Bring vaccines to the provinces

Even though national supply is lacking, the government must find a concrete plan of action that will equitably distribute the vaccines. The COVID-19 vaccine rollout and deployment in the Philippines cannot ignore the needs of those places outside the main urban centers. The current spread of the virus has affected the whole archipelago, especially the geographically isolated and disadvantaged areas.

The National Government, in close collaboration with the regional and local public health and government units, must implement a rational and equitable allocation program of prioritization. With the supply allocation concentrated at the National Capital Region (NCR), slow-moving immunization in other regions and municipalities including Zamboanga City (which serves as a case study) must be corrected.

The COVID-19 vaccination rollout began on March 1 this year. The target is to immunize 50 million Filipinos. The immunization campaign list created by the National Immunization Technical Advisory Group (NITAG) prioritized groups assessed as the most vulnerable to the virus, namely senior citizens, persons with comorbidities, and frontline workers in the health sector.

The vaccination deployment intends to follow a cost-effective immunization strategy that is anchored on implementation by local government units (LGUs). Based on the guidelines of the National Vaccine Deployment Plan for COVID-19 by NITAG, priority population groups will be selected based on geographical areas. The prioritization is based on the COVID-19 burden of disease (current active cases, attack rate per 100,000 population in the past four weeks, and population density) and vaccination site and/or LGU readiness, particularly in relation to supply chain capability.

Supplies for vaccine rollout have been primarily distributed to the National Capital Region (NCR), with over 7.6 million residents having completed two doses of the vaccines out of the eligible population of 9.8 million (78% of Metro Manila’s total population), as of Oct. 11. Calabarzon’s full vaccination rate is 29.48%.

More distant regions have a lower rollout percentage. As a case in point, only 20.72% of the Zamboanga Peninsula regional population have been completely vaccinated as of Oct. 11.

Supply shortage is the most obvious factor for vaccine rollout delays in the country. Insufficient human resources, lack of healthcare facilities in most provinces, vaccine hesitancy, and delivery delays contribute to the slow vaccination progress, particularly in the regions outside of NCR.

Delayed immunization significantly explains the high COVID-19 transmission in the whole country. The unvaccinated people are the most vulnerable to getting infected, being hospitalized, and dying. The health of medical health workers is also harmed. They suffer from mental health issues, and many of them have likewise have gotten the infection.

Zamboanga City makes an illustrative case study. The report as of Sept. 27 showed that 98% of 1,654 cases were community acquired. Between August and September, infections in Zamboanga City, mainly caused by the Delta variant, increased by almost 37%.

But vaccination sorely lags. As of Sept. 27, Zamboanga City has administered a first dose for 179,578 residents and a second dose for 107,290 of the eligible population. But with a population of 977,234 (as of 2020), the number of fully vaccinated in Zamboanga City constitutes only 11% of the total.

Thus, Dr. Norvie Jailani, an epidemiologist at the government-owned Zamboanga City Medical Center (ZCMC), has called on the Department of Health (DoH) and the local government to speed up the vaccination rollout.

The Asia Foundation and Alliance for Improving Health Outcomes, Inc. recently conducted a study through Project Converge, “Assessing the COVID-19 Vaccination Needs of Selected Municipalities and Cities in Mindanao” Zamboanga City is one of the selected municipalities for the study. Data was collected through phone or online interviews from July 15 to Aug. 2. The results show the different factors that have contributed to the slow vaccine rollout.

Shortage of staff, specifically healthcare workers to administer vaccination, has contributed to the low vaccination turnout. The vaccination sites lack capacity and are unsuitable for the online/ digital electronic nature of rollout. The capacity problems include shortage in electricity, weak connectivity, and inadequate laptops.

But the most apparent reason for the low immunization rate is vaccine supply shortage. The available vaccines for Zamboanga City are far from enough to meet the demand.

Vaccine hesitancy in Zamboanga City, according to a local government representative, is no longer a pressing issue. The representative said that most people in Zamboanga City have expressed their desire to be vaccinated. A lot of people want to be vaccinated, but they are not receiving updates regarding their vaccine registration.

The case of Zamboanga perhaps mirrors the situation in the whole country. Demand is already up, but supply is woefully lacking. Exacerbating the situation is the people’s lack of information regarding the vaccine supply and distribution and the performance of vaccines.

The government must do its job and address funding, supplies, and human resources. Transparency also matters for people to be informed about the vaccine distribution and the performance of vaccines.

We have stressed time and again that the government can generate the resources not only for vaccination, but for the whole response to the pandemic. The government, for example, has benefited from the International Monetary Fund’s Special Drawing Rights, equivalent to around P140 billion. That amount should be used to procure additional vaccines and to provide augmented funding for other health and non-pharmaceutical interventions like social relief.

The government, too, can reallocate resources from the existing budget or from the proposed 2022 budget. A review of government spending shows a skewed priority for programs that are not responsive to fighting the pandemic, like the funds for counter-insurgency, unaccountable intelligence activities, and pork barrel.

Still, we acknowledge the tight global supply. In this context, the government must ensure the equitable distribution of scarce vaccines. The data show that vaccination has favored the NCR and the main growth centers. But this has meant sacrificing the poor regions like the Zamboanga peninsula and the Bangsamoro region. (The full vaccination rate for the Bangsamoro Autonomous Region, as latest figures show, is a dismal 9.5%! Compare that to the rate of 78% for NCR.)

The greater the number of people vaccinated in the country across all regions, the higher the vaccine effectiveness rate will be. That means a sharper reduction in infections and deaths.

Our call then is for the government to: 1.) increase the budget allocation for vaccination and other related health and socio-economic interventions, 2.) reform the vaccination system that gives premium to strategic guidance, logistics, training, and planning, and, 3.) implement the vaccine rollout equitably, for the benefit of the poorer LGUs.

No one is safe until we are all safe

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Emmanuella Iellamo is the researcher for the health policy program of Action for Economic Reforms.