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The long, slow grind

SEARCH FOR TRUTH - Ernesto P. Maceda Jr. (The Philippine Star) - March 6, 2021 - 12:00am

The arrival Thursday night of the initial batch of Oxford-AstraZeneca vaccines, manufactured in their South Korea facility, is another big stride in our push back against the virus and the march to normalcy. It was uplifting to see the President personally welcome the British vaccine widely perceived to have higher efficacy and acceptance among the populace.

One year ago, it was all desolation and desperation. The situation was as distressing for its despondency as it was for its doubtful outcome. With these vials of hope landing on our soil, we inoculate ourselves with more positive thoughts.

The vaccines are trickling in and they will build up toward the inevitable stockpile. Planes are landing around the world, in Third World countries, with their own small, initial batches. Rwanda, Nigeria, Kenya, Sudan, Cambodia etc. Production of vaccines will stabilize, ultimately. They will be as ubiquitous as flu vaccines. In the meantime, we wait until our turn comes. Then a stretch of the same experience as a year ago with the masks, alcohol shields, COVID tests shortages as supply catches up with demand.

So far, we got 600,000 Sinovac and 487,200 AstraZeneca. 756 Filipinos were vaccinated on that first day in what was largely a ceremonial effort. With a targeted 77 million for herd immunity, we’ll be needing hundreds of thousands vaccinated daily (up to roughly 250,000 per day) once all the needed stocks are in. We need to do this to cover as much ground in the remaining 10 months of 2021.

The bigger elephant. But how do we get more people to the vaccination centers? For now, the Nays still have it. 46 percent of Filipinos in January, 47 percent in February still comprise the No group.

There are several subgroups within. Some simply prefer the more natural solutions, especially for their children. The Dengvaxia experience just made it worse for them. Others simply don’t trust the government’s performance or are protesting against perceived inefficiencies. Among their grievances: fumbled messaging, illegal vaccinations, dropping the ball on the indemnification agreements, even the breaches in protocol in the ceremonial vaccinations. There are those who would rather wait for better vaccines or for the virus to become endemic.

Science, science, science. Their justifications, as we can see, are not irrational. In fact, it’s those who are ready to trust the science that seem to be taking a leap of faith. Even the science seems to get rebooted as we go along. We are hearing terms like mutations and variants that keep changing the picture that we know.

Even the vaccination two-step itself is raising questions. The feedback from the US is that the side effects from the second dose are even more adverse than those from the first. The reason for this, medically, is that the body has already responded to the first dose with the creation of necessary antibodies. So that when it breaks in again at the second dose, the antibodies are ready to be triggered for the immune response. That is the swelling, pain, body aches, fever etc. Hence, more drama.

Look out. At home, we now see spikes in what were otherwise plateauing infection rates. Will this be enough to convince more to get jabbed? Positivity rate hit 9.8 percent last March 4. This is the first time in quite a while that we have strayed that far from the ideal 5 percent. We actually dipped to 3.9 percent in early December. We have to exert more effort to recover lost ground.

What’s happening to testing? We celebrated reaching a 75,000aday testing capacity back in July. The math is simple, the more you test, the more you detect, treat and keep from infecting even more. Last July, we shared that with 32,000-plus tests, we avoid 4,000 to 6,000 deaths. Yet we have simply not managed to hit even half of our capacity. That 9.8 percent positivity rate was 2,510 positives from only 25,706 tests. The best testing performance is still the one-day high of 44,825 last September.

First movers. Around the world, countries are starting to normalize. England, 5th in the world in vaccination rate as of March 3 with 32.3 percent coverage, will begin face-to-face schooling this Monday, March 8. Regions in India, states and cities in the US will also open their schools. This is a snapshot of what we are missing and what we can expect if we step up.

In Israel, 92.5 percent of the population has been vaccinated as of March 3, 2021 (Israel at 9 million people has a population smaller than Metro Manila). They lead the world in vaccinations, followed by Seychelles, UAE and the US. Their vaccination campaign has been called the world’s largest clinical trial, their population being at least 10 times larger than the patient bases of regular clinical trials.

It will be weeks or months before we can make assumptions from the results of their efforts. The many variables that affect outcomes will be considered and given due weight in order to understand the data. We would have to tease out whether a drop in cases is attributable to the vaccine or to ramped up health protocols or the effects of a lockdown.

Hope in a bottle. But here is what’s undeniable. Within the first months of their roll out, when up to 90 percent of the older and at-risk groups had received their first doses (Pfizer), there was a 53 percent drop in new cases, 39 percent lower hospitalization and 31 percent decline in severe illness.

The most anticipated finding is whether the vaccine also figures in preventing virus transmission. The initial feedback suggests that there is a “significant” decrease in the cT value (i.e. the amount of virus carried by an infected person) in vaccinated individuals.

Our messaging is important, from the top as well as from the ground. The national talking heads and the influencers can only do so much. Community health workers are the most influential to the grassroots on making health decisions.

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