Inside the dengue ward in the Philippines

The first line of defence: a nationwide clean-up drive, by overturning or covering containers with stagnant water. Massive fumigation campaigns are also being carried out, alongside a village-level information drive.

Dengue has claimed the lives of 622 Filipinos, with nearly 150,000 dengue infections reported until July 26, 2019. Up to 5,000 new dengue cases are reported each week and children are the hardest hit.

Health Secretary Francisco Duque told a news conference: "This (number) is high."

He declared a nationwide dengue "epidemic" as cases ballooned 98 percent in the first seven months of 2019, compared to the same period last year.

Mosquito repellent patches

Even the big pharmacies in Sorsogon, a city 600 km south of Manila, are reportedly either rationing or had altogether ran out of a popular sticker-based mosquito repellent patch, according to parents.

One parent said a pharmacy with remaining stocks no longer sells the repellent patches in boxes (at 165 pesos or $3.23 per box, which contains four pouches). Instead, the outlet retails (locally known as “tingi”) each patch for Php58 ($1.13) — and only for limited individual orders.

Many Filipino parents are fearful for their children.

“Dengue is deadly,” said a mother of three in Sorsogon. “We can’t take a chance with our children."

The government has launched a daily clean-up drive — called the "4pm habit" — to “search and destroy” mosquito breeding areas. But with the onset of the rainy season, the tropical disease may not just go away.

Experts say the dengue threat remains the whole year round in tropical countries like the Philippines.

Vaccine controversy

Worse, Filipino parents had developed an aversion for all sorts of immunisation for their children.

This followed the Dengvaxia scare, now seen as the cause of a surge in measles cases as many parents skipped MMR vaccine, a shot against measles, mumps, and rubella (German measles) for their children altogether.

Drugmaker Sanofi Pasteur insisted their vaccine against dengue works on those who are already infected by the virus to boost their immunity, though the company warned in November 2017 the vaccine did not work on those who have not yet contracted the virus.

In December 2017, Philippine health authorities altogether banned Dengvaxia, the world's first dengue vaccine.

In 2018, following autopsies on at least 22 victims, Dr Erwin Erfe, a medico-legal working for the Public Attorney's Office (PAO), pointed to Dengvaxia as the "probable" cause of the children's death.

The children were among the 830,000 who received Dengvaxia shots in 2016. Both the Department of Health and the Department of Justice later dismissed Dr Erfe's report as not having the weight of an "expert opinion."

In March, the Department of Justice (DOJ), indicted former health secretary Dr. Jenette Garin with eight counts of reckless imprudence resulting to homicide for what it said were "procedural lapses".

Dr Garin, who saw the implementation of the Php3.5-billion mass dengue immunisation drive towards final months of the Aquino administration, had been accused of practicing bad science and flouting WHO rules in her decision to carry out a mass dengue vaccination with Dengvaxia.

Her supporters, on the other hand, cry foul, saying she and her co-accused had been wrongfully prosecuted.

The credibility of Dr. Erfe, meanwhile, also took a severe blow in March 2018 as the American College of Forensic Examiners Institute where he supposedly studied had been discredited.

A journalism student working on an ACFEI project, claimed she was able to become a member after paying a $660 fee — despite having zero background in forensics.

Dr. Erfe's conclusions were also questioned by a team led by forensic pathologists from the UP-Philippine General Hospital, the country's premier health sciences institution. In their report, the UP-PGH team found no "causal association" between Dengvaxia and the 14 children who died, and whose cadavers the UP team had exhumed.

They recommended further studies to be performed by pathology experts, especially of tissue samples from the victims.

PAO chief Persida Rueda-Acosta, however, fired back: She suggested those who rejected Dr Erfe's report were on the take from Sanofi, further triggering a social media circus.

Duterte seeks expert advice

On Friday, amidst the raging controversy where science, ethics and mounting dengue death toll intertwine, President Rodrigo Duterte said his government was "open" to the lifting the Dengvaxia ban upon the advice of Filipino experts.

This has added more fuel to the social media fire.

Many argue that lifting the Dengvaxia ban would, in effect, absolve former president Benigno Aquino and his health secretary, now-Congresswoman Dr. Janette Garin, of wrongdoing.

The two, among the respondents in a case file by PAO based on Dr. Erfe's findings, are facing prosecution for their role in the nationwide innoculation involving Dengvaxia.

In contrast, neighbouring Singapore and 19 other countries allow the use of Dengvaxia, following a blood screening proving the recipient had been previously dengue-infected.

Still, Dr. Duque, Duterte's health secretary, vigorously argues that Dengvaxia does not squarely address the most vulnerable group: children ages 5 to 9.

His objection, however, implies an admission that it does work on those who had been previously infected who may not necessarily belong to the 5-9 age group.

While Dengvaxia vaccine was administered in four Philippine regions, no children in the Bicol region were innoculated with it, the Inquirer reported in 2017. 

The government-run Philippine Information Agency reported 37 dengue deaths in Bicol from January 1 till July 27, 2019 -- with 3,631 suspected dengue cases this year so far.

The death toll had gone up to 40 on Thursday, according to local media reports.

On Thursday, a mother in Sorsogon (southern-most province of Bicol) rushed one of her three children to a private hospital following a bout of fever, as the dengue ward at main government hospital is already full.

The child was confined in an isolation room, but blood test results on Friday showed the child was negative for dengue.

Meanwhile, the hallway of the private hospital itself was filling with "probable" dengue patients, the mother said.

The scene at a nearby government-run provincial hospital is no better. The medical staff and relatives attend to the dengue ward, where spill-over patients are confined to folding beds as all regular hospital beds had been taken.

Most dengue patients recover if the infection is detected and treated early.

In Sorsogon alone, provincial health authorities recorded 1,601 "probable" dengue cases, with 12 confirmed dengue-related fatalities as of August 9, Friday.