Mass vaccination PH: Throwing away our shots (Part One)

April 15, 2021

by Rosario Guzman

(First of Two Parts)

Even with the global vaccines roll-out, the end of the health crisis appears to be far away yet, especially for countries such as the Philippines.

A number of Asian countries are seeing an increase in COVID with surges particularly large in South Asia and, in Southeast Asia, the Philippines. Highly infectious new variants have also arrived in the Philippines aside from one which developed locally. The Duterte administration has been telling us since last year that the arrival of vaccines is its ultimate solution but, dismally, these are coming in trickles.

New wave, same bungle

The Philippines recorded a new peak of a whopping 15,310 new infections on April 2, surpassing its first wave record of 6,725 in August last year. In relation to population, the country is among the most affected in Asia. The 7-day rolling average of new cases per one million population stood at 93.89 on April 13 which is higher than the average worldwide (92.06) and in Asia (63.82). It is also the highest in Southeast Asia, more than double that of distant second Malaysia’s 46.84, and far above Vietnam’s 0.10 and Laos’ 0.06.

At first glance, it seems reassuring that the Philippines’ cumulative 884,783 COVID-19 cases as of April 13 is just around half of Indonesia’s 1.58 million infections. However, the Philippines’ 165,534 active cases is the highest in the region and more than Indonesia’s 108,599 active cases – even if Indonesia’s population is over two-and-a-half times bigger.

More than 15,000 Filipinos have already died of COVID-19 – some 1,700 of which were in the past week. All this only shows how our health system is grimly unable to prevent surges and the deaths these bring.

The government’s response was to restrict travel within the Greater Manila area on March 21 and, a few days later, raise the lockdown here to the highest enhanced community quarantine (ECQ) level. After two weeks, this was eased to a modified ECQ (MECQ) lockdown.

The reasoning behind the pacing of these efforts beyond being a desperate attempt to arrest the spread of COVID is unclear. The government does not seem to be taking any real measures to improve its testing and tracing capacity, nor to increase the close contacts quarantined or make it easy for every patient needing treatment to get this. If anything, the Duterte government just seems stuck in its false dichotomy of health-versus-economy more than a year since the pandemic hit.

COVID-19 is still spreading so quickly in the country that it is being given the conditions to mutate further. The more virulent British, South African and Brazilian variants are already present in the country. There is a fourth one called P.3, a third-generation variant originating in the Philippines which is suspected to be a descendant of the Brazilian mutant. Current vaccines are feared to be less effective against these new variants.

Yet, with things so dramatically taking a turn for the worse, the Duterte government is bungling its mass vaccination program. The government declared a target 70 million Filipinos vaccinated by the end of the year to achieve herd immunity. Yet as of April 13, only 1,093,651 Filipinos have been vaccinated with just 162,065 of them already getting the required two doses. This means that an average of 29,203 doses were given per day between March 1, when the first official vaccine was administered, and April 13.

This also means that the government has to administer about 138.7 million doses from April 14 until the end of the year to be able to give at least 70 million Filipinos the required two doses. Coming to an average of 531,587 doses daily, this is an impossible target which the administration is cynically bandying about to distract from how poorly its vaccination program is actually performing.

Only around 3.02 million doses have arrived, with just 1.3 million administered so far.

The country is lagging behind neighbors in vaccinations with only 0.84 dose administered per 100 population by the first week of April. This is much lower than the 5.66 doses per 100 people in Cambodia, 4.92 doses for Indonesia, and 2.56 doses for Malaysia. On a 7-day rolling average, the Philippines ranked 7th in vaccination among the 10 ASEAN countries.

What is wrong with the Duterte government?

Severe symptoms in governance

The World Health Organization (WHO) representative to the Philippines Dr. Rabindra Abeyasinghe said that the Philippines is not unique in seeing an increase in cases. He also gave the unsolicited analysis that the increase “is not attributed in any way to incompetence”.

Before we make such a hasty conclusion, however, it would be more prudent to look back to more than one year of lockdown. For the record, the Duterte government’s management of the pandemic has been very poor.

From the beginning, the Duterte government has adamantly denied the importance of mass testing as the first step in containing the spread. Then and now, over a year later, it insists on a “targeted approach” starting with the most vulnerable which has basically kept us blind about the true extent of infections. The Department of Health (DOH) has always aimed low – from just 8,000 tests daily and even if these are increased periodically to keep up with the rising cases.

The government eventually targeted testing capacity of 50,000 per day. But it was still only testing mostly in the 30,000-40,000 range from July 2020 and really only started to breach 50,000 in March 2021 or well over a year after the pandemic hit. But this is not even done in a proactive manner, for instance as a follow-through to assiduous contact tracing.

The DOH proclaims that the Philippines has tested more unique individuals than its neighbors – even if the country only ranks third to Singapore and Malaysia in terms of number of tested individuals relative to 1,000 population.

The thing is, this ratio is not even as important as the cumulative positivity rate or the number of COVID-positive individuals divided by the total number of tested individuals – this remains high at a staggering 9.4% for the Philippines.

The daily positivity rate meanwhile even peaked at 25.2% on April 2 and only slightly fell to 19.4% as of April 12. In May last year, the WHO recommended that the daily positivity rate be down to 5% or lower for at least two weeks before governments consider easing restrictions. This has only been achieved for a few days at a time in May and June last year and then again in December.

The arithmetic of a high positivity rate is that either there are many COVID-positives or there are few total tests or both. A high positivity rate then suggests that transmission may be high, relative to the amount of testing, and that there are likely more infected people who have not been tested yet. Our very high positivity rates definitely tell us one thing – we need to test more.

A rough rule-of-thumb to see how much testing is needed is to divide the number of new confirmed cases per day by 5 percent. So, to illustrate, the 11,378 new cases on April 12 implies that we should be testing at a magnitude of around 227,560 per day – yet only 34,665 individuals were tested that day.

The Duterte government’s “testing czar” Vicente Dizon said that it can only ramp up tests to 90,000 a day, which is clearly far below what is needed. In any case this remains to be realized — the most number of individuals ever tested in a day by the DOH was just 58,975 people (on April 9).

Mass testing is not about testing the entire population as the so-called testing czar still apparently erroneously understands it to be. Rather, it is testing enough for us to confidently say that we are keeping track of most of the cases. This is not merely obsessing with the numbers but about scientifically and wisely controlling transmission and saving lives.

The Duterte government has failed as well in having efficient contact tracing. The target is to have a ratio of 30-37 contacts traced per case in urban areas (25-30 per case in rural areas). Yet the National Task Force (NTF) against COVID-19 reports an overall contact tracing ratio of just 1:6 as of April 2021. The National Capital Region (NCR) which has the highest number of cases actually also has one of the lowest numbers of contact tracers organized by the government.

This failure to track cases results in the coronavirus spreading freely, in uncontrolled waves of new cases, and in isolation and treatment facilities being overwhelmed. In NCR, there are reportedly 1,918 usable beds in isolation and monitoring facilities, but almost 5,000 patients have already been admitted. There are 3,210 usable beds in COVID-19 hospitals in the epicenter region but with 6,231 admitted patients.

Tertiary hospitals in the NCR have also recently registered 86% occupancy rate of intensive care unit (ICU) beds – a statistic that does not tell the horrors of public hospitals and of travelling outside NCR just to be admitted for confinement. The health system is overloaded.

The pandemic calls for a responsive and compassionate government, on-top and hands-on management, and visible leadership. But looking at the low priority given by the Duterte government to health and COVID-19 response shows that it is not any of these. In its 2021 budget, the government only alloted Php221.1 billion for health versus Php1.1 trillion for Build, Build, Build infrastructure (of which only 1.3% or Php14.7 billion is for the DOH). The health budget is not even much more than the military’s Php207 billion budget.

Measured as a share of gross domestic product (GDP), the Philippines also had among the smallest COVID-19 fiscal response in Southeast Asia. This is not simply about incompetence but about the COVID-19 response being militarized, politicized and self-serving. (Read Part Two)