Don’t risk it

I’m a bit worried that we could be putting children’s lives at risk.

What triggered this is the Department of Health’s (DOH) rebidding of the vaccine to reduce the chance of catching pneumonia. Until now, the pneumococcal conjugate vaccine 13 (PCV13) has been used because it covered the widest range of possible strains of bacteria causing pneumonia, called serotypes.

The choice was based on a comprehensive and independent analysis of scientific data behind the product. On a cost-benefit analysis, PCV13 well outweighed the cost. That, incidentally, is another area where far, far too often the government chooses the cheapest purchase price, not taking into account all the other factors that affect cost and performance. These other factors include quality of material, provision of the product or service on time, length of life, cost, and likelihood of breakdown or failure, and so on. In this instance, vaccine cost-effectiveness is not just about price or short-term gains, it is also about protecting more Filipino children by preventing more diseases and lowering the cost of public health care overall.

A study published in 2019 funded by the World Health Organization (WHO), Global Alliance for Vaccines and Immunization, and the Gates Foundation found that 92 percent of countries globally that introduced this vaccination used PCV13, as it was proven to be cost-effective. This means that the investment in vaccination was compensated by savings from averted hospital inpatient care and health center visits, and that resulted in cost savings from productivity gains from reduced care-giving and reduced out-of-pocket expenditures, further offsetting the cost of vaccination. This study confirms that the DOH’s decision in 2014 to invest in PCV13 for the national immunization program, which has been used up to this time, was cost-effective, especially as the prevalence of the three additional serotypes which are covered by PCV13 was high.

In October, the DOH was again set to sign a new contract for PCV13 when someone who is not a medical expert challenged the DOH’s well-considered decision and said this shouldn’t be done because the government must go for public bidding. That’s acceptable, if there are several products of equal performance available. In this case, there aren’t. The only possible competitive product covers fewer serotypes of pneumonia. It covers only 10 types and is referred to as PCV10, while PCV13 covers 13 strains.

Pneumonia is a leading cause of death among Filipino children, particularly those under five years old. The additional serotypes (19A, 3, 6A) need to be covered. The WHO recommends the vaccine with higher coverage for countries with incidence of 19A and 6C, which are causes for severe pneumonia. Those additional three serotypes are prevalent in the Philippines. So a product that doesn’t protect against 19A, one of the additional three serotypes, would result in an estimated 495 children dying. So why would you consider a less effective product just because it’s cheaper? Yes, PCV13 costs about 10 percent more, but what price would you put on a child’s life? Maybe ask the 495 mothers. Mind you, that 10 percent equates to P500 million, and that number clouds people into thinking it’s a huge amount. But it isn’t if taken in the context of the size of the program, which will cost P5 billion; that P500 million is only 10 percent higher. A cheap price to pay for a child’s life.

I’m against monopolization in anything, but in this case there’s no real choice. PCV13 is the only vaccine that covers the three additional serotypes. The only thing you can do is to ensure it is provided at a fair cost—by looking at the price worldwide. The DOH is checking now the prevalence of these serotypes. They have been high in the past, and if they still are, then PCV13 is the only humane choice. Any bidder will have to prove his product is demonstrably effective in counteracting the additional three serotypes.

Out of 157 countries with national immunization programs, 126 countries, or 80 percent, have PCV13 in their programs. Most Asian countries have PCV13 in their vaccine programs—Indonesia, Taiwan, Hong Kong, India, Japan, South Korea, Singapore, Cambodia, Laos, Myanmar, and Mongolia.

Experience in other countries, such as Belgium and El Salvador (representing developed and developing economies), shows that when they switched to PCV10 from PCV13, there was an increase in the bacterial strain responsible for more severe disease (due to 19A) like severe pneumonia. Thus, they had to switch back to PCV13.

When most countries have made the step forward to PCV13, it would seem unwise to go the other way. The decision must be based on saving lives, not cost.

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