COVID-19 vaccines in the Philippine context

Several months and over 400,000 COVID-19 cases later, the Philippines has begun its long-awaited and promised process of acquiring vaccines as a means to end the pandemic. As early as April, President Duterte spoke optimistically of the prospects of a vaccine. Realistically, however, we must be aware of the realities of vaccination in the recent past in order to truly ensure its success.

Before looking at the advances of COVID-19 vaccine technology, it is important to look at the role immunization has played in the Philippine health care system. Indeed, this has been one of the cornerstones of preventive care for disease not just of childhood (mumps, chickenpox) but eventual adult concerns (HPV, pneumonia) as well. Yet despite the government’s Expanded Program on Immunization (EPI) and the National Immunization Program (NIP), the country has seen a drop in population coverage, leading to the resurgence of vaccine-preventable illnesses such as measles, diphtheria, and even poliomyelitis in the past decade. The Philippines’ circulating vaccine-derived polio cases in 2019-2020 placed us on a list with African countries struggling to end the transmission of this disease.

Many attribute the dismal immunization coverage to the dengue vaccine scandal, but while it doubtless eroded vaccines confidence in the Philippines, our immunization programs have actually been problematic long before Dengvaxia, failing to reach the coverage goal of 95 percent for many years now. The scandal only represented the nadir of what’s already been an alarming trend.

In fact, when it comes to timeliness of vaccination, the 2017 National Demographic and Health Survey showed only a 10.6 percent rate for all vaccines (ranging from 38 to 67 percent per vaccine). The gaps in delivery boil down to the quality and accessibility of our public health system, which, during the recent polio vaccinations, for instance, relied heavily on private sector support. It also faces a lot of challenges when it comes to maintaining the cold chain.

Looking forward to the COVID-19 vaccines, there have been major breakthroughs, the speed and complexity of which have never been encountered before. Of those nearing approval, there are two mRNA vaccines from Moderna and Pfizer—both requiring negative temperatures in their delicate handling. There are also the vector-based vaccines from Astra-

Zeneca and Gamaleya’s Sputnik V, as well as China’s inactivated vaccines developed by Sinopharm and Sinovac, all of which will only need normal refrigerated temperature.

Beyond the vaccine type, its corresponding handling, and the limitations of our health infrastructure, a major concern is the potential politicization of the acquisition, prioritization, and distribution protocols that will be put in place. There have been conflicting reports on who will be vaccinated first—health workers, vulnerable individuals, the poor, and uniformed personnel—according to different government agencies. There is also a need to address people’s concerns about the vaccines, from fears of being made “guinea pigs” to misconceptions about side effects and efficacy.

Surprisingly, there are reports of politicians having already received the vaccine, even if no emergency use authorizations have been granted by the local FDA. The vaccine “czar,” Gen. Carlito Galvez Jr., also mentioned that equitable access to the vaccine will only be achieved by 2022—an election year, which may bring about a predicament not unlike that of Dengvaxia in 2016, which some quarters allege was funded and launched for political considerations. These issues once again raise the danger of politicizing vaccination, especially if the process for prioritization will have potential interference from vested interests. With the urgency called for by the still uncontrolled pandemic, the success of not just the COVID-19 vaccine, but also of the entire vaccination institution in our country, hangs in the balance.

In the end, however, the solution for COVID-19 goes beyond vaccination. The World Health Organization reminds governments of the continuous need to strengthen their countries’ health system to provide for adequate testing, tracing, quarantine, treatment, and monitoring, aside from the provision of essential services. States must invest in public health to strengthen the infrastructure for pandemic preparedness, and to ensure the well-being of all, now more than ever.

Joshua San Pedro, MD, and Gideon Lasco, MD, PhD, are both physicians and anthropologists.