy in many countries.

Health ministry sets lofty HIV reduction goal Bangkok Post 2nd Dec 2017
Sixteen people test positive for HIV/Aids every day, and the Public Health Ministry wants to cut that number to three per day by 2030, while reducing fatalities by 70%. The country now has more than 1.5 million registered HIV/Aids-infected patients, accounting for 2.3% of the population, according to statistics for 2015 from the ministry's Bureau of Epidemiology. This year alone, it said, there were 5,801 new reported cases, averaging 16 per day. The ministry aims to reduce the rate of infection to 1,000 cases a year by 2030, or three new patients per day. Another target is to lower the fatality rate to 4,000 a year, from 15,000 at present.

Patients paying more for ‘free’ medical equipment Vietnam News 11th Dec 2017
Dương Đức Tuấn, director of the Centre for Health Insurance Appraisal and Multi-level Payments in the North, under Việt Nam Social Insurance, tells Vietnamplus that “socialisation” of the healthcare sector has not proven to be very friendly to patients. What do you think of the Government’s policy to mobilise resources from the whole society to develop the healthcare sector? I appreciate the policy. It has helped the healthcare sector acquire more advanced technology and raise the quality of its services. The new policy looks for financing of social services from all sectors so as to address the problem of funding shortage experienced by in public healthcare establishments in many province and cities.

Vietnam aims to treat HIV, halt drug rise Vietnam Net 10th Dec 2017
Vietnam must step up efforts to ensure 90 percent of HIV-infected people will receive sustained antiretroviral (ARV) therapy by 2020, in line with the international UN target, Deputy Prime Minister Vu Duc Dam said at a meeting of  National Committee for AIDS, Prostitution and Drug Prevention on December 8. Currently, about 50 percent of Vietnam’s HIV-infected people are being treated with ARV. The Health Ministry, Financial Ministry and Vietnam Social Security must work together to ensure enough ARV drugs are available. State and local budgets must be generous enough to cover the drug supply, he said.

Vietnamese mothers, children get good healthcare Borneo Bulletin Online 6th Dec 2017
The 26-year-old ethnic Thai woman has given birth to two healthy daughters with minimum fuss, which in itself might not be something extraordinary, but considering that she and her husband are, in her own words, “floating on rivers all day to earn our living,” she has reason to be thankful. It is thanks to the careful support and supervision of local medical workers during her pregnancy and delivery that Tan was able to safely deliver her two children. The native of the central province of Thanh Hoa used to be worried about many women in her community and hometown give birth at home, exposing themselves to a lot of risk.

Deputy PM warns against complacency in combating HIV VOV 8th Dec 2017
There is no room for complacency in the fight against HIV, though the number of new carriers is showing a downward trend, has said Deputy Prime Minister Vu Duc Dam. Dam, who chairs the National Committee for AIDS, Drug, and Prostitution Prevention and Control, addressed a national online conference in Hanoi on December 8 to review AIDS prevention and control this year and devise tasks for next year. “We should stay aggressive in combating HIV. We shouldn’t be lax, but patient. There are three targets called 90-90-90. 90% of all people living with HIV will know their HIV status. 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.

Ministry of Health clarifies health insurance VOV 8th Dec 2017
Private hospitals that have signed health-insurance contracts with the Vietnam Social Security (VSS) will continue the contracts next year. However, private healthcare facilities must now have their classifications authorised by the Ministry of Health. Le Van Phuc, deputy director of VSI’s Department for Health Insurance Policy said that VSS did not order provincial social insurance agencies to end their existing healthcare contracts with private healthcare facilities. The agency requested private healthcare facilities to add health ministry decisions on the levels of service and technical classifications of their facilities. He said this information would serve as a foundation to identify health-insurance payment levels according to the Health Insurance Law.

Innovation in medical-ed highlighted Vietnamnews 4th Dec 2017
As Việt Nam and its Southeast Asian neighbours integrate into the ASEAN block, which will require the free movement of health care workers and patients, there is an urgent need to update the country’s system of medical education including university curricula and approaches to teaching and learning, according to medical professors. Speaking at a two-day conference that ended on December 3 in HCM City, Professor David Gordon, president of the World Federation for Medical Education, said that a training programme should include not only basic science and clinical medicine, but also teaching ethics and medical law, which are clearly not optional.