COVID-19 vaccine in the Philippines: How and when will we get one?
Immunizing the Philippines may still take a longer time even if President Duterte receives the first shot of Russia’s controversial vaccine as early as May 2021.
News Feature | Jazryl Galarosa & Justin Hapa
At least some of us are now used to telling our friends the phrase “when this pandemic is over,” optimistic that scientists around the world have the COVID-19 crisis sorted out and a vaccine that would end the pandemic is on the way. After all, President Rodrigo Duterte assured us that a vaccine is just “around the corner” during his fifth State of the Nation Address.
However, it may still take Filipino time to end the coronavirus pandemic in the country even if the world finally acquires a working vaccine.
How are scientists working on the vaccine?
A vaccine helps develop immunity to a viral disease by introducing (parts of) the killed or weakened form of the virus into the body. This stimulates our immune system to produce antibodies, the y-shaped molecules that neutralize the virus, without developing an illness. When the active virus later infects the body, the prepared immune system responds to it with a greater strength and for an extended duration.
Scientists across the globe use various ways to develop the coronavirus vaccine.
Some take pieces of the coronavirus’ genes and deliver it into the body directly to trigger an immune response. Others use a different virus to carry the coronavirus genes into the body. And some vaccine candidates use fragments of the coronavirus’ outer coat such as the spike and M proteins that are found on its surface.
To determine its safety and efficacy, the vaccine undergoes an animal testing trial and then three different phases of human trials, involving a few individuals up to thousands. But because of urgency, some developers are now conducting two different trial phases at once.
These trials take plenty of time and effort, so vaccine development usually takes years or decades. But with the pandemic collapsing countries’ healthcare systems, scientists and pharmaceutical companies are working at an unprecedented speed and scale.
More than 165 candidate vaccines are now undergoing trials, eight of which are in the third phase of human trials involving thousands of individuals. Moderna, Pfizer, and the University of Oxford in partnership with AstraZeneca are some of the developers in this stage.
Meanwhile, China and Russia appear to cut corners to front a lead in the vaccine race. Last June, the Chinese military offered to state-owned companies a vaccine developed by CanSino Biologics that has not yet finished the last trial phase. And Russia recently approved a vaccine developed by the Gamaleya Institute in Moscow that has also yet to complete the last trial phase.
Is the Philippines developing a vaccine?
Evidently, the coronavirus vaccine development is dominated by Westerners although there are also Asian developers who are led by the Chinese. But no vaccine research and development (R&D) takes place in the Philippines.
“While our scientists may have the skill level for the task [of developing vaccines], we barely have any of the necessary infrastructure for either the R&D or manufacturing, and certainly not in any sufficient quantity for robust vaccine research,” said Joshua Miguel Danac, member of Scientists Unite Against COVID-19 — an alliance of concerned scientists, organizations, and other citizens that calls on the Philippine government to expand our local and national testing capacity.
Despite the lack of infrastructure, the Philippines is still involved in the process, and its participation may be its best bet to gain access to the coveted would-be vaccines.
“Even though vaccine research and development is unheard of here, we still participate through clinical trials,” said Sam Ezrael Dela Cruz, a faculty member at the National Institute of Molecular Biology and Biotechnology (NIMBB) in UP Diliman. Danac added that this allows our frontliners to be vaccinated earlier as part of the testing.
Thus, it has always been the Philippines’ usual strategy to import vaccines from foreign institutions. But some scientists are hopeful that because of the pandemic, the government will begin creating some changes.
“It has been found to be more cost-effective to import vaccines than develop one ourselves. But the government has been rethinking this strategy and is exploring how we can restart capability,” said Dr. Jose Enrico Lazaro, director of NIMBB, as the Philippines has not been producing vaccines since 2012.
When will we have a vaccine?
In spite of the promising developments of the world’s scientists, the Philippines’ lack of vaccine R&D infrastructure means that it may have to take the backseat and wait a little longer than developed countries.
Lazaro said that one optimistic estimate is that the “vaccine will become ‘widely available’ by mid-2021.” The likely estimate is November 2021. But Lazaro and other experts contend that supply may not quickly match demand.
“The staunch global competition for coronavirus vaccines will face the Philippines up against bigger, richer countries,” Danac said, citing the case of the United States securing for themselves several months’ worth of remdesivir, a coronavirus drug with a proven level of efficacy.
Vaccine manufacturing also remains to be one of the toughest challenges. Danac said that high global demand combined with the intricacy of the manufacturing process could leave the Philippines with limited access to the vaccine over months or even years.
This would put low-income countries like the Philippines at a heavy disadvantage. Hence, in spite of the Philippine government already negotiating with about 10 suppliers to secure a coronavirus vaccine, according to Lazaro, the business-as-usual approach of independent procurement, where the Philippine government “acts as an ordinary buyer with any vaccine supplier” would likely leave hundreds of thousands of Filipinos unvaccinated for a while.
The Universal Healthcare Act also requires fourth trial phase (postmarketing surveillance) data for mass procurement and mass vaccination. This may leave us waiting while the rest of the world is using the new vaccine.
This issue is now being addressed by a more coordinated approach. The Global Alliance for Vaccines and Immunization (GAVI) is an initiative in which countries collaborate on a single, global manufacturing process. This would allow for vaccines to be allocated to “poorer” countries like the Philippines at a more affordable cost.
Warning that GAVI doesn’t necessarily include the best vaccines available, Lazaro said, “This situation does not preclude other forms of purchase (such as private consumption), as long as the vaccines have obtained a certificate of product registration by the Food and Drugs Administration.”
Dela Cruz said that we could also acquire the vaccines through donations just like what happened during the H1N1 pandemic in 2009. However, he cautioned that the circumstances are now different as “the rest of the world would also be scrambling to acquire vaccines.”
“Since vaccines come at a cost, if not for donations, this is already one big hurdle for us,” Dela Cruz warned.
Nevertheless, Lazaro said that the vaccine for COVID-19 is “likely to be much cheaper than the pneumococcal vaccine.” He further estimated that the coronavirus vaccine may cost around 700 pesos per dose. As we are going to spend four billion pesos on the pneumonia vaccine already, the cost of the coronavirus vaccines may not be much of a problem.
As per the latest pronouncement of the Philippine government, the vaccines under development in Russia will undergo the third phase of clinical trials in the Philippines alongside other countries which is not unusual. In fact, it would be beneficial for the phase III trials to be conducted in different countries to be assessed in different populations. However, the Russian vaccines offer no assurance as Danac cautioned that its phase I and phase II data have not been published by the Russian institution to be scrutinized by the scientific community.
“Before any clinical trials are conducted in the country, the phase I and II data must be reviewed and published to determine whether it is indeed safe and worth moving on to phase III trials. It should also be noted that a phase III trial is not the same as mass immunization or deployment of the vaccine. There must be strict enrolment of subjects, monitoring, and oversight. While hundreds or thousands of subjects may be enrolled in a phase III trial, this is not the same as declaring a vaccine to be ready for use in the general population,” Danac said.
But even if proven safe and effective vaccines come pouring in from other countries like Russia and China who vowed to help the country, the Philippines may still find it difficult to immunize the population. Our recent outbreaks of polio (which was already eradicated) and measles — whose vaccines were available for a long time — were aftermaths of the Philippines’ poor immunization coverage.
“Simply put, we have a bad track record of vaccinating people, especially the poor and underprivileged — the underlying issues will have to be addressed to achieve efficient and effective immunization. Herd immunity will not be achieved unless a sufficient proportion of the population is vaccinated, and that could be a very high proportion (more than 80% up to 90%). Below that, the vaccine will not be effective at stopping the pandemic,” Danac said.
“Without the necessary level of coordination and planning at the national level, there will be no effective immunization program, especially considering the disparities in geographic and economic access to the vaccine [and healthcare in general],” Danac stated.
The way forward, with or without vaccines
With several hurdles hurting our bid to acquire the right amount of vaccines at the right time, the question remains: what should we do while there’s no vaccine? And this is a question that developed countries must also answer since the vaccine candidates in the last trial phase, while promising, are not guaranteed to be completely effective.
“What we know is that the vaccines that have reached [the last trial phase] all induce the production of COVID-specific antibodies, but antibody levels in blood [measured in micrograms per ml, or in ‘titres’] are not a guarantee that the antibodies will be protective at that level or even protective at all,” Lazaro said.
In curbing the spread of COVID-19, Danac, Dela Cruz, and Lazaro agreed that lockdowns and social distancing measures would not be enough without rigorous testing and contact tracing.
“Lockdowns are not a solution in themselves — they are only mitigation strategies meant to buy time to implement effective containment strategies, primarily the active case finding through mass testing, efficient contact tracing, and effective isolation of identified carriers [of the virus],” Danac said.
Lazaro noted that even though our lockdowns prevented a large number of deaths, there is no clear evidence that we have flattened the curve.
“The strange thing about COVID in the Philippines is that in spite of having the longest and strictest lockdown rules in the world, cases continue to rise. True, compared to much of the world, our death rates are not the worst, but cases and deaths are not the only metrics in deciding this question of policy,” Lazaro said.
Dela Cruz also lamented that the growing number of cases show that we are not doing enough in testing and tracing.
Lazaro shared the same opinion. He explained that “if the proportion of positives among all tested is about 10–15%, [then] this means that we are screening effectively.” But he said that a 30% proportion is typical in our testing labs, which “means that we are only testing the symptomatics.”
“This is not effective contact tracing and screening. The aim of effective screening is to alert people early. So, it seems this is not working,” Lazaro said, speculating that the availability of the more reliable RT-PCR tests affected our tracing efforts.
What’s clear for the experts is that we are already doing what we’re supposed to do: testing and tracing. But the way, the manner, and the extent in which it is done simply does not seem enough.
To clear the path towards a COVID-free future, the government will have to reconsider its response to the pandemic. Lest it jeopardizes the many efforts already made, it has to get more organized to address the issues facing the country.
It has to look beyond “bent” curves and “beaten” predictions because as Dela Cruz emphasized, “amid all these statistics, numbers, and policies, human lives are at stake.”
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