dengue and vaccine in the Philippines

This Lancet article from last year discusses Dengue in the Philippines.

Yes, the government was doing programs to try to stop it, but they ran into problems:

One significant barrier to its success is the lack of empowerment among the stakeholders in taking responsibility for dengue prevention

unclear who they are pointing fingers to. Those in charge of the Barangay, or poor people?

This might show part of the problem:

Another problem encountered was the challenge of eradicating local breeding sites, which are primarily water-holding containers. In areas with unreliable piped water, residents store water in such containers. Further, miscellaneous containers are commonly kept by residents as these can be used for other purposes or even sold for income. Lastly, inefficient garbage collection services may result in scattered trash that can accumulate rainwater.

Yes! these are problems that contribute to the spread of Dengue. I mean, you know you have to change the dog's water because if you don't do it every day, you get wrigglers floating in the dish

Now imagine it is a puddle from the rain that didn't dry up, or garbage that collects water (i.e. plastic cup discarded), etc. And since we got a new mayor (the sister of the previous one) we haven't had the streets cleaned regularly, although we do have garbage pickup weekly

but the government program gave 8oo thousand kids a dengue shot: the problem? If you never hda dengue before, the shot could cause a secondary immune problem. The rest of the article is about if they should introduce Wolbachia infected mosquitoes.

Lancet article on the severe dangue cases .

The risks associated with Dengvaxia must be put into perspective. First, many cases of hospitalisation and severe dengue following vaccination are likely to be attributable to vaccine breakthrough cases in seropositive vaccinees because a high proportion of vaccinees are dengue seropositive, in whom the vaccine protects but does not give total protection.

 italics mine. But I thought you were only supposed to give the vaccine to those who had had dengue in the past.... if they didn't have dengue in the past, getting the vaccine led to an increased chance of getting severe dengue or something.

I admit I am confused about this.

But did the vaccine help? It appears yes.

Second, in all children vaccinated, the overall incidence of hospitalised dengue is likely to be substantially lower in the 5 years following vaccination than would have been the case had no one been vaccinated.

italics mine. 

On a population level, in highly endemic regions, like the selected regions of the Philippines, the number of dengue cases averted by Dengvaxia is likely to substantially outweigh the number of vaccine-induced cases, and vaccination with Dengvaxia has an overall net benefit to the population.

I agree. But like the kerfuffle over covid shots, if it is your kid who dies, well maybe you might object to that cold hearted analysis. 

Vaccinating only those testing seropositive would be the preferred strategy for future use of the vaccine, but this depends on the development of sensitive and specific rapid point-of-care tests to identify this group.