What about our country’s essential routine vaccines for children and other demographics?

First of 2 parts

WHEN the coronavirus pandemic was still raging, nations faced unprecedented tests of strength and resilience. But seven months ago, a collective sigh of relief was heaved across our country after Proclamation 267 was issued, which lifted the state of public health emergency due to Covid-19. While this proclamation was a significant achievement in our battle against the virus, it does not indicate the end of challenges posed by Covid-19 or other infectious diseases. Instead, it highlighted our nation’s capacity to manage the virus’ rapid spread and our adaptability in confronting potential health crises.

Central to our country’s response was a comprehensive, whole-of-nation approach that utilized various strategies, ranging from community quarantine measures to strengthening health care infrastructure and from widespread testing and contact tracing to targeted treatment programs. Public health campaigns played a vital role in raising awareness and promoting preventive measures, while economic incentives sought to ease the socioeconomic impact of the pandemic. Particularly notable was the swift procurement and equitable distribution of vaccines, which became a cornerstone of our national strategy, instilling a sense of urgency among Filipinos to seek immunization. Indeed, the statistics speak volumes. As of March 16, 2023, the Statistica Research Department reported that 79.2 million Filipinos had received a dose or two of a Covid vaccine. This figure is a demonstration of our shared determination and effective mobilization in the face of adversity.

However, amid the achievements of our Covid vaccination campaign, we must not overlook the importance of routine immunizations. These vaccinations are critical for protecting the health of children, pregnant women and senior citizens, forming an essential part of our public health infrastructure. Yet, is the coverage of these vaccines adequate in safeguarding these demographics from vaccine-preventable diseases?

In the last quarter of 2023, I participated in a small documentation project in a village in Metro Manila. The dedicated and friendly staff at the local health center, including village health workers, were committed to providing services to a large population across a vast geographic area. Nurses administered vaccines free of charge at the health center daily and extended services to various village enclaves on scheduled days. The health center obtained its vaccines from the Department of Health (DoH) through its city health office. However, our findings were disconcerting. The number of fully immunized children (FIC) younger than 12 months decreased by more than half (55 percent) in 2022 compared to 2,749 in 2018. FIC should receive several vaccines before reaching 12 months of age, including bacillus Calmette-Guérin (BCG), diphtheria-pertussis-tetanus (DPT), oral polio, Hepatitis B and measles vaccines, administered according to a scheduled plan.

We were also alarmed to find that the number of pregnant women vaccinated with tetanus diphtheria (Td) toxoids plummeted from 1,363 in 2018 to 124 in 2022. The reason? A lack of vaccine supply in recent years, forcing women to purchase the vaccine from local drugstores at a reported cost of P140 per dose before having it administered by a nurse at the health facility. Pregnant women should receive the Td vaccine (two to three doses) to protect both mother and baby during labor and childbirth.

The human papillomavirus (HPV) vaccine was available at the health center, yet very few schoolgirls ages 9 to 14 received it: 31 in 2019, 18 in 2020, and zero in 2018, 2021 and 2022. Nurses claimed to have administered the vaccine in 2022, suggesting issues with recording and reporting. The HPV vaccine’s low uptake can be attributed to the poor understanding of its importance in protecting girls from reproductive health cancers. The controversy surrounding the Dengvaxia vaccine, administered to public school children, likely contributed to parental hesitancy to immunize their daughters. However, there was an increase in vaccine acceptance among senior citizens, from zero in 2018 to 1,723 in 2022. Unfortunately, the data was not disaggregated for influenza, which should be administered annually, and the pneumococcal vaccine, which is given once every five years.

Our team asked if these issues persisted in other similar and geographically isolated villages. Can they be attributed solely to the pandemic? While the pandemic may have affected vaccine performance due to limitations on physical activities, the problem of routine vaccine coverage has persisted since the establishment of the Expanded Program for Immunization (EPI) in 1976. Despite the program’s initial target of achieving 95 percent FIC coverage, this goal has not been met over the years, with coverage ranging from 70 percent to 80 percent. Former Health secretary Francisco Duque 3rd addressed challenges in administering routine childhood vaccinations through Administrative Order 2021-0045, issued on Sept. 30, 2021, providing guidelines for catching up on routine immunizations. Despite these efforts, national FIC coverage decreased to 59.92 percent in 2022, according to the DoH’s Epidemiology Bureau Monitoring and Evaluation Division’s Field Health Services Information System annual report for 2022. The United Nations Children’s Fund reported on World Polio Day in October 2022 that 1 million Filipino children had not received a single vaccine dose. In 2021, our country was among the “[t]op 5 contributors to the 18 million zero-dose children globally and the top 7 contributors with children unprotected against measles.” The DoH report also highlighted low Td uptake among pregnant women, first-timers or not, as well as low vaccine uptake among seniors.

What accounts for the low coverage and vaccine shortages? While behavioral and perception-related issues may contribute to demand-side challenges, the primary challenges lie with the supply side, particularly within the DoH.

To be concluded next Sunday, Feb. 25, 2024