poor dr. ona! indeed.  it would seem that the health secretary has been prejudged over his decision to procure the cheaper of two pneumonia vaccines when, as boo chanco explains, it was apparently a professional decision grounded on what makes the most sense, given cost and need.  dr. ona deserves a fair hearing.  the same is true with regard to the use of malaria herbal meds as treatment for dengue.

Dengue, Deaths, Drugs and Politics
By Godofredo U. Stuart M.D.

ActRx TriAct®—an herbal based treatment that combines artemether and artesunate, both used to treat malaria, and promoted as a new breakthrough treatment for Dengue— should be most welcome news, especially as a painless two-day regimen sprayed under the tongue.

Instead of celebrating a potentially life-saving treatment—for a disease that has, to date, no specific drug therapy available—Health Secretary Ona is under scrutiny for authorizing the breakthrough drug for use in dengue.

WHO Dr. Julie Hall warned the DOH against using the Artemisinin combination treatment—mainstay treatment for falcifarum malaria saving thousands of lives each year—for fear of development of resistant falcifarum malaria. She’s also concerned dengue and malaria are coendemic in some areas, and use of artemisinin in those areas could cause an emergence of malaria resistance.

Here are some numbers. In 2012, there were 187,031 cases with 921 deaths. In 2013, 204,906 cases with 660 deaths. This year, “some 24,900 cases have resulted in (at least) 100 deaths, or a ration of one fatality for every 249 cases,” Ona said. 

Malaria, on the other hand, has significantly declined since the mid-2000s, with an 83% reduction from 2005 to 2013. and deaths down from 150 in 2005 to 12 last year. A DOH report reassuringly headlines: The Philippines is on the verge of attaining malaria-free status.

And as important, of 53 known provinces endemic for the disease, 27 have already been declared malaria-free (Cavite Batangas, Marinduque, Catanduanes, Albay, Masbate, Sorsogon, Camarines Sur, Iloilo, Aklan, Capiz, Guimaras, Bohol, Cebu, Siquijor, Western Samar, Eastern Samar, Northern Samar, Northern and Southern Leyte, Biliran, Camiguin, Surigao del Norte, Benguet, Romblon, Batanes, and Dinagat Islands)—while dengue is earning epidemic status.

In 2012, in a regional surveillance report by the DOH, Cebu City topped the list with 3,081 cases of dengue with 12 deaths. Cebu is one of the 27 provinces that has been declared malaria-free. Iloilo, also designated malaria-free, reported a 71% surge in dengue cases. Aklan, also malaria-free, has seen an increase of 75%, up 1,340 cases compared to 763 last year. There are deaths buried in those numbers. Davao, although not Malaria-free (3 cases in 2013), reported 39 dengue deaths. These are compelling numbers.

I hope it’s real clinical concern that’s putting the ActRx TriAct on hold—that it’s not being stonewalled by ego and politics. Infectious disease experts should do a think-tank on the dengue health issue, devise appropriate treatment protocols. Judiciously using the treatment only for severe and lab-diagnosed cases should help avoid the emergence of resistance.

And why look to the WHO for advisement? While it suggests no specific drug therapy, it has listed dengue fever as a “neglected disease” and estimates that there may be 50 to a 100 million dengue infections worldwide each year. Rather, while others concern themselves with vector control and other public health measures, our medical community can take the initiative and embark on a pioneering treatment program that may eventually prove useful in the dengue pandemic. And if need be, until the warring factions settle their issues, the drug should be placed on “compassionate use” status.

There have been many pharmaceutical breakthroughs—studies finding new uses for old drugs. That a drug that saved lives from malaria can now be used to prevent deaths from dengue is one such breakthrough. A godsend. . . a eureka moment.

The Phase III clinical trial has concluded that ActRx TriAct is a highly efficient and successful treatment for dengue. Unless or until that is proven otherwise, if ActRx TriAct can prevent hundreds of dengue deaths a year. . . it would be medically unethical not to use it. Perhaps, criminal.

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Ona in trouble over use of malaria-dengue drug
Ona’s fate hangs as PNoy reads report on vaccines
Was Secretary Ona let go because Usec Janet Garin, former staunch RH advocate in the House, would be more determined to push the RH Law into full implementation?