The need for a Philippine CDC

Six months after the Duterte administration, its flawed and chaotic COVID-19 response continues to haunt current efforts to procure bivalent vaccines against specific variants of the virus, and to finally see the country recover from the health crisis.

As earlier pointed out by the Advisory Council of Experts (ACE), the lack of a sense of urgency and the unclear delineation of roles among multiple agencies involved in the management of the crisis were the weak points in the government’s pandemic response. The ACE is convened by Go Negosyo founder Joey Concepcion and is meant to help the private sector’s own initiatives at the height of the pandemic.

The medical experts noted that the lack of clarity on the roles of the Vaccine Expert Panel (VEP) and the Health Technology Assessment Council (HTAC) caused delays in making decisions about the vaccines that, in turn, was blamed for the low vaccination rate in the country.

The experts pointed out how the government’s different vaccination bodies have become a virtual alphabet soup: in addition to the VEP and HTAC, there were also the Nitag (National Immunization Technical Advisory Groups), the FDA (Food and Drug Administration), and the FEC (Formulary Executive Council). The VEP is under the Department of Science and Technology, while the rest are under the Department of Health (DOH). But the ACE noted a duplication of functions and overreach in mandates among these agencies.

For example, while the HTAC examines the cost-benefit and effectiveness of vaccines before procurement, the VEP recommends the age and prioritization of populations for vaccination. Yet it is the HTAC’s task to formulate the guidelines for this.

Former health secretary and Iloilo Rep. Janette Garin also blamed the HTAC for the vaccine delays. “Even if the expert panel or specialty society say otherwise, fear prevails if HTAC does not give the go signal,” Garin said.

Dr. Maricar Limpin, former president of the Philippine College of Physicians, agreed that functions overlap across the committees. “Time to delineate each and maybe collapse one or two,” she said.

Concepcion, for his part, has warned that these mistakes might be repeated in the procurement of bivalent vaccines targeted for the first quarter of 2023. The bivalent vaccines specifically target the Omicron variant which has become the dominant strain causing infections in the country and around the world.

“We can’t afford to make the same mistakes twice with our bivalent vaccines,” Concepcion said. The businessman, who led the private sector in procuring vaccines in the early days of the pandemic, noted how delays in decision-making led to billions of pesos worth of vaccines wasted. In July, the private sector lost 4.25 million expired vaccines in its warehouses worth P5.1 billion.

The DOH previously reported that as of November, the Philippines has wasted a total of 31.3 million vaccines amounting to about P15.6 billion, but stressed that this was still within the “acceptable level” of wastage by the World Health Organization.

The massive losses in terms of vaccines wasted and huge foreign debts have tragically led to lives lost, which should nudge the new administration to take into account the painful lessons of how not to handle a health crisis, and hereafter, to craft policies that would avoid those mistakes.

One such policy is the creation of an agency like the United States’ Centers for Disease Control and Prevention (CDC) as the lead agency handling public health emergencies, such as the pandemic.

President Marcos Jr. has listed the creation of the Philippine CDC and the Virology and Vaccine Institute as among his priority bills during his first State of the Nation Address, with the House approving both measures earlier this month.

House Bill No. 6522 proposed the creation of the Philippine Centers for Disease Prevention and Control as the lead agency to address public health emergencies caused by a pandemic, bioterrorism, or a nuclear attack or accident. As proposed, the CDC will lead and coordinate with various agencies to “clarify governance, decision-making, communication, and coordination processes and protocols related to identifying, diagnosing, forecasting, preventing, controlling, eliminating and eradicating, and monitoring diseases of public health importance.” It will also ensure “swift, coordinated, and data-driven surveillance and response” through the DOH.

If enacted into law—a counterpart bill in the Senate is yet to be approved—it is crucial that the CDC be composed of experts who will be independent in making crucial decisions during health emergencies.

Like in the US, the proposed CDC will be headed by a director general and will be attached to the DOH. It is thus important that the DOH secretary—who has yet to be named—ensures that CDC’s decisions are guided only by medical and scientific data, and not by politics. It should avoid such mistakes as that of Duterte’s health secretary Francisco Duque III who, in the first days of the pandemic, refused to impose a travel ban on Wuhan, China, where the virus originated, saying it might cause a diplomatic flap with China.

As that case has proven, the biggest flaw in the country’s pandemic response is that politicians, not medical experts, prevailed.