Formulary

Our standards are not any higher. But our procedures are infinitely slower. The poor suffer because of it.

The DOH admitted the other day that bivalent vaccines will not be available for Filipinos for a few more weeks. These new generation of Covid-19 vaccines still require a few more permits before they could be administered. In the meantime, infections are on the upswing.

Bivalent vaccines have been administered in other countries for months now. They have proven effective against new variants of the virus that brought about a pandemic. These variants are very likely circulating in our midst as we speak.

The matter of delayed administration of bivalent vaccines is merely symptomatic of a problem that has haunted us for years.

Recently, the president of the Philippine Society of Medical Oncology, Dr. Rosario Pitargue, urged our health officials to prioritize procurement of new generation cancer drugs that inhibit the mutation of a gene that causes breast cancer. A new drug Olaparib enhances the capacity of our immune system to fight cancer and may be used in combination with traditional chemotherapy.

Although this new drug was granted regulatory approval in 2021, it has yet to be included in our national formulary. Under our regulations, only drugs listed in the national formulary may be distributed to registered patients.

Under our system, new drugs will need approval from the Health Technology Assessment Council. The process could stretch for three years.

New drugs have been developed the last few years and are in wide use in other jurisdictions. In our case, new drugs to help fight cancer are still trapped in the permitting process.

Wealthier patients often travel abroad to be treated using new drugs that are not yet permitted in our national formulary. But poorer patients, the majority, are trapped here waiting for the permitting process to play out. The delay is anti-poor.

The new drugs will help extend the benefits of the cancer assistance fund by bringing down the costs of treatment. At the moment, only a small percentage of registered cancer patients benefit from this assistance because funds are limited and treatment costs remain high.

The problem is magnified by the dramatic pace with which new drugs have been developed over the past few years. In addition, new uses for existing drugs – as in the case of treatments for diabetes found to be effective in addressing obesity – are being discovered in rapid pace. But until these new treatment drugs are included in the national formulary, they will not benefit our people.

Our doctors are proposing that new medicines, once they are approved in jurisdictions with credible permitting procedures such as the US, the EU, Japan or Singapore, should be automatically allowed to be administered here. It makes no sense to waste time in bringing the benefits of new medicines to our people by insisting on undertaking our own tests. Our laboratory capacity is inferior to those of advanced countries.

About 9,000 Filipinas die of breast cancer each year. Many of these deaths should have been avoided if we had enough resources for early detection and if we could administer new treatments to them. Congress allocated only P1.6 billion for cancer treatment in public hospitals. That will cover only a small number of patients.

We cannot expect, given fiscal constraints, to have much more funds for early detection and treatment of cancer cases. But we could save more lives if we could move more quickly in the permitting process for new medical treatments.

It will take nothing more than a single utterance from the President to dramatically shorten the period for new treatments to be included in the national formulary.

Burned

Another architectural icon has been gutted by fire. This latest one is at the very center of our capital city and, once upon a time, was the vital communications nerve center.

The Manila Central Post Office is a relic from the past in more ways than one. It was built nearly a century ago in the neoclassical style preferred by the American colonial government.

In the Battle for Manila, the building was reduced to rubble. It was reconstructed in the late forties with its imposing concrete façade. Inside. however, the fire-prone building was all combustible.

The grandeur of the edifice notwithstanding, the postal service had lost much of the importance it once had. Hardly anyone uses snail mail anymore in this age of instant digital intercourse. Hardly anyone uses stamps either, although our postal service issued colorful stamps with regularity. Commercial logistics companies were more efficient in getting our packages to their destinations – and with lesser risks of pilferage.

I recall meeting a team from the Postal Corporation about two decades ago to discuss the possibility of setting up a postal bank. With less patronage for snail mail, the Post Office’s only remaining assets were its strategically located office spaces nationwide. That idea, however, died somewhere along the way with the rise of digital banking and real time point of sale payments.

The grand building sitting by the Pasig River was a museum piece on its own. Maintaining it was a burden for our unprofitable Postal Corporation. Poor maintenance probably caused that fire.

The postal service was shriveled by technological change. It could easily be relocated. With enough investments in sorting technology, it might even be made a little more efficient.

With its enviable location, the burnt out edifice could probably be rebuilt to serve a new function, possibly as part of the museum complex already existing.