The Politics of the Pandemic Vaccine: The Philippine Situation, Part2

The Philippine vaccine situation has become brighter with the announcement that the World Health Organization (WHO) will be providing 40 million doses of covid vaccine to the Philippines through its COVAX initiative. The rich countries can afford the most expensive vaccines but the poor/medium poor countries like the Philippines rely on the World Health Organization (WHO). COVAX is funded by participating country donors from Europe (U.K., France, Germany, and Italy) among others, including the Melinda/Bill Gates Foundation who is a major donor. The U.S. under Trump refused to take part while China belatedly joined.

The vaccine delivery date to the Philippines, however, is uncertain but it could come as early as February. Since vaccines now available that were given emergency use authorizations require two doses, the 40 million will only cover half, or 10 million people. The Philippine population is now at 110 million but the pandemic is fueling a baby boom in the country. Local government units and private companies have also secured agreements for an additional 1.2 million doses for about 600,000 people. The government clearly needs to reach out to rich countries (like the United States, Canada and China) for vaccine donations to cover for the majority of Filipinos.

But timing is going to be crucial in the country’s effort to defeat the covid disease transmission. At the moment, it appears that the Philippines will not be able to vaccinate every Filipino in 2021. The Philippines joins the United States and most countries who will most likely fail to vaccinate all its citizens because of the lack of vaccines. There is also a large percentage of the population who will refuse the vaccine thus the need for a massive public education blitz.

With the more virulent variant strain (B117) now in the country, government efforts to stem the tide of disease transmission will get complicated. The variant strain has now been established as locally transmitted thus there is a high possibility that this B117 strain or other mutant strain may also be present in the archipelago. The country’s molecular laboratories have the capability to detect mutant strains, however, they don’t test a large number of samples routinely enough because of budgetary constraints.

As President Rodrigo Duterte averred that politics will take a back seat because of the pandemic, it would behoove his vice president Leni Robredo and the opposition to do the same. One critical area of cooperation is the vaccination program. There should only be one coordinated approach versus having LGUs shop for their vaccine preference. It is becoming clear that rich cities and metropolitan areas are given preferential treatment to buy their own vaccine choice while poorer localities rely on the government’s free vaccination.

VP Robredo was complaining about a double standard regarding vaccine access when the Presidential Security Group got their donated vaccine, but this approach of allowing rich municipalities to buy their own choice vaccines will precisely give that perception especially if the free government vaccine brand is different from what the elite group are getting. Having a centralized approach will do away with branding issues and perceptions of double standard.

Beyond the vaccinations, the Philippine government needs to tackle other areas that complicates pandemic control efforts. Sen. Ralph Recto before the end of the year batted for a bigger amount (P100 billion) for the purchase of covid vaccines but the recently signed budget for the fiscal year 2021 only identified 82.5 billion with only 2.5 billion funded.

Recto’s bigger amount was to allow for making down payments to vaccines undergoing clinical trials. While this is laudable, there is no guarantee that such “investment” will actually result in a successful vaccine trial. If the candidate vaccine chosen does not progress successfully, then the down payment is forfeited.

Another area is the country’s woeful capability to do more covid testing. This is one area that legislators ought to focus on also for future pandemics, which is a certainty. Of the 100 licensed covid testing laboratories, 76 (mostly private) are located in the National Capital Region. The Bicol Region (where VP Robredo is from) only has one RT PCR facility located in Legazpi City. The Bicol Medical Center, Naga City has a cartridge based PCR which requires laboratory validation from the Legazpi laboratory.

This situation is critical given that such diagnostic tests are the standard molecular tests for detection of influenza viruses. The influenza situation in the Philippines is not adequately surveilled given lack of funding and that spells badly for the country to detect emerging viral diseases. Global patterns of the influenza virus has been shown that the most infectious strains of influenza A (H3N2) has originated in the east and Southeast Asian circulation network which includes the Philippines.

Influenza pandemics are often traced to animals (pigs, avian, bats) common in the Philippines. Covid-19 was thought to have been acquired from bats in Wuhan, China. But before this, coronaviruses (SARS-CoV) and (MERS-CoV) were previously identified in the Philippines. The point is that influenza viruses mutate most of the time and variant strains are almost expected to appear. Thus the need for continued surveillance for antigenic shifts. Many viruses that are often associated with animal-to-animal transmission can mutate because of animal interaction with other animals and animal interactions with humans (from droplets to inhalable form).

Influenza is a serious public health concern that causes hundreds of thousands cases in the Philippines. The Philippine influenza program is in bad shape for a variety of reasons. For many years, the Philippines have used the trivalent vaccines that were tied to the Northern Hemisphere (NH) because of its location above the equator. But studies conducted through the WHO and other grants have shown that the Southern Hemisphere (SH) trivalent vaccines were better suited for the Philippines because of seasonal rains. The Philippines then switched its annual flu vaccines using the SH.

The problem, however, is the lack OF surveillance data to truly establish the country’s annual influenza occurrence rates, associated deaths and vaccination compliance. Studies using regression models (backward look) have estimated the country’s annual influenza mortality rate at about 6,000 as excess deaths (high of 8,784 in 2009). This number is likely much bigger given that reporting in the Philippines is grossly underestimated since many cases in rural areas and poor neighborhoods are not well reported.

The joint Armed Forces of the Philippines Medical Center (AFPMC) and U.S. Armed Forces Research Institute of Medical Sciences (AFPMC-AFRIMS) molecular laboratory in the Philippines services the nation-wide hospital system of the AFP. This laboratory’s main focus is the diagnosis of influenza. Duterte should negotiate to expand this research facility to complement the Research Institute of Tropical Medicine including more samples from outside the military system.