The vaccine: Coming to grips, or coming to grief?

President Duterte has made it appear that the emergence of vaccines spells deliverance from COVID-19. Nothing is so far from the truth.

Foreign Secretary Teddy Locsin and Ambassador to the US Babe Romualdez tell us of their heroic efforts to get 10 million doses of the Pfizer vaccine as early as January 2021, which was botched when a top official in the Philippines “dropped the ball.” Secretary Francisco Duque III was quick to deny that any ball was dropped when Sen. Panfilo Lacson identified him as the ball dropper. Sen. Grace Poe then weighed in to say that the failure to secure the early batch of the Pfizer vaccine was tragic and bordered on the criminal.

But the larger picture is alarming. While the government is eager for the Pfizer vaccine, it may not be ready for the vaccine. It turns out that Pfizer and Moderna owe their relatively higher levels of effectiveness due to the mRNA approach they have used, as against the other vaccines. This method has been a potential for decades, but only now actualized in vaccines. The drawback is that the formulation requires ultra-low temperature storage, minus 70 degrees Celsius (-94 F) or below in the case of Pfizer, and -4 degrees Fahrenheit in the case of Moderna. No drug has required this extremely low temperature before, and even countries like the United States do not have a health care system that is equipped to handle it. The scramble for ultra-low temperature freezers is on in the United States, but apparently, at $20,000 (P1 million), only hospitals in cities can realistically be equipped with them. It also means the vaccine cannot go to the rural areas and periphery; the people will have to come to properly equipped hospitals, a logistical nightmare.

The Philippine government is aware of the logistical requirement for the Pfizer vaccine, but it has not fully realized the scale and expense required. The Philippines plans to vaccinate 60 to 70 million of 110 million people in three to five years. If there is going to be a mix of vaccines, each requiring two doses 21 or so days apart, delivering these vaccines with different logistical requirements will be terribly complex. The danger is that these doses may be delivered physically but may no longer be potent as the storage requirements could have been grossly compromised. Even just the technical human power required to install and maintain ultra-low temperature freezers is in short supply in the United States, and would be virtually nonexistent across the Philippines.

Luzviminda Garcia of the DOH Disease Prevention and Control Bureau tells us that our facilities are only for +8 degrees C and -20 degrees C vaccines, and none for the minus 70- or 40-degree C vaccines. It is almost surreal that Health Undersecretary Rosario Vergeire assures us that the government plans to have four cold storage rooms and two walk-in freezers in Metro Manila which will serve as the central hub of all vaccines. The DOH is also “looking at equipping each region” with a cold storage facility.

The infantile capacity of the nation to come to grips with the logistical nightmare is compounded by the monopoly that a small cabal of midnight executives surrounding Mr. Duterte has exercised over the design and information on the vaccination plan. Senate President Pro Tempore Ralph Recto laments that Congress has not been privy to the government’s vaccination plans. Sen. Franklin Drilon wryly remarks, “I guess we just have to look at the sky and pray.”

The real grief will come when people and local governments realize that the latter will again be left holding the bag and will be largely blamed for the failure of the vaccination program, by both the Duterte administration and the people. The LGUs are expected to (1) inventory public and private hospitals to serve as vaccination centers, (2) inventory cold chain storage facilities, (3) inventory suitable transportation such as ambulances, vans, trucks, and “air and naval vehicles,” (4) prepare QR codes in coordination with the Philippine Statistics Authority for people to be vaccinated, (5) prepare and mobilize the people and vaccinators and pay for their training and orientation, (6) enter into a tripartite agreement with the national government and a vaccine company, (7) defray the costs required in the preparation and implementation of the vaccination program.

So, it seems we are poised to come to grief over the vaccination program, not to come to grips with it.

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