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Vaccine logistics

DEMAND AND SUPPLY - Boo Chanco (The Philippine Star) - March 15, 2021 - 12:00am

We are suffering a serious spike in the number of COVID cases just when many countries are preparing to lift restrictions because their cases have gone down. A big reason for the decline in cases abroad is aggressive vaccination.

Of course, it is no surprise the vaccines are arriving here in trickles. These are just donations from China and COVAX, a facility of the World Health Organization.

As far as has been publicly revealed, the Duterte government has signed a contract only with AstraZeneca for 17 million doses. Others like J&J, Moderna and even Sinovac are still at the signed term sheet stage.

Harry Roque claims a contract for 30 million Novovax doses was supposed to be signed March 10. No news if that happened.

Why don’t we have enough vaccine supply to start vaccination beyond healthcare workers?

Recall the cryptic tweet of Foreign Secretary Teodoro Locsin Jr. sometime last year. He said an offer brokered by him, Ambassador to the US “Babe” Romualdez, and US Secretary of State Mike Pompeo would have locked in 10 million doses of the Pfizer vaccine by as early as January 2021 “but that somebody dropped the ball.”

Last Dec. 17, 2020, Sen. Ping Lacson shared what he called a “direct quote” but didn’t say from whom. We can guess.

“In July, we passed the ball to him. Instead of aiming at the hoop, he scratched his balls, so he dropped the ball even as time was running out. Then, Singapore grabbed and shot the ball,” Lacson said.

Then again, a deal with Pfizer could have materialized earlier. Last June 24, 2020, Pfizer sent an overview of its candidate vaccine development and manufacturing program to the Philippine government.

Apparently, Duterte officials dribbled the ball. From the time Pfizer officials approached them in late June to start discussions on its vaccine candidates, it was only in late October, or four months after, that Health Secretary Duque signed the preliminary document. The document was finalized only in November by vaccine czar Carlito Galvez Jr.

Assuming those vaccines eventually arrive, can we trust these same officials to run a complex logistical operation to get the vaccines from cold storage in Manila and into the arms of millions of Filipinos nationwide?

They have prepared an extensive manual of 137 pages that will guide the process. From what I have read, it seems they are passing on most of the responsibility to LGUs. That should be fine if most LGUs had mayors like Vico Sotto of Pasig. Otherwise, expect implementation to be rather spotty, specially at barangay level.

But it is a good manual. I doubt if they have made good progress on the preparatory activities the manual mandates. No deadlines were set.

For our sakes, it is critical that everything happens as planned. The vaccines have short expiry dates and must be handled under strict temperature control. We could be wasting scarce supplies if planning and coordination is on the usual bahala na basis.

What should worry us is the track record of the folks, assigned by Duterte to manage our COVID response. We are where we are now because they have fumbled the ball too often. Also, none of them have commercial logistics experience.

The two top guys, Duque and Galvez, will likely play it by ear. The other one, Vince Dizon, is pretty good in accomplishing assignments, but even he has no experience in managing complicated logistics.

Yet, Duterte has a very experienced logistics professional in DOTr Sec. Art Tugade. If Duterte knows what is good for him and the country, he will pull out Tugade from DOTr temporarily to run this vaccine logistics operations. Tugade has worked logistics all his professional life and is respected by those in the business.

Maybe Vince can be OIC of DOTr since the remaining job there is just to make sure the projects are on schedule. Tugade has done most of the heavy lifting already.

I thought of Sec. Art after I read the column of my colleague Andrew Masigan in this paper on how seemingly clueless DOH was in drafting the basic bidding documents for the private entity that will handle logistics for the vaccine rollout.

According to Andrew, “the request for quotation (ROQ) issued by the DOH lacked many important details. It was silent on the timelines, quantities and final drop-off points of the vaccines, among other vital considerations. All these were left to the bidders to assume…. The inadequacy of information on the ROQ is indicative of the DOH’s level of preparedness.”

I checked with a friend who understands logistics and he said that there was a logistics summit held last December 2020 supposedly to get information on how to distribute the vaccines. Apparently, DOH didn’t listen much. My friend explained, the way DOH designed the supply chain added to the cost.

The one other thing that should worry us is waste disposal. Someone said on television that used syringes and vials will be collected, placed in a special container, then “brought to a sanitary landfill for disposal...”

LANDFILL?!?!? Are they kidding??? That will stay there for CENTURIES!!! These should be destroyed using pyrolysis burning to kill any infectious materials and other bio-hazards.

I checked the manual and they do have provisions for waste disposal:

“Onsite system. The healthcare facilities or implementing units may construct concrete vault within its premises to serve as the final disposal for the syringes and vials. The vault must be constructed of concrete walls and slabs with a minimum size of 1m X 1m X 1.8m.

“Offsite system. The healthcare facilities or implementing units may avail the service of a DENR-accredited waste transporter to transport all the hazardous waste generated during the vaccination to the final treatment and disposal facility.

“Used/opened vials should be inactivated prior to destruction. The recommended methods are:

“a. Inactivation by autoclaving, boiling, chemical inactivation, encapsulation or incineration.

“b. Destruction and disposal by transporting to the waste facility or burying.”

Something seems wrong here. Hazardous medical wastes must be burned, not buried, in a cement vault or a sanitary landfill. But that’s getting ahead. Get the vaccines first.

 

 

Boo Chanco’s e-mail address is bchanco@gmail.com. Follow him on Twitter @boochanco

COVID-19 VACCINE
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