DOH Secretary Ubial and her record of ‘flip-flopping’

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BYPASSED. Health Secretary Paulyn Ubial attends her confirmation hearing on May 17, 2017. The Commission on Appointments bypassed her. File photo by Lito Boras/Rappler

Barely a year in office, Health Secretary Paulyn Ubial has been caught flip-flopping at least 3 times on key issues involving her agency.

Ubial has yet to get the nod of the powerful Commission on Appointments (CA), which deferred her confirmation, effectively bypassing her. At least 3 oppositions were filed against her, with one complainant, Kabayan Representative Harry Roque, citing her supposed record of "flip-flopping."

Ubial has been caught changing her stance on major health issues, such as the dengue vaccine, the status of the Zika virus in the country, and recently, the number of evacuees who died of health-related causes in Marawi City.

Here are the times Ubial retracted her statements:

On dengue vaccine

Prior to heading the Department of Health (DOH), Ubial was assistant secretary when the P3.5-billion dengue vaccine program was approved during the Aquino administration.

On July 18, 2016, the newly appointed DOH chief Ubial signed a resolution recommending the deferment of the program, saying the vaccines are not proven safe.

She also earlier told the House of Representatives panel deliberating the 2017 budget that "a panel of experts convened by the DOH revealed the dengue vaccine has potential health risks."

But on September 28, 2016, she issued a Certificate of Exemption for the vaccine, Dengvaxia, so it could still be used despite her earlier flagging of certain issues.

Roque questioned this: "Ang tanong ko, may red flag ka na pala, bakit noong Secretary ka na noong September 2016, nagbigay ka pa rin ng Certificate of Exemption sa dengue vaccine? Atras abante siya." (My question is: You already had red flags. Why did you issue a Certificate of Exemption in September 2016? You’re moving back and forth.)

When confronted during a House hearing, Ubial apologized and said she had "forgotten" about the July resolution.

CERTIFICATION. After initially moving to defer the dengue vaccine program, Ubial issues a certification allowing it, following the advice of experts.

Ubial also defended her issuance of a certification, saying she consulted with "experts," as she had no expertise on dengue vaccines.

"I deferred to the wisdom and the decision of the experts that recommend to me the action to be taken because I admitted that I am not an expert on the dengue vaccine. So, ‘yun po nangyari na (that’s what happened), every time we move forward in this initiative, we convene an expert panel so that based on the scientific and logical thinking of scientists and experts [we decided] what would be the next step to take in moving forward the dengue vaccination program," she earlier said.

The health department is already administering the 2nd of the 3 doses of the dengue vaccine to around 489,000 public school students (at least 9 years old) in Central Luzon, Calabarzon, and the National Capital Region.

But Ubial, on May 5, said they would again stop the dengue vaccination program after the 3rd and final round of injections is administered, saying they have to wait for the results of the pilot testing.

Roque questioned this: "Kung ito ay delikado sa kalusugan, dapat tinigil no matter what. Pero hindi pupuwede ‘yung minsan tuloy, minsan tigil. Ang nagiging epekto nito, natatakot ang taumbayan sa lahat ng forms ng vaccines, hindi lang sa dengue, kasi nga naman ‘yung Secretary of Health, hindi maintindihan kung tuloy or hindi tuloy."

(If this is dangerous to people’s health, this should have been stopped no matter what. It can’t be that it’ll push through, then it’ll be stopped. The effect of this is the public gets scared of all forms of vaccines, not just the one for dengue, because the Secretary of Health is unsure if it will continue or not.)

On Zika virus

On September 2, Ubial, in a press conference, declared that the Philippines was Zika-free, as there is no local transmission of the virus.

"Wala po tayong local transmission. Ibig sabihin, wala pong umiikot dito sa Pilipinas na nakuha ‘yung virus galing sa isang taong galing sa endemic countries (We don’t have local transmission. It means there is no Zika virus circulating in the Philippines that came from a person who came from endemic countries)," said Ubial.

She added that the 5 cases recorded at the time were "imported" or obtained from other nations.

But in May 2016, when Ubial was just assistant secretary, the DOH already reported that the virus exists in the country. A disease or condition is endemic when it is regularly found among particular people or in a certain area.

The DOH under former secretary Janette Garin already pointed out that the 5th case, a 39-year-old Korean man, was apparently infected during a visit to the Philippines.

"What is important is that all the patients who contracted Zika virus in the Philippines did not have any complications and that agaran silang na-identify at agaran ding nakita na ‘di naman kumakalat ang virus at walang buntis na nagkaroon ng complication (they were immediately identified and we immediately determined that the virus is not spreading and no pregnant woman suffered complications)," Garin said in May, as quoted by SunStar.

On September 5, a few days after Ubial’s pronouncement that there was no local transmission, Health Undersecretary Gerardo Bayugo, Health Assistant Secretary Eric Tayag, and the World Health Organization confirmed the 6th case of Zika in the country and said it was transmitted locally.

On September 26 and 27, in a press conference and in an interview with ANC respectively, Ubial changed her tune and said there were indeed "local transmissions." She also said this in a House hearing in October.

"We do not recommend travel ban to affected areas since Zika and the mosquito that carries it is actually endemic in the Philippines – it’s found all over the country," Ubial said on September 26.

"International travel actually has nothing to do with actual spread of the case because many of the cases are discovered that there is no history of travel, international. What we’re saying, particularly in the Philippines, there is local transmission," she said on September 27.

In response to Roque’s CA opposition, Ubial said there was a "time lag" from the infection and the manifestation of symptoms to the confirmation.

"We fully understand that there is a time lag between virus infection and the symptoms, the symptoms and the confirmatory tests, and the tests and reporting. The situation for reporting Zika virus infections change from day to day depending on the updates and reports submitted by RITM (Research Institute for Tropical Medicine)," she said.

"Endemicity was established a few days later after the press conference when the Secretary of Health declared that the Philippines was still Zika-free," Ubial added.

But Roque pointed out: "How could Dr Ubial not know about these when at that time, she was an Assistant Secretary at the DOH? Amazingly, she apparently did not get the Zika virus memo about its being endemic to the country."

On deaths in Marawi evacuation centers

The secretary’s most recent retraction of statement occurred in June 2017.

At a forum in Legazpi City, Albay on June 15, Ubial said 40 people from Marawi City, who were not in evacuation centers, died of dehydration, while 19 died in evacuation centers, where their existing health conditions were aggravated.

Ubial, as quoted in a statement posted by Social Welfare Secretary Judy Taguiwalo, singled out Rappler for "totally and intentionally" giving the "wrong numbers" in our report titled, "59 Marawi evacuees die of health-related causes – Ubial."

The same numbers and direct quotes were also used by the Inquirer, the Manila Times, and government-run Philippine News Agency (PNA). But the PNA took down its post.

Ubial said she reviewed the video recording and claimed she "clearly said" there were "no deaths in evacuation centers."

The Philippine Star, on June 16, published a report that quoted Kadil Sinolinding Jr, the health chief of the Autonomous Region in Muslim Mindanao (ARMM), who cited a higher number of persons dying in evacuation centers – 39 people against Ubial’s 19. Sinolinding said only 19 of the cases had been properly documented.

Here is the transcript of part of the press conference held at the DOH’s Bicol office during the launching of ASEAN Dengue Day 2017 on June 15:

Reporter: Ano na po ang update sa health situation ng evacuation centers sa Lanao, Lanao del Sur following the Marawi crisis? Can we get some profile, picture kung out of the how many evacuees, ano po ang health concern ang ina-address ng DOH? At tsaka ano’ng concern ang dapat, ano, bigyan ng pansin sa, doon sa evacuation centers? Then may balita rin po na meron na raw mga casualties na mga bata? Baka meron na po kayong report niyan? Casualties ng diarrhea and pneumonia? Ano’ng safety of the water supply?

Ubial: As of June 14, meron na pong na-established na 68 evacuation centers in many areas of Iligan, Lanao del Norte, Misamis Oriental, particularly in Cagayan de Oro and in Lanao del Sur. Pinakamarami po sa Lanao del Sur, and of the 68 evacuation centers, we are monitoring around 20,627 persons or 4,244 families in the evacuation centers. Pero ang karamihan po ng mga bakwit po natin are outside evacuation centers. There’s about 218,551 evacuees from Marawi in different areas of Lanao del Norte, Iligan City, Misamis Oriental, and Lanao del Sur.

So, ‘yung nare-report po sa atin araw-araw is from the evacuation centers. Meron po kaming mga datos diyan. And the, as of June 14, meron po tayong 19 deaths. Ah, ito po ay hindi naman dahil sa shall we say crisis o natamaan sila ng bala o naputukan sila. Ito po ‘yung mga pasyenteng dati nang may sakit, pagdating sa evacuation center medyo lumala, may mga dina-dialysis, may alam po akong namatay na may cancer, dinala po sa ospital, ginamot, namatay, 19 po ‘yun.

Ngayon, ‘yung, may mga reports rin po sa evacuation centers na tumataas ‘yung mga kaso ng acute gastroenteritis, upper respiratory tract infection, mga skin diseases. ‘Yan pong pagtaas po ng mga kasong ganyan ay expected po natin because of the crowding and because of the situation in evacuation centers.

Pero, sa datos po namin, bumababa naman po siya, hindi po siya tumataas. From May 24 up to June 2, pataas po siya. From June 2 up to now, June 14, pababa na po ‘yung mga diarrheal cases, skin diseases, at tsaka mga upper respiratory tract infections.

So, nabibigyan naman po natin ng mga assistance ang lahat ng taong nasa evacuation centers. Ang problema po namin ‘yung wala sa evacuation centers, which are siguro 180,000 po sila. Kasi 20,000 lang ‘yung nasa evacuation centers. ‘Yun po, sa evacuation centers araw-araw nakikita po ng mga duktor natin, may mga tinalaga tayong mga health workers sa 68 evacuation centers. Ang problema po may mga bakwit na hindi po namin nakikita araw-araw. So, meron nga po akong report na may apatnapung (40) namatay ng dehydration pero ito po ay hindi po sa evacuation centers nangyari.

So ‘yun lang po ang situation natin ngayon sa Marawi at sa Lanao del Sur na parang, sinusuyod na rin po namin ‘yung community but I don’t think we can cover the 180,000. Ah, in the meantime, pero pinapanawagan nga po namin sa radyo, sa mga barangay captains na kung maaari po na kung may mga nagkakasakit sa mga bahay-bahay eh talagang i-refer na sa ating mga health centers, sa ating mga ospital sa lugar, kasi nagdagdag po tayo ng mga tao.

‘Yung mga health center doon sa Lanao del Sur at saka sa Iligan dinagdagan po natin ng tao ‘yung mga ospital, dinagdagan natin ng tao, kasi alam po natin na dadami ‘yung mga may sakit. Pero kung hindi po sila pumunta sa’min hindi po namin sila matutulungan, ‘yun po ‘yung situwasyon.

Reporter: Ma’am, do’n sa evacuees that are suffering from gastro, upper respiratory, and skin diseases, ilan po ba ang mga bata, ilan po ba ang matatanda? Anyway kung meron data (pause), pero kung meron sana ngayon na para magawa na.

Ubial: We can send to ah… Meron kasing makapal na datos ‘yun. Pero ito na po ‘yung… pinakadatos po natin. There are, total of, ‘yung sa mga hospitals po na galing sa mga na-refer from evacuation centers, araw-araw po mino-monitor natin ‘yan.

But as of June 14, we have 1,290 patients referred to hospitals of which 178 were admitted and 467 were given treatment on outpatient basis. The others were sent to home, without treatment ‘yun. Lahat po ng binibigay nating gamot libre. Kung ia-admit po ‘yung pasyente, 178 inadmit, libre po lahat ‘yun, okay. And the, PhilHealth also is working with us, ah no-balance billing po lahat ng pasyente and pay all.

Ibig sabihin ng pay all babayaran ng PhilHealth lahat po ng mga pasyente galing sa Marawi at Lanao del Sur, hindi po nila kailangan mag-produce ng birth certificate, ng ID, or whatever. Basta pasyente galing do’n sa area babayaran po ng PhilHealth.

Moderator: Thank you so much, madame secretary.

Reporter: Ma’am, out of 1,290 patients po, ilang mga bata, siguro ilan?

Moderator: Sir, supply na lang po natin ‘yung data after, ‘pag nagkaroon po ng (inaudible) data.

Ubial: Supply na lang iyong data.

– with a report from Rhaydz B. Barcia / Rappler.com

Inside Track is Rappler’s intelligencer on people, events, places and everything of public interest. It’s a take-off from Newsbreak’s Inside Track section. Contributions are most welcome. Just send bits of information to investigative@rappler.com.