Pfizer: Step One

Opinion

Written by Jean Marcus Sahagun
Illustration by Sophia Dumlao
Published 2020 December 23

Recent headlines had been brimming with the good news of a possible vaccine coming earlier than we initially thought.[1–4] Exponentially reducing vaccine development time from the usual fifteen to twenty years into just one is, after all, an outstanding accomplishment for the scientific community and everyone involved.[5] The first COVID vaccine from Pfizer was inoculated by a Filipina health worker in the UK;  The Moderna and AstraZeneca vaccines also show great promise with their Phase 3 clinical trials.[2,6–9] I was elated with these developments, as I oped to return to my old life before the pandemic.

However, this excitement did not last.

 Do not get me wrong, the news of the vaccine is one that should bring joy to anyone… anyone who can get it anyway. 

The highly sought-after vaccines – Pfizer, Moderna, and AstraZeneca among others – may take more than a year to be introduced here in the Philippines. Richer countries have been pre-ordering vaccine doses for their population at a staggering amount since the start of this pandemic.[10–12] Case in point, Canada has pre-ordered vaccines worth four times its population; while the US, UK, Australia, and Chile approximately twice of theirs. Moreover, the EU, Israel, Hong Kong, and Japan can immunize at least 100% of their current constituents. At the same time, upper-middle-income countries such as Brazil, Indonesia, Mexico, Argentina, Ecuador, and even Venezuela, have also been able to pre-order vaccines in their Phase 3 clinical trials. Meanwhile, lower-middle-income countries such as the Philippines  are lucky to even have vaccines ready for a proportion of their population.[11,13]

In the best-case scenario, the Philippine government will be able to obtain 25 million vaccines by the end of the first quarter of 2021 through Sinovac.[14]  Another 2.6M doses may also be procured from AstraZeneca through a tri partnership agreement between them, the government, and the private sector.[15,16] There are also deals currently happening right now with Moderna and Novavax with the potential of obtaining 25M and 30M more doses respectively.[17,18] Additionally, we could retrieve doses from COVAX (an initiative that ensures equitable access to vaccines), enough to cover 20% of our population by the end of 2021.[19–21] 

Alongside these negotiations, the government has made a vaccination plan. The government has a priority list of people to vaccinate first. The priority list is separated into five tiers, all of which constitute roughly 25M (22.8%) people or 50M vaccines doses as most of the vaccines require two doses to be effective.[22]

Sounds good so far, right? Unfortunately, timelines and promises are not strong suits of our country. We must be aware that AstraZeneca has multiple pre-orders to uphold.I doubt the vaccine will be available by early 2021. By the time it is available, it will only cover part of the first-tier priority group (consisting of 1.7M or 1.6% of the population).

Even then – a lot can go wrong. 

What if development gets stuck in a rut? What if a business deal goes awry? Just one error can delay the promised vaccination program.

Furthermore, there are other potential problems. Sinovac and Gamaleya, the two candidate vaccines that are expected to come in early 2021, are stifled with both questionable data and reputation.[23,24] As for COVAX, the initiative has only procured approximately 700M doses of its 2B goal.[11] Take note that we will have to share these doses from COVAX with 185 other COVAX-partnered countries.[25] In the scenario that COVAX will be unable to gather 2B doses by 2021, it will only provide enough to vaccinate  3% of each country’s population.[26]

Bottom line?

The majority of us Filipinos might not get the vaccine for a long time The worst-case estimates project a 2024 arrival.[13]

I want to emphasize one point: vaccines are not the be-all and end-all solution to the pandemic. Although they are necessary and important, they are not the magic bullet that will end all our worries.

 Waiting goes to show we have failed to contain the disease. By merely waiting for this “magic bullet”, we fail to realize concrete actions that we can do right now to contain COVID-19 transmission Do not demand resilience from a country managed by a negligent government, instead, demand responsibility.

Yearly, the Philippine government has been criticized for not upholding standards set by The International Health Regulations (IHR). The major concerns for Philippine Health standards deal with [27,28]: 

1. National plan for health security
2. Low vaccine coverage and increased hesitancy towards vaccination
3. Slow and inflexible mechanism of vaccine procurement
4. Inadequate service distribution
5. Inadequacy of cold chain capacities
6. Low diagnostic capabilities
7. Lacking surveillance systems
8. Uneven distribution of health professionals

We would have already contained COVID-19 had we implemented better public health plans and systems. Our neighbor Taiwan only has 766 confirmed cases [29,30] thanks to the government’s aggressive contact tracing national strategy, and steadfast implementation of protocols.[29,30,31,32] In comparison, the Philippines is still using unreliable and weak paper-based contact tracing for the majority of its lockdown.[33]

The Philippines has attempted to transition to digital contact tracing, yet even then, it’s inconsistent. The government-sponsored Staysafe.ph for example is disregarded by the Department of Transportation in favor of their contact tracing app, Traze. At the same time, there are miniature contact tracing apps by LGUs. Although Staysafe.ph claims that this is not a problem as it can be integrated with other contact tracing apps, the redundancy is confusing. Who takes responsibility for organizing all this data? Organizing the mess takes valuable lifesaving resources away from other important needs such as logistics, effective policymaking, and human resources – all of which are needed to combat the pandemic.[28,34–37].

Beating the pandemic demands urgency from those in charge. Whereas countries such as Taiwan reacted with haste and seriousness the moment a COVID-19 patient landed within their borders the Philippines has been slow with  COVID-19 testing and containment measures.[38–40] Concerns with contact tracing were only addressed last November, despite raising concerns as early as summer 2020. As a result,  the Philippines has been consistently on top in terms of COVID-19 cases compared to other countries in the Western Pacific Region [41,42, 47,48]. Furthermore, information about the current human resources of the Philippines and its logistical capacity is lacking. With that in mind, are we even capable of doing mass vaccinations, to begin with?

Giving credit where it is due,  lab testing capacity in the Philippines has been increased to 192 as of 10th December. In addition,  price limits have been implemented to make tests more affordable for us Filipinos.[43,44] 

But this is not enough.

People may say that comparing the Philippines to countries with successful COVID-19 responses is unfair.[45,46] I say otherwise,  if we look once again at Taiwan, Taiwan has over twice our population density. Higher population density means a higher risk of transmission, and yet they still managed to hold it off [49] Instead of accepting excuses, what we must do instead is to demand strong and proper leadership in these uncertain times.

With Christmas nearing, obeying the IATF guidelines set by the government becomes much harder. People will flock to places like Divisoria, malls, churches – in hopes for a semblance of their old life.[50,51] We have been in lockdown for roughly eight months afterall, the longest in the Western Pacific Region.[47]  Although I sympathize with wanting to head out,  we must not—doing so will further burden our already inefficient system.

We must do more than just lockdowns to beat the pandemic. . If we do so, we will only be stuck in a hellish loop of rising cases and lockdown extensions.  We must centralize our testing, organize our labs, and strengthen our health systems.

 This will not happen by waiting for a vaccine.

References

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