PH government’s slow vaccine rollout: Plainly inept or intentional?

SINCE THE pandemic hit the country in January 2020, the Philippines has moved through a chain of snafus and scandals: Filipinos suffered the longest-running lockdown, the highest number of cases in Southeast Asia for at least two months, and more recently, ended last in the line of ASEAN countries to get their vaccines.

London-based The Economist observed, “Few countries have handled vaccine procurement as shambolically as the Philippines, which dithered over signing a deal with Pfizer, an American firm, and ended up scrambling to secure shots from Sinovac, a Chinese one, at what many suspect are inflated prices.”

Ironically, President Duterte had repeatedly expressed his own belief that only a vaccine could end the pandemic, a usual remark in the video meetings supposedly meant to update the public on the latest developments in the COVID-19 front.

Scrambling for vaccines

In his State of the Nation Address (SONA) in July 2020, Duterte announced that he  “made a plea” to President Xi Jinping to prioritize the Philippines in its distribution  of its vaccines: “Can they allow us to be one of the first – or if it’s needed that we will have to buy it – that we will be granted credit so we can normalize as fast as possible.”

On December 15, 2020, Foreign Secretary Teodoro Locsin Jr. tweeted that “somebody” had “dropped the ball” in providing the paper work for a plan he was working on with Jose Manuel Romualdez, the Philippine ambassador to the US, to procure 10 million doses of the Pfizer vaccine funded by the World Bank and the Asian Development Bank. He confirmed on December 22 that he was referring to Health Secretary Francisco Duque III.

The president pointedly snuffed out all talk about this allegation, saying he had never authorized anyone else to procure vaccines except Carlito Galvez, Jr., the retired general he appointed to serve as chief implementer of the national action plan on COVID-19 and whom he also designated as his “vaccine czar.”

Nothing much was discussed in the interim, until December 26, when Duterte himself unwittingly let on that members of his close in security had already been vaccinated. A casual remark, but it might as well have been a presidential proclamation for the furor that it sparked. Perhaps, to control the damage of the presidential slip, Brig. Gen. Jesus Durante, commander of the Presidential Security Group (PSG), took responsibility for what was done and admitted that his subordinates voluntarily inoculated themselves because it was “so easy.”  Media coverage picked up on officials’ noting how this showed the dedication of the soldiers to their sworn duty to keep the president safe.

But public reaction expressed a mix of shock and outrage: that the president himself had made light of this violation of the law, that some of the soldiers may have been forced to submit to an untested vaccine, and that no other officials dared to condemn the flouting of a strict regulatory process.

Because the PSG had used China-manufactured Sinopharm, many Filipinos interpreted the premature vaccination as another presidential effort to prime public acceptance of China’s promised supply. Sinopharm had not yet applied for the necessary emergency use authorization (EUA). Undersecretary Eric Domingo, director-general of the Food and Drug Administration (FDA), admitted in two separate interviews in February 2021 that his agency’s investigation of the vaccine’s proscribed use had hit a blank wall of secrecy. No other member of the PSG was willing to talk, what with a reported gag order from the president himself. 

Meanwhile, Ramon Tulfo, a Duterte supporter and columnist appointed as special envoy to China, wrote in a pro-Duterte daily that he had also availed himself of the same Chinese vaccine that the PSG used, adding that he hoped to become Sinopharm’s Philippine distributor.

Galvez kept silent about the outright violations of vaccine protocols. He had begun briefing Congress about the national vaccine plan with a target goal of inoculating 70 million Filipinos before the end of 2021, written up in a document of 118 pages.

Another controversy loomed over the pricing of Sinovac Biotech’s Coronavac — another China-manufactured vaccine — which would have made it the most expensive of vaccines. A Senate hearing in January found the allocation in the DOH 2021 budget for the purchase of 25 million doses, with a single dose at a higher price than what Thailand or Indonesia were paying for. To compare: PHP3,600 per dose in the Philippines, PHP240 in Thailand and PHP817 in Indonesia. DOH said it based the cost estimate on its Google. Galvez said he did not know about the “highly improbable” figures and claimed confidentiality about the negotiations with Sinovac. After meeting with select senators on the issue, Galvez confirmed the Palace’s earlier claim that the Philippines would pay no more than PHP700 per dose.

Working with the global COVAX facility that ensures equitable vaccine distribution, Galvez announced on January 31 that Pfizer and AstraZeneca would arrive by mid-February.

Bungled plan

To prime the process, Galvez engaged local governments to prepare master lists, as LGUs held simulations of the vaccine process,which the media duly publicized. All well and good, except the vaccines did not arrive at his appointed time. All Galvez could say was “Yung tinatawag nating (what we are calling) delay is not coming from the Philippine government. We are only on the receiving end. We are finishing our documentation on time.”

His was a clumsy attempt to throw the blame at the pharmaceutical companies, which required recipient countries to enact a law authorizing an indemnity fund. Since the vaccines were only allowed for emergency use, manufacturers set as a condition an indemnity agreement to protect against any liability for any harm resulting from the vaccination.

Media reported that Galvez informed the Senate about this condition only in February. Cabinet Secretary Karlo Nograles said the pandemic managers were not informed by the pharmaceutical companies about it.

Two media organizations, Inquirer and Rappler, threw back the blame on government, pointing to the official responsibility of those negotiating with COVAX to know about this requirement and showed the information available online. Media reported that Congress went through final reading of indemnity legislation by February 23.

Pfizer and AstraZeneca had already received their respective EUAs on January 14 and 29 respectively. Meanwhile, FDA was holding back the EUA for another Sinovac because of the lack of Phase III clinical trial data; it then gave its approval on February 22 but did not recommend its use for frontliners because it had showed only 50.4% efficacy among healthcare workers directly exposed to COVID-19 in Brazil.

Yet on February 26, the IATF suddenly announced its approval of Sinovac for the health sector based on the recommendation of the DOH along with the National Immunization Technical Advisory Group, a recommendatory body formed to advise on vaccine and immunization policy that few even knew about. The DOH said the vaccine is still 100% effective against moderate and severe symptoms, clarifying that the frontliners can choose to wait for other brands without losing their priority status in the vaccination. The FDA turned around and concurred with the decision.

As though on cue, a mere two days later, a Chinese military plane arrived on February 28 with China’s donation of 600,000 doses of Sinovac.  The red carpet event was attended by the president himself and was covered by the media. On time for the turnover, Duterte thanked China, saying the Chinese government willingly gave vaccines without asking for anything in return. Duterte might have forgotten his admission that he pleaded with Xi for the vaccines. Understandably, he wanted to make a big thing of China’s donation and managed to shine his light on Sinovac.

The president was obviously satisfied that China’s vaccine had won the day and set the tone for everyone else. Galvez waxed with sentiment when he admitted that he was near tears saying, “Halos maluha-luha po kami nu’ng dumating po ‘yung Sinovac dahil talagang at last dumating na ang doses of hope natin na hinihintay.”  (We were in near tears at the arrival of SinoVac, because the doses of hope that we had been waiting for were here at last.)

As though there had not been enough twists and turns, Duque on the same day of Sinovac’s arrival announced that AstraZeneca would now be delayed due to “supply problems.” Duque did not go into detail. Galvez also told the media that the arrival of Pfizer would be pushed back to the second quarter. And so it was that on March 1, only Sinovac was available for the rollout of the vaccination program for all Filipinos to see.

On March 4, a mere four days later, a shipment of 487,200 doses of AstraZeneca arrived to full media coverage. The event was given the same red carpet treatment and fanfare as Sinovac, but Duterte was two hours late for the welcome ceremony.  Not surprising at all, as he has repeatedly expressed his lack of preference for products manufactured by “white people.”

Media noted that the supply was lower than the 525,600 doses which government had said COVAX would deliver, which apparently was due to packaging constraints in the commercial flight that delivered them.

Frontliners’ “choice”

Understandably, with lead officials not letting on how much longer they would wait for other vaccines, many frontliners decided to be vaccinated with what was available. Government officials who were not on the priority list went ahead and had themselves vaccinated in an attempt to encourage more healthcare workers to avail of Sinovac. When Galvez addressed them, he described getting vaccinated as every Filipino’s “moral obligation.”

Above the buzz of expressed disappointment and chagrin, some doctors and healthcare workers took time to explain their decision to get Sinovac. Some had checked out the efficacy in preventing severe symptoms and hospitalization, deciding that this level of protection was better than none at all.

Going around social media and picked up in the news, some messages expressed their sense of duty to restore public confidence in vaccine protection. Vaccine hesitancy rose notably in 2019 after some government officials actively campaigned and effectively demonized Dengvaxia for protection against dengue. Some of those who were inoculated with Sinovac still expressed disappointment in the delays.

Gideon Lasco, physician and medical anthropologist, put it best in his opinion piece in the Inquirer: “Indeed, while the oft-quoted “the best vaccine is the one that is available” makes sense if you have no choice, we have to question why we have no choice in the first place, and why those responsible for making the best vaccines available have not lived up thus far to their mandate.”

The timeline CMFR has tried to trace is important. It puts together a sub-text of some other objectives than providing in the best ways and means possible to protect the health of Filipinos, including honoring the word given to the frontliners of the country.