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Preparing for COVID-19 vaccination: the last mile
In my previous column, I wrote about the issues of preparing for the launch of the COVID-19 vaccine in terms of our current ability to meet the requirements of moving massive quantities of vaccine from arrival at the port to the actual point of injection. Since then, we have heard promising results from Pfizer, Moderna and AstraZeneca. The UK is poised to be the first country to roll out the vaccine next week, when it approved the one developed by Pfizer in conjunction with BioNTech. But for us in the Philippines, it will be a while before we actually get that plague liberation blow. The national vaccine czar, Carlito Gálvez, estimates that the best case to start the implementation of vaccination is the second quarter of 2021, while the worst case is in early 2022.
The government has a National Vaccine Roadmap for the Philippines that contains a seven-stage plan: vaccine selection, access, procurement, shipping and storage, distribution, implementation, monitoring and evaluation. For acquisitions, it has an allocated budget of P2.5 billion by 2021 to vaccinate 20 percent of the population. It is currently in talks with Pfizer and Moderna, and has signed an agreement with AstraZeneca for 2.5 million doses. The government is also online to access up to 20 million doses through the UN’s COVAX facility.
Vaccines come with different handling, storage, and administration requirements. For example, Pfizer’s and Moderna’s require ultra-cold temperatures of -700C and -200C, respectively, while AstraZeneca’s vaccines only need a regular refrigerator temperature. These requirements pose challenges in cold storage, warehousing, and transportation. So when these vaccines arrive, how prepared are we to implement the COVID-19 vaccination program, from distribution to administration and post-vaccination monitoring?
The role of LGUs is fundamental
In this column, I will focus on the last mile element of the supply chain in vaccine administration, which belongs to local government units (LGUs). How ready are the LGUs to implement a vaccination program against COVID-19?
To find out, the Zuellig Family Foundation (ZFF), which has been involved in strengthening the primary health care capacity of the provinces as they transition to Universal Health Care (UHC), commissioned a team of researchers to investigate the preparation of three provinces (Bataan, Aklan and Agusan del Sur) in the handling of vaccines. However, I need to disclose that at ZFF, we always keep drugs and vaccines at a distance. The assistance we provide to LGU partners is preparing their health systems to administer the vaccine, but the decision of which vaccine to purchase rests with them. We do not get involved in acquisitions. Once they have made a decision on which vaccine to receive, the next concern is involvement in the type of supply chain management (SCM) they must establish.
Research showed that while the basic SCM system is in place, it needs to be expanded. The major concerns raised by those who responded to the study were: (1) The need to prepare implementers, health workers, and the community with the necessary information about the vaccine. (2) The handling and storage of products from the provinces to the municipalities and barangays, especially since current facilities have sometimes been inadequate for regular immunization programs. And, (3) The need for guidance in the selection of your target population to prioritize and address possible shortages in case of insufficient supply from the national government.
The study concludes with what needs to be done at the local level to meet these requirements. You need to invest in adequate storage and distribution facilities. The provinces should have their MCS systems evaluated and ready when the vaccine arrives. Good vaccine quality is highly dependent on proper storage and distribution activities. There must be clear policies at the local level to protect quality.
While the national government will establish the guidelines for prioritization, allocation, and distribution, the provinces must have robust information to identify the target critical population, frontline health workers, and high-risk groups based on local epidemiological data, storage capacity and distribution capacity.
ZFF attaches great importance to prior work, which adds value to the task at hand and makes it easy to adjust should problems arise. So, the LGUs must do their work prior to the arrival of the vaccine. Even in the context of continuous change, if systems exist, the necessary adjustments can easily be made.
Overcome doubts about vaccines
Vaccine hesitancy has been identified by the World Health Organization (WHO) as one of the top 10 threats to global health in 2019. There are a variety of reasons ranging from cultural, social, and even political. But it is misinformation that has been the biggest culprit in generating confusion and mistrust in the government response and public health. In the Philippines, fear of Dengvaxia was a major factor in the decline in immunization in the country.
The COVID-19 vaccine already faces acceptance issues due to its accelerated pace of development and lack of historical data. The fact that it has to be given in two doses, each with possible sudden side effects (fever, body aches, muscle aches, and headaches) further complicates acceptance.
Risk communication and community involvement will be very important. Provincial governments must be clear and transparent in their messages. They should address rumors about vaccine safety, explain the implementation process, and state the expected results. They should warn people about the possible side effects of COVID vaccines so they know what to expect and aren’t afraid of getting a second dose.
It will be ironic if now that we have the weapon at hand to end the pandemic and return life to normal, we cannot convince enough people to get vaccinated to reach the number where community immunity is achieved.
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