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 pre-work 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.