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Preparation of the COVID-19 vaccine
Like Donald Trump, the Philippines cannot wait too long for the COVID-19 vaccine to be available to ensure survival. The economy is in the midst of its worst economic recession and the World Bank expects it to recover much more slowly than our Asian peers, even under ideal conditions. The Treasury is nearly empty and has forced the government to increase its lending to record levels. He has even gotten President Duterte to consider selling our iconic properties in Tokyo. I hope that the reason prevails that this hasty and irrecoverable action is not carried out. These properties have a symbolic and practical value much more invaluable to the country than the amount they will obtain from direct sale. Cabinet officials have previously said that adequate funds are available without the need to sell state assets.
Since the cycle of alternate shutdowns and uprisings has not effectively slowed the disease and wreaked havoc on the economy, we, the president himself admits, depend on the availability of an effective and safe vaccine to return the country to normalcy. On the contrary, its lack or its slow deployment will prolong the economic malaise.
The challenge for our government, therefore, is twofold: ensuring access to a sufficient supply of vaccines and deploying it as quickly as possible. It sounds simple until you consider the magnitude involved. To achieve herd immunity, the point at which transmission of infection stops, at least 60 percent (some say 70 percent) of the population must be vaccinated. That means at least 60 million doses. Where do we get those supplies and can we pay for them? Is there a plan to acquire the necessary supply and then get them to the point where the injections are given? Do we have the infrastructure and logistical capacity for deployment?
Access to vaccine supply
There are currently three options to ensure access to the vaccine. One is through participation in the COVID-19 Vaccine Global Access Center (COVAX Center). The second is through bilateral government-to-government agreements. The third is commercial contracting, either through advance purchase agreements with manufacturers or by buying on the open market. In all options, the government is the key actor and the decision maker.
The COVAX facility offers the best option to acquire vaccines from a large portfolio of COVID-19 candidate vaccines (at least 10 manufacturers in six different countries and another nine in negotiations) at subsidized prices. This means that even if there are separate bilateral agreements with vaccine manufacturers, through the facility, countries have a much better chance of accessing vaccines that are shown to be more effective.
The Philippines is one of 98 low- and middle-income countries participating in the installation, which is a collaboration of WHO, Gavi, UNICEF, CEPI, PAHO, World Bank, and the Bill and Melinda Gates Foundation, among others. Their goal is to initially get enough vaccines for 20 percent of the participant population. In the case of the Philippines, that would translate to 20 million doses.
The Philippines is in talks for bilateral supply deals with China and Russia. The downside is that they will give priority to their own people and it has not yet been proven whether the vaccines they are developing will be safe and effective without question.
The third option will be the most expensive and will require self-financing. Advance purchase deals will be relatively cheaper, but will also involve betting on the success of a particular manufacturer in developing the vaccine. Buying proven vaccines on the open market will be expensive and we will have to queue to get them. DOH said they are negotiating with some of the manufacturers in the final phase of clinical trials.
Deployment: Where are we?
How much will it cost to buy the vaccine? Recent estimates of the prices of COVID-19 vaccines made in the US range from $ 4 to $ 20 per dose for supplies purchased federally from companies that had been subsidized up to $ 35 to $ 40 for others. Those from the COVAX Facility can be purchased at subsidized prices that reportedly range from $ 3 (of an Indian pharmaceutical product) to $ 7 per dose. DOH sources say they have contracts for P350 per dose, presumably from the facility, for 20 million doses.
The Secretary of Finance, Carlos Domínguez III, says that the Philippines plans to acquire 40 million doses, the cost of which is estimated at 20,000 million pesos. That’s an average of P500 per dose, which is probably low. Another variable is that, at this time, it is still unknown whether the vaccine will provide immunity for life or only for a specific period of time and whether they should be administered in one or two doses. It is also not determined whether this would be provided free or under Philhealth coverage (good luck with that). Initial dose assignments will be given to health and social workers, followed by subsequent installments of vaccine doses for the sectors of our population most at risk of severe COVID-19 disease. I would suggest that our seafarers, who are critical to the global supply chain, be put on the priority list.
Herd immunity is said to be achieved if 60 million are vaccinated, so we will need another 20 million to reach that threshold. Ideally, of course, it should be the entire population, as the maxim goes, “no one is safe unless everyone is safe”, that is, 60 million more. Who will acquire and pay for this?
The aforementioned expense is only for the vaccine itself. This estimate does not include the infrastructure necessary for controlled temperature storage and logistics, distribution from customs to the end point of service, that is, injection. Allowances must be made for syringes and needles. The same goes for the hard and soft infrastructure of cold chain logistics, including warehouses, refrigerated trucks, cold boxes with corresponding dry ice, whether third-party or government-owned. There would be the salaries and training costs of those who will handle and administer the vaccine. Robust digital technology must be used to track each individual dose from arrival to injection. Smooth edge FILIPINO WORLDVIEW … From B3
Processes will need to be in place to ensure timely regulatory approvals, proper security measures, and proper handling and clearance.
Health Secretary Duque announced that DOH will provide a detailed roadmap for successful vaccine procurement. He said that once a viable vaccine is identified for acquisition, the Department will provide “a detailed roadmap for its acquisition and deployment. Details would include their budget, funding scheme, pricing schemes, interim vaccine reimbursements, clinical trial insurance for side effects, volunteer participation fees for testing, and other specific guidelines. That ad ran in the newspapers on September 11. I’m afraid it may be a bit late, especially as an assessment of the cold chain logistics requirements has not yet been done so that the necessary investments can be made to meet the scaling-up requirements. from initially 20 million doses, but eventually up to 100 million doses, although these will be administered in a staggered manner.
The government will have to roll up its sleeves to meet this gigantic challenge. And it would be better if it did so in collaboration with the private sector, civil society and LGUs.
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