Chasing waterfalls

SEARCH FOR TRUTH - Ernesto P. Maceda Jr. (The Philippine Star) - November 21, 2020 - 12:00am

On this, the week marking the anniversary of the first appearance in Hubei of SARS-CoV-2 in 2019, the biggest news is that there is good news at all. In an annus horibilis, we celebrate the breaks we get. The pharmaceutical world has been overtaken by the exhiliration over the Pfizer (95 percent) and Moderna (94.5 percent) vaccines. They’re effective, they’re fast. They’re just too good to be true.

With no serious side effects and efficacy consistent across race and ethnicity, the companies will be applying for emergency use authorization after only eight months. In the vaccine universe, this is groundbreaking as the time horizon of normal development processes is computed in years. Far more than Biden v. Trump, the result of this race to first matters globally.

The “grand” plan. What is encouraging is how in the Pfizer and Moderna clinical trials, even the senior set has returned a 94 percent effectivity. This is the age group particularly vulnerable to COVID-19. Not the most responsive to vaccines, their weaker systems pose a challenge to the production of neutralizing immunities. But even a third vaccine, from Oxford-AstraZeneca, has shown a remarkable efficacy with older adults.

Realistically, the emergency approval sought may not come as fast. This experimental technology has never before been approved for human use. Both companies would inject synthetic vectors with COVID-19 genetic material (messenger RNA or mRNA) for cells to simulate the covid “spike” protein. This in turn prompts the production of antibodies and T-Cells. Should you encounter the real virus, the simulated covid fragment triggers the already primed immune system to strike.

We’ll be well into December before FDA regulators sign off with the necessary confidence on vaccine safety. Also, questions remain unanswered, like duration of the vaccine or protection against re-transmission which would impact on herd immunity.

Logistical nightmares. How do you manufacture the quantities needed for the largest scale worldwide vaccination effort ever attempted? Distribution has been called the “defining global challenge of 2021.” Storage is particularly tricky given the fragility of the vaccines. The Pfizer variant requires freezing temperatures (- 75ºC) though it can be stored in an ordinary refrigerator freezer for 5 days. The Moderna vaccine requires more reasonable temperatures (-20ºC) but will keep in a standard refrigerator for up to a month. The Oxford-Astrozaneca version will need even less cold temperatures. And we’re talking about not one, but two doses.

And then there is the question of equitable access to the limited supply. This is the concern that birthed the pooled resource COVAX (Covid 19 Vaccines Global Access), the global anti-hoarding law. US (no signals yet from President-elect Biden) and Russia continue to be the major holdouts. Per the WHO, this will only serve to further prolong the pandemic. China is now on board.

Valuation of salvation. Our own vaccine distribution strategy will be dictated by these considerations. For sure, storage requirements and cold chain facilities (not to mention syringes, vials, gauze, alcohol swabs, etc.) will require massive investments. As it is, the 2021 budget for vaccine procurement stands at only P2.5 billion. This is far from the figure of P12.9 billion needed to inoculate at least 20 percent of our population, i.e. health frontliners and the senior set. So where to source the balance of P10.4 billion? Finance Secretary Sonny Dominguez has assured the public that an LBP-DBP lending facility is ready with up to P20 billion for our vaccine needs.

President Duterte, once averse to upfront payments for vaccine reservations and committed to a policy of waiting on more friendly deals with China and Russia, has since reconsidered. Just this week, he greenlighted the advance market commitments (AMCs) necessary for securing our place on the list with these private companies. Even our participation in COVAX requires AMCs.

But WHO warns against the allure of the unicorn. The vaccine is not a panacea. It won’t end the pandemic. Rather, its arrival heightens the potency of our existing arsenal to make the cocktail more effective. Like any cocktail, however, it is critical that each and every ingredient is consumed for maximum utility. The vaccine will be wasted if we stop wearing masks, washing hands and distancing.

Yukan’t get enough. One of our two Tiger Woods clones on the world’s women’s tours, Yuka Saso, gifted us with a peek into the future. In the final round of the TOTO Japan Classic, Saso shot a 9-birdie round of 63 to rally from 12th position to secure 2nd place. To shoot a 63 is course record territory but to do it in a tournament’s final round is a feat more impressive than hanging on to a lead.

This core of granite is why Saso inspires confidence. She has both the game and the mind frame to take herself, and us along with her, to the highest stage. Potentially, the biggest hurdle in her way is her Asian Games Philippine team gold medal partner and good friend, Bianca Pagdanganan. The other Tiger clone. That’s what I call a good problem.

Bianca is in Florida this weekend for the US Tour’s Pelican Women’s Championship, while Saso campaigns in Dahime, Japan at the Daio Paper Elleair Ladies Open. As of press time, Saso is leading her tournament going into the last two holes of the second round. Both have qualified for the world showcase, season ending Women’s US Open to be played in Houston, Texas next month. This is only the oldest and most prestigious American women’s major championship.

Saso has reclaimed her place atop the Player of the Year race on the Japan Tour and is No. 1 in money earnings. This is unprecedented for a rookie. In world rankings, she is No. 55 (from 73 just two weeks ago). She broke through the elite top 100 after having played only 19 events. This is the fastest of all the ranked players. As a perspective of her brilliance, the world Top 10 got there playing an average of 49 events.

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