The sad story of our delayed vaccine rollout

At the virtual vaccine summit organized the other day by the country’s leading business groups, vaccine czar Secretary Carlito Galvez Jr. told participants: “We are very confident that the country will be able to achieve herd containment within this year with the help of the private sector, with the inoculation of 50 to 70 million Filipinos.”

Even with the lower figure of 50 million, the road ahead seems longer. It means administering 100 million jabs (at two doses per person) within a period of eight months—assuming, it goes without saying, the steady arrival of the promised vaccines. Subtracting the 1.8 million doses that have already been given leaves us with about 98 million to be dispensed in 245 days. That’s exactly 400,000 inoculations per day—an ambitious and unrealistic target, given the varying logistical requirements of the different vaccines and the fragmented character of the vaccine rollout itself.

To cite just one source of complication: Half a million Filipinos have been given their first dose of the AstraZeneca vaccine, and are due to receive their second dose soon. These second doses are not yet in the country, and it is not part of the protocol (at this time) that a different COVID-19 vaccine may be given as second dose.

But, who can blame Galvez for painting a bright scenario whose realization depends on factors that now lie beyond our control? As far as he is concerned, they have done everything possible under the circumstances. Still, as the saying goes, hope is not a strategy.

Those circumstances, in the language of risk theory, are called “contingencies.” The assumption is that things can happen differently from that expected. Refusing to be ruled by chance, modern societies attempt to manage these contingencies by reducing to a minimum the dangers and costs they pose. Decisions are made today to manage future outcomes—to avoid a loss or to gain an advantage, which may or may not materialize. Every decision (which, of course, includes the decision not to act) carries its own risk.

An example may illustrate this. Some relatives and friends have asked me whether they should avail themselves of the current vaccines being offered to them, or to wait for the arrival of their preferred vaccines. I tell them that they alone can make this decision, even as I remind them of the Department of Health advice to take the first approved vaccine that is available. That is the public health perspective.

The personal perspective may show things differently. Even after being assured of the comparable safety and efficacy of the available vaccines, people may continue to have reservations. For example, if two doses are required (except for the Johnson & Johnson single-dose vaccine), they want to know what will happen if the second dose is delayed due to supply problems. For now, they will have to wait until a second dose of the same vaccine is available to be assured of some measure of protection. Is it better then to wait until the vaccine supply is more certain? But when will that be?

Many people I know, including friends in the corporate sector who are in the queue for specific brands of vaccines that have been ordered through the tripartite agreement, are opting to get their jabs now with whatever vaccine is available, albeit with some reluctance. The management of risk is part of their everyday world.

For the rest of us, the higher the reported numbers of daily infections and deaths go, the more unbearable the wait for the other vaccines seems to become. This panic mode plays right into China’s current dominance of the local vaccine scene.

It is not where we would want to be given the current tension in the West Philippine Sea. Whether we like it or not, our dependence on China for the continuing supply of the Sinovac vaccine constrains the country’s negotiating position on the troubling issues affecting our relations with this powerful neighbor. As Mr. Duterte puts it: “May utang na loob tayo sa Tsina.”

What is worth keeping in mind is that the situation in which we find ourselves may not be so much the product of a strategic risk calculation by the Duterte administration as it is the outcome of a risky hesitation by our decision-makers to make the hard decisions regarding vaccine procurement.

President Duterte’s preference for the Chinese vaccines, whether for scientific or pragmatic reasons, was clear from the start. That this was not translated early enough into a willful decision to purchase a significant amount of the Sinovac or Sinopharm vaccines—as was the case for Indonesia, Chile, and Turkey—remains a puzzle.

I suspect our vaccine experts weren’t sure the Chinese vaccine would be readily accepted by our people. And, worse, they probably thought that they could afford to postpone making a decision one way or the other (e.g., ordering any of the Western-made vaccines). Risk theory says that decisions can only be made in the context of the present. In November-December last year, when vaccine purchases could have been firmed up, new COVID-19 cases had significantly gone down from their July-August peak. Hence, there was no felt need to rush.

By the time vaccine manufacturers were already being swamped with orders, I suppose we were still thanking our lucky stars for sparing us COVID-19’s most punishing lashes. The National Task Force Against COVID-19 clearly thought we had time. More crucially, our President probably believed, deep in his heart, that he could always count on China, “our friend,” to deliver the vaccines we need when we needed them.

That’s how vassals think. That is not how modern leaders govern.

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