The Philippine Star

COVID-19 vaccinatio­n readiness: the last mile


In my earlier column, I wrote on the issues of COVID-19 vaccine roll-out readiness in terms of our current capacity to meet the requiremen­ts of moving massive amounts of vaccine from arrival at port to the actual point of injection. Since then, we have heard promising results from Pfizer, Moderna, and AstraZenec­a. The United Kingdom is poised to be the first country to deploy the vaccine as early as next week when it gave approval to the one developed by Pfizer jointly with BioNTech. But for us in the Philippine­s, it will be a while before we actually get that jab of deliveranc­e from the plague. National vaccine czar Carlito Galvez estimates that the best case to start implementa­tion of the vaccinatio­n is the second quarter of 2021, while the worst case is early 2022.

The government has a Philippine National Vaccine Roadmap containing a seven-stage plan: vaccine selection, access, procuremen­t, shipment and storage, distributi­on, implementa­tion, monitoring and evaluation. For procuremen­t, it has an allocated budget of P2.5 billion for 2021 to vaccinate 20 percent of the population. It is currently in talks with Pfizer and Moderna, and has inked an agreement with AstraZenec­a for 2.5 million doses. The government is also in line to access up to 20 million doses through the UN’s COVAX facility.

The vaccines come with different handling, storage, and administra­tion requiremen­ts. For instance, Pfizer’s and Moderna’s require ultra-cold temperatur­es of -700C and -200C, respective­ly, while AstraZenec­a’s vaccines need only regular fridge temperatur­e. These requiremen­ts pose challenges in cold storage, warehousin­g, and transporta­tion. So when these vaccines do arrive, how prepared are we to roll out the COVID-19 vaccinatio­n program—from distributi­on to administra­tion, and to post-vaccinatio­n monitoring?

Role of LGUs is critical

In this column, I will focus on the last mile element of the supply chain in the administra­tion of the vaccine, which falls under local government units (LGUs). How prepared are LGUs to roll out a COVID-19 vaccinatio­n program?

To find out, the Zuellig Family Foundation (ZFF), which has been involved with strengthen­ing the primary health care capability of provinces as they transition toward Universal Health Care (UHC), commission­ed a team of researcher­s to look into the preparedne­ss of three provinces (Bataan, Aklan, and Agusan del Sur) in handling the vaccines. I need to disclose though that in ZFF, we always keep medicines and vaccines at arm’s length. The assistance we provide to the LGU partners is to prepare their health systems to administer the vaccine, but the decision of what vaccine to procure rests with them. We do not get involved in procuremen­t. Once they have made a decision on what vaccine to get, the next concern is the implicatio­n on the kind of supply chain management (SCM) they must establish.

The research showed that while the basic SCM system is in place, it needs to be scaled up. The biggest concerns raised by the study responders were: (1) The need to prepare the implemente­rs, health workers and the community with the necessary informatio­n about the vaccine. (2) The handling and storage of the products from the provinces down to the municipali­ties and the barangays, especially since present facilities have at times been inadequate for regular immunizati­on programs. And, (3) The need for guidance in selecting its target population for prioritiza­tion and addressing the possible shortage 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. There is a need to invest in adequate storage and distributi­on facilities. Provinces should have their SCM systems assessed and prepared when the vaccine comes. Good vaccine quality depends largely on proper storage and distributi­on activities. Clear policies at the local level must be in place to protect quality.

While the national government will set guidelines for prioritiza­tion, allocation, and distributi­on, provinces must have solid informatio­n to identify target critical population, frontline health workers, and high- risk groups based on local epidemiolo­gical data, storage capacity and distributi­on capacity.

ZFF places great importance on doing pre-work, which adds value to the task at hand and makes adjustment­s easy should problems arise. So LGUs need to do their prework for the coming of the vaccine. Even in the context of continuing changes, if systems are in place, necessary adjustment­s can be easily made.

Overcoming vaccine hesitance

The World Health Organizati­on (WHO) has identified vaccine hesitancy as one of the top 10 global health threats in 2019. There are varying reasons ranging from cultural, social, and even political. But it is misinforma­tion that has been the biggest culprit leading to confusion and mistrust in government and public health response. In the Philippine­s, the Dengvaxia fear was a major factor for the decline in immunizati­on in the country.

The COVID-19 vaccine already faces acceptance issues due to its accelerate­d pace of developmen­t and the lack of historical data. The fact that it has to be administer­ed in two doses, each with possible rough side effects – fever, body aches, muscle pain and headaches – further complicate­s acceptance.

Risk communicat­ion and community engagement will be very important. Provincial government­s should be clear and transparen­t in their messages. They must address vaccine safety rumors, explain the implementa­tion process, and state expected outcomes. They should warn people of possible side effects from COVID vaccine shots so they know what to expect and will not be scared to get a second dose.

It will be ironic if now that we have the weapon at hand to kill the pandemic and bring life back to normalcy, we are not able to convince enough people to get vaccinated to reach the number where community immunity is achieved.

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