268
W. T. Woo et al.
3 SDG 3: Good Health and Well Being
SDG 3: Good health and well-being, aims to ensure healthy lives and promote wellbeing for all at all ages. Focused global attention is needed to combat and end longterm epidemics of infectious diseases. For decades, humanity has been plagued by
dengue, HIV, tuberculosis, malaria, hepatitis and other neglected tropical diseases.
This SDG 3 can be achieved by the expansion of universal health coverage for all.
A prerequisite is a firm commitment to social equity and an unequivocal respect for
ethics and human rights (Raviglione and Maher 2017). Achieving good health and
well-being for all, the salient goal of SDG 3, is one of the most compelling global
challenges. Subscribing to SDG 3, the Malaysian Ministry of Health (MOH) is currently evaluating the licensing of dengue vaccine Dengvaxia. Vaccine is a control
measure adopted to complement other dengue control programs, such as mosquito
control, disease surveillance and case management. Dengue exerts heavy disease
and social-economic burdens on tropical countries in Southeast Asia (Shepard et al.
2013), including Malaysia (Shepard et al. 2012). The second author is invited by
MOH to provide key scientific and economic advice to MOH in formulating a pharmacoeconomic model for transparent decision-making. Guided by the aspiration
of SDG 3 and World Health Organization (WHO) guidelines, the research team
devised a set of five criteria consisting of safety, efficacy, social equity, affordability
and cost-effectiveness as a basis for evaluation. This licensing exercise consists of
two components; one is to determine whether Dengvaxia is safe and the second is to
establish a price threshold that Malaysia considers highly cost-effective, following
WHO criteria (WHO 2012). WHO advocates the principle of harmonizing equitable
and cost-effective prevention measures via vaccine and behavioural adaptation. This
is complemented with adequate entomological and epidemiological surveillance,
coupled with good case management within existing health care systems. A fundamental underlining obstacle in dengue vaccine development is the fact that dengue
is caused by four distinct but related viruses (DENV 1–4), transmitted primarily by
the Aedes aegypti mosquitoes (Coudeville and Garnett 2012). The Aedes mosquito
ecology promotes the co-circulation of these four related virus serotypes, in densely
populated and unhygienic urban conditions. Co-circulation causes a heightened risk
of sequential infections with increased severity in a subsequent infection. The failure
of vector control such as the release of genetically modified (GM) mosquitoes to
reduce dengue incidences has put additional pressure on the need for vaccine.
The mosquito field experiments jointly conducted by Oxitec and the Malaysian
Medical Research Institute beginning in 2011 in Bentong, Malaysia failed to confirm
the efficacy of GM OX513A male mosquitoes produced by Oxitec to suppress wild
mosquito population. As the male GM mosquitoes will eventually die and as their
offsprings are designed to die before maturity, the release of GM mosquitoes must be
performed repeatedly over extended period, a critical flaw of OX513A. The second
author was invited to participate in this research to verify the effectiveness of this
GM release method for vector control. A numerical simulation model known as
DEER (Dengue Encephalitis Eradication Routines) was developed to examine the
W. T. Woo et al.
3 SDG 3: Good Health and Well Being
SDG 3: Good health and well-being, aims to ensure healthy lives and promote wellbeing for all at all ages. Focused global attention is needed to combat and end longterm epidemics of infectious diseases. For decades, humanity has been plagued by
dengue, HIV, tuberculosis, malaria, hepatitis and other neglected tropical diseases.
This SDG 3 can be achieved by the expansion of universal health coverage for all.
A prerequisite is a firm commitment to social equity and an unequivocal respect for
ethics and human rights (Raviglione and Maher 2017). Achieving good health and
well-being for all, the salient goal of SDG 3, is one of the most compelling global
challenges. Subscribing to SDG 3, the Malaysian Ministry of Health (MOH) is currently evaluating the licensing of dengue vaccine Dengvaxia. Vaccine is a control
measure adopted to complement other dengue control programs, such as mosquito
control, disease surveillance and case management. Dengue exerts heavy disease
and social-economic burdens on tropical countries in Southeast Asia (Shepard et al.
2013), including Malaysia (Shepard et al. 2012). The second author is invited by
MOH to provide key scientific and economic advice to MOH in formulating a pharmacoeconomic model for transparent decision-making. Guided by the aspiration
of SDG 3 and World Health Organization (WHO) guidelines, the research team
devised a set of five criteria consisting of safety, efficacy, social equity, affordability
and cost-effectiveness as a basis for evaluation. This licensing exercise consists of
two components; one is to determine whether Dengvaxia is safe and the second is to
establish a price threshold that Malaysia considers highly cost-effective, following
WHO criteria (WHO 2012). WHO advocates the principle of harmonizing equitable
and cost-effective prevention measures via vaccine and behavioural adaptation. This
is complemented with adequate entomological and epidemiological surveillance,
coupled with good case management within existing health care systems. A fundamental underlining obstacle in dengue vaccine development is the fact that dengue
is caused by four distinct but related viruses (DENV 1–4), transmitted primarily by
the Aedes aegypti mosquitoes (Coudeville and Garnett 2012). The Aedes mosquito
ecology promotes the co-circulation of these four related virus serotypes, in densely
populated and unhygienic urban conditions. Co-circulation causes a heightened risk
of sequential infections with increased severity in a subsequent infection. The failure
of vector control such as the release of genetically modified (GM) mosquitoes to
reduce dengue incidences has put additional pressure on the need for vaccine.
The mosquito field experiments jointly conducted by Oxitec and the Malaysian
Medical Research Institute beginning in 2011 in Bentong, Malaysia failed to confirm
the efficacy of GM OX513A male mosquitoes produced by Oxitec to suppress wild
mosquito population. As the male GM mosquitoes will eventually die and as their
offsprings are designed to die before maturity, the release of GM mosquitoes must be
performed repeatedly over extended period, a critical flaw of OX513A. The second
author was invited to participate in this research to verify the effectiveness of this
GM release method for vector control. A numerical simulation model known as
DEER (Dengue Encephalitis Eradication Routines) was developed to examine the