Waiting for the vaccine

The vaccine is still several months away from mass application in the Philippines. People in less-blessed countries like ours will watch with envy when COVID vaccination starts in the United Kingdom next week, and in the United States the week after.

Even people like me, made vaccine-averse because of my potentially life-threatening allergic reaction to several drugs, will long for the possibility of a speedier return to normalcy and revival of livelihoods if we could begin rolling out a COVID vaccine before Christmas.

This, unfortunately, is just wishful thinking for developing countries like ours with no local vaccine production, and with limited resources for drug procurement further hammered by the pandemic.

It will be a challenge for the government to manage the impatience that will inevitably set in as Filipinos watch COVID vaccination get underway in other countries.

The fact that the vaccine being rolled out is made by US pharmaceutical giant Pfizer, with 95 percent efficacy, adds to the vaccine envy. The logistics hurdle for the company’s vaccine, which requires 70 degrees below zero storage temperature, is apparently being dealt with through the use of the special dry ice product of US firm Capitol Carbonic. German cryogenics firm Mecotec is also offering its services. If the vaccine can cross the Atlantic safely from the US to the UK, then the problem has been addressed.

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Also inviting envy is the speed by which the UK food and drug regulator approved the emergency use authorization for the Pfizer-BioNTech vaccine.

The US, where vaccination starts in two weeks, has vowed its own regulatory approval shortly, and aims to vaccinate 100 million people by the end of February next year.

That’s nearly our entire population. In our case, the typical period for approving the use of a drug by the Food and Drug Administration, according to Health Undersecretary Maria Rosario Vergeire, is 250 days. Presumably, those are working days, so that’s nearly a year of FDA assessment.

For emergency use, which President Duterte has ordered the FDA to authorize for the COVID vaccines, the process could be as short as 21 to 40 days, Vergeire told “The Chiefs” last Wednesday night on OneNews / TV5.

Yesterday, with Duterte breathing down its neck, the FDA said emergency use approval could come as early as this January.

Not all vaccines, however, can be fast-tracked for regulatory approval. Vergeire explained that this is possible only for pharmaceutical products sourced from countries whose drug regulatory regimes meet standards set by the World Health Organization.

Fortunately, the countries include the US and UK, so the vaccine being procured by the Philippine private sector from British pharma AstraZeneca, which was developed together with Oxford University, can be fast-tracked.

Vergeire is not sure if the countries include China and Russia. I’m guessing that the other countries include Switzerland, France, Canada and Germany.

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The speed of economic recovery will depend on the availability of a vaccine. In our region, it’s a safe bet that city-state Singapore, which can afford to buy all the jabs it needs and vaccinate its entire population in less than a week, will lead in the economic recovery.

Because of the population size, the extent of COVID infection, procurement capability and dependence on imported vaccines, the Philippines and Indonesia will probably be among the last to recover in Southeast Asia. Several investment and business consultancy firms, however, are projecting that the Philippines will be the regional laggard in post-pandemic recovery.

The next hurdle will be the orderly distribution, with orderly being the operative word. Because of the rush, let’s hope it won’t be as messy as the rollout of cashless transaction on the toll roads. In the past days, the traffic jams have been horrid at the approach to the NLEX and CAVITEX toll booths, with even long-time RFID holders supremely inconvenienced.

Even the release of the latest version of the P1,000 note needs better coordination. The notes can be withdrawn but can’t be deposited; several ATMs have yet to be calibrated to accept them. It’s been about two months now but the ATMs of even banking giants such as Citibank keep spitting out the new notes when you try to make a deposit.

Before the vaccine arrives, the government will also have to clarify its policy on those who refuse to be vaccinated. This pandemic calls for healing as one, so health experts say a substantial number of people must be vaccinated especially in the epicenter, Metro Manila, to achieve herd immunity.

There could also be resentment in the prioritization of recipients. No one will challenge the wisdom of vaccinating the health frontliners first, including the security frontliners who enforce quarantine rules, as well as the most vulnerable elderly and those with high-risk comorbidities such as lupus and cardiovascular diseases.

But there could be debates on whether the relatives of the priority recipients should be included (and up to what degree of family ties).

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The other side of the coin, which governments are also grappling with, is vaccine skepticism.

Since the US and UK vaccines were developed with unprecedented speed (using the ground-breaking messenger RNA technology, the companies stress), and long-term side-effects obviously can be known only after a sufficient period has passed, there is resistance to at least being the first in line for the vaccination.

In the US, despite the country registering the highest number of COVID infections and deaths in the world, vaccine skepticism is such that three former presidents have offered themselves up as vaccine guinea pigs: Barack Obama, Bill Clinton and George W. Bush.

Can our government compel people to get vaccinated? The general opinion is no – the government is mandated to provide universal vaccination for childhood illnesses such as measles, mumps and rubella, for example, but parents can refuse to have their kids vaccinated.

In the case of a killer pandemic that has crippled the economy, however, will the rules be amended?

One advantage of not being first in line for the vaccines of Big Pharma is that we will have some time to see if there will be adverse side effects on the first recipients. It would help shape an informed choice on whether or not we should get an anti-COVID jab.

But first, we have to get the vaccine here. The sooner, the better.