Vaccines don’t save lives, vaccination does!
My mantra for the longest time, vaccination is my advocacy, my passion, my life. Anybody who knows me would attest that I am a Vaccine Warrior. Indeed, my compulsion to save lives stems from the conviction that (1) Prevention is better than cure and (2) Vaccination is most effective in saving lives.
As a young doctor in 1974, I first realized the value of vaccine and vaccination’s mass dissemination. Awareness must trickle from medical fora down to the very roots of society and serve mankind’s greatest need: Health. Thus, I was initiated into evaluating an immunization program being started then for well-baby clinics in government hospitals. It gave me an opportunity to conduct my first research in 1974, a study on how mothers were complying and accepting the monthly immunizations and well-baby checkups after their delivery at the Philippine General Hospital (PGH). The mothers had an average of 50% monthly drop-out rate. Only 10% were able to complete the full immunization of a dose of BCG, three doses of DPT and polio, and a measles dose at 9 months of age. Data showed the mothers’ lack of awareness on immunization, and they took for granted the free BCG, DPT, polio, and measles vaccines. I realized early on that there is much to do to convince mothers and the public on preventing infectious illnesses and misconceptions had to be corrected and corrected fast.
With zeal and vigor, I began teaching mothers to continue the full course of vaccination. I initiated strategies to increase vaccine coverage in as many areas as possible. Years later, my work on vaccine and clinical trials of various oral dehydration solutions (ORS) for acute diarrheal diseases proved highly successful and reinforced my mission of saving lives. My involvement in the WHO Control of Diarrheal Diseases (CDD) with studies on the etiology of acute diarrhea and several clinical trials on various ORS becoming a big part of my scientific endeavors. Measles vaccination then was part of the prevention of deaths from diarrhea. This is the very reason I became a doctor.
“I will be a doctor when I grow up” were words dear Mother planted in my 2-y-old brain and which she made me repeat incessantly through the formative years. To be a doctor was actually her life goal, but their poverty dictated otherwise. So I knew early on that nothing else would make Mother happier than me fulfilling her thwarted dream.
But for a family of ordinary means and coming from a province a hundred kilometers from the big city, it was like reaching for the stars. Without adequate subsidy, we could not afford a medical school education. But as lady luck would have it, I was able to hurdle the highly competitive examinations and enter the University of the Philippines (UP) system. The State University afforded me the invaluable opportunity for high school, college, and medical school in Manila. In 1972, I graduated from the UP College of Medicine at the age of 22 as one of the youngest in my class of 89 students. Eventually, two-thirds of my classmates would seek greener pastures abroad.
I, however, stayed behind to finish a 3-y pediatric residency (1973–1976) at the UP-PGH, the largest training hospital in the Philippines. It was in this field of pediatrics where my future career began to take shape. I owe a lot to my husband of 43 y, Dr Petrarch Bravo, for this career choice as he read my mind and my heart then, stating so accurately that children are and will always be my foremost interest.
For my 2-y sub-specialty training in 1976–1978, I went on to infectious diseases.
During my residency, I was exposed to managing hundreds of serious cases with very limited materials and resources as with most government hospitals in the Philippines. I cannot forget the time I stayed up almost 12 hours desperately ambu-bagging (no mechanical ventilator available at that time) a baby with severe pneumonia. Miraculously, he survived. Years later, I even took care of this baby’s own kids. He never stopped to thank God for dear life and never fails to acknowledge my humble role in it.
In my second year of residency, I got involved in the care of a congenital meningocoele baby abandoned by mother after birth. I borrowed him for the Christmas Holidays and took him home. From that time on, he became a permanent member of my family beloved by all. Mother nurtured him until she died in 2000. Now, he has been under my care; a 46-y old with the mind of a child who needs nursing and feeding assistance. The family considers him a blessing for he bestowed us all immeasurable joy in his growing up years sharing his surprisingly remarkable talent in music and dance.
It was also during this time that I started doing research and my passion for vaccination was awakened. I did research during my residency on using BCG vaccine as a possible agent to suppress myeloproliferative disorders as suggested by my professor in hematology and the use of steroids in aplastic anemia. My research papers won successively in 1975 and 1976 in the Philippine Pediatric Society’s annual research competition. In the next years, I had 12 other winning research papers submitted to various medical societies where I was coauthor or first author. Receiving recognition for my papers served to motivate me to pursue further studies with the limited availability of financial and logistic resources.
My knowledge of basic research, the analyses of results, and the dissemination of their beneficial value to target constituents, as well as the means to effectively communicate these for mass benefit; I owe to two Filipino medical luminaries.
For my infectious disease researches, I am indebted greatly to Dr Thelma Tupasi-Ramos, a recognized Rheumatic Fever and Rheumatic Heart Disease Chemoprophylaxis researcher, a TB fighter and Control of Nosocomial Infection Advocate, all of which I pursued during my infectious disease fellowship training program under her tutelage. This motivated me to study the epidemiology of nosocomial infection, a project I took up at the University of Texas Southwestern Health Science Centre in Dallas with two well-known and accomplished professors, George McCracken and John Nelson, editors of the Journal of Pediatric Infectious Disease. The rare chance of spending a 6-month fellowship enhancement program with these distinguished pillars of the pediatric world was given to me in 1986, vastly enlarging my insights into the differences of infectious diseases in the US and my third world country, the Philippines. Being exposed to the cases and their management in the US made me realize the enormous tasks ahead of us to improve Filipino health-care delivery.
The outstanding pediatrician I owe so much was University Professor and Emeritus Perla D. Santos Ocampo, a National Scientist awardee, beloved and well respected by the entire medical community locally and internationally. She taught me not just science and research but social, professional, and organizational skills that spell the difference between success and failure in my undertakings. She taught me the value of connecting with people and institutions to pursue programs and projects, thereby establishing partnerships that serve to maximize resources. As her assistant in organizing international congresses, I was led to interact and associate with various international societies like the International Pediatric Association, Asia Pacific Pediatric Association and the International Society of Tropical Pediatrics as well as the World Health Organization (WHO). These experiences led me to establish and develop the Asian Society for Pediatric Infectious Disease founded in 1998, the Asian Vaccine Conference (ASVAC) launched in 2009, and the Philippine Foundation for Vaccination which became a formidable voice of vaccine advocacy in the Philippines since 2000.
While I continued to play a role in the organization of both national and international scientific meetings and communicating my researches through these conferences, I was appointed at the UP College of Medicine as a Special Assistant to the Dean and then as College Secretary, with a monicker of the “Little Dean” from 1997 to 2003. My administrative, academic, and curricular skills would be challenged with the handling of 900 faculty members, half of which were working pro bono, teaching more than 800 medical students, 200 medical interns, and 600 residents. An important program I started then was to establish a vaccination information campaign for medical students. The program ensures a catch-up on the individual vaccination status of medical students before they enter medical college. This was initiated in 1998 and has since then been taken up by other colleges.
From 2005 to 2011, I was appointed as Vice Chancellor for Research and Executive Director of the National Institutes of Health of UP-Manila. I had to cut down on my own research studies, particularly on vaccine trials from pharmaceutical companies, to focus on research development in the university and encourage more publications by faculty. My consolation at that time was Filipino pediatricians were already using many of the combination vaccines, DPT-HIB-IPV-HepB, the first clinical trials of which I had been part of as principal investigator in the 1990s. It showed there was no interference among all the various antigens in the combination vaccine when used in infants for routine immunization. The Philippines was one of the first countries which licensed and used these combination vaccines even ahead of the USA. The use of combination vaccines has produced better compliance, coverage, and convenience in vaccination programs and serves as a milestone in vaccine development.
In the first decade of the millennium, I was being invited to numerous advisory panels on various vaccine-preventable diseases such as the Pneumococcal Awareness Council of Experts, the Dengue Vaccine Initiative, the End Polio Game Strategy, the Rotacouncil, and in our own Department of Health for the Adverse Events Following Immunization (AEFI) Monitoring Committee to provide better and safer environment for vaccination.
The impetus then, as it is now, is greater awareness of pneumonia and diarrhea as top killers of children. It must be disseminated at all costs, including the use of new vaccines to achieve the millennium development Goal 4 of reducing deaths in children. I had a chance to do my part in justifying the introduction of pneumococcal conjugate vaccine in national immunization programs by presenting written and oral evidence to the House of Commons of the UK Parliament. This undertaking established successfully a 2.5 billion dollar advance market commitment for the purchase of PCV for GAVI-eligible countries. I consider this one of the highlights of my career in saving children’s lives. It also earned me in 2018 a “Pneumonia Fighter” award as bestowed by Just Actions, a US nongovernment organization known in the area of public health sustenance.
The Philippine Foundation for Vaccination which we established in 2000 to provide needed information and support for our national immunization program has significantly contributed to the giving of Hepatitis B at birth and inclusion of new vaccines in the NIP such as Hib, MMR, Rotavirus, PCV, and HPV through the years.
But challenges continue to arise. In 2017, disinformation and misleading news brought hysteria, panic, and fear of a dengue vaccine that was introduced as a mass vaccination in the Philippines in 2016. The manufacturer, Sanofi, had announced publicly that the vaccine can cause severe dengue in those who had no previous dengue infection. Unfortunately, the statement was misinterpreted as causing harm, even death. This led to a significant loss of public trust on ALL vaccines and other vaccination and health programs of the government.
Parents later refused to have their children vaccinated. The country was beset by an outbreak of measles and other erstwhile controlled diseases all preventable by vaccines. Sadly, deaths piled up. Vaccine coverage dropped to an all-time low of 30% with vaccine confidence decreasing from a high of 93% in 2015 to 32% in 2018. With this turn of events, I and my advocacy colleagues now double efforts in networking and partnerships and vigorously push strategies to restore the trust and confidence of Filipinos in vaccines. Our efforts center now on overcoming vaccine hesitancy, one of the top ten global threats recognized by the WHO for 2019.
Our work is overwhelming as the world clamors for continuing improvements in health delivery systems. This is a never-ending task, one that must transcend our lifetimes, commitments, and convictions. I am a warrior and the fight continues. Humanity, after all, deserves to be free from preventable diseases. The slogan of our National Institutes of Health at the University of the Philippines Manila says it all:
Science for Humanity
Scientists with Souls
Biography
About Dr. Lulu C. Bravo. Dr. Bravo is a Professor Emeritus at the College of Medicine, University of the Philippines Manila. She is the former Vice Chancellor for Research and Executive Director of the National Institutes of Health, University of the Philippines Manila (2005-11) and current head of the Vaccine Study Group of the NIH–UPM. She is the President of the Immunization Partners in Asia Pacific (IPAP), current Executive Director and past President of the International Society of Tropical Pediatrics (ISTP; 2008-11), past Chair and Founder of the Asian Strategic Alliance for Pneumococcal Disease Prevention (ASAP; 2007-11), and Executive Director, Sec-General (1998-2006) & past President of the Asian Society for Pediatric Infectious Disease (ASPID; 2006 8). She has served in various capacities in many other Asian medical and professional societies and as WHO Technical Advisor. She has served as well in national medical organizations such as PMA, PPS, PIDPS, PSMID and the Philippine Foundation for Vaccination (PFV) of which she is the founding President and current Executive Director. In the international scene, she is a member of the Rota Council, Pneumococcal Awareness Council of Experts (PACE) and member of the Dengue Vaccine Initiative (DVI).Her work has earned for her various national and international honors and awards in the professional, academic and research fields, including the Outstanding Physician (2009) and the prestigious Dr. Jose P. Rizal Memorial Award for Academe (2011) given by Philippine Medical Association, the 2012 Asian Outstanding Pediatrician Award given by the Asia Pacific Pediatric Association, Centennial Outstanding Researcher by the UP Pediatrics (2016) and 2018 Outstanding Professional in Medicine given by the Professional Regulation Commission of the Philippines. As vaccine advocate, she was named Pneumonia Fighter in 2018 by the Just Actions Organization, a US-based movement and corporation associated with People Empowerment.Dr. Lulu Bravo completed her MD, pediatric residency and subspecialty training in infectious disease at Philippine General Hospital-College of Medicine of the University of the Philippines Manila. She supplemented her fellowship in pediatric infectious disease at the University of Texas Southwestern Health Science Center in Dallas, USA in 1986.
Disclosure of potential conflicts of interest
The author has no conflicts of interest to disclose.