POSTSCRIPT / December 8, 2020 / Tuesday


Philippine STAR Columnist

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Trial shots not yet the mass vaccines

RUSSIA started Saturday distributing in Moscow its COVID-19 vaccine while the United Kingdom set to start today its own mass vaccination. The Philippines, meanwhile, is awaiting delivery in the spring of next year of 2.6 million doses bought by private business firms.

In January, the Philippines will start the clinical “Solidarity Trial” of selected vaccines for Filipino patients – but that is not the mass vaccination that President Duterte has promised. We point this out because people have to understand what is going on.

The media was told Friday by the Department of Science and Technology that large-scale clinical trials of vaccine candidates will start in January in several sites or hospitals in cooperation with the World Health Organization.

The “Solidarity Trial” involves randomized Phase 3-4 clinical tests organized by the WHO and partners, one of them the Philippines, to compare various treatments for COVID-19 patients in some 500 hospitals in 30 countries.

The trials will evaluate the effect of specific drugs on patients’ mortality, need for assisted ventilation, and duration of hospital stay. Treatment options will be compared against standard of care to assess their relative effectiveness.

On Oct. 15, a report on the trials said treatments using remdesivir, hydroxychloroquine, lopinavir/ritonavir, and interferon were found to have had little or no effect on overall mortality, initiation of ventilation, and duration of hospital stay. It said only corticosteroids have been proven effective against severe and critical COVID-19.

(Hydroxychloroquine was one of the drugs that President Trump admitted in May he was taking as prophylaxis against COVID-19 infection. Days after the news came out, the White House said he discontinued taking it.

(Hydroxychloroquine is available in the Philippines under the Plaquenil brand of Sanofi, and as a generic product of the Indian company IPCA. Registered with the Food and Drug Administration in Manila even before the COVID-19 outbreak, it is mostly used by lupus patients.)

With the unintended message having been floated that the vaccine is here, government may want to clarify that the trial vaccination is not yet the start of the mass inoculation of an initial 1.3 million Filipinos out of an ultimate target of some 60 million.

With experts saying that limiting the vaccination to a small percentage of the population is likely to be ineffectual in stopping the spread of the virus, one is left wondering if inoculating about 20 million Filipinos would impact on saving a population of 100 million.

Aside from 25 barangays as trial sites, these hospitals will participate in the “Solidarity Trial”: Philippine General Hospital (lead hospital), Research Institute for Tropical Medicine, Manila Doctor’s Hospital, San Lazaro Hospital, St. Luke’s Medical Center-Quezon City, St. Luke’s Medical Center-Bonifacio Global City, Lung Center of the Philippines, The Medical City, Makati Medical Center, De La Salle Medical Center-HSC in Cavite, Vicente Sotto Memorial Medical Center in Cebu City, Southern Philippines Medical Center in Davao City, Baguio General Hospital and Medical Center, and Western Visayas Medical Center in Iloilo City.

The government has set aside P89 million to cover such requirements as cold chain storage, reverse-transcription polymerase chain reaction testing quality assurance, blood sample collection, and supplies.

While better-prepared nations are scrambling to nail down their share of the total production of vaccine developers, the Philippines is just saying it is willing to pay.

A buyer must not only say “may pera ako” (I have money) but must pay at least a deposit. We may have billions but if the money is locked up in the bank earning interest for whoever, the vaccine supplier might decide to make an earlier delivery to somebody else.

Sorry if we nag the government to move faster. Between now and when a sufficiently large number of us are vaccinated to achieve herd immunity, how many will have to die on the altar of neglect and incompetence?

Several wealthy countries have sealed deals to buy more than two billion doses of the vaccine, with low and middle-income countries looking up to a global joint fund called the COVAX facility to help them get their share.

The US had placed an initial order of 800 million doses, with an option to buy one billion more. The United Kingdom was the world’s highest per-capita buyer, with 340 million doses that break down to around five doses for each British subject.

COVAX is headed by Gavi, a Geneva-based funder of vaccines for low-income countries, along with Coalition for Epidemic Preparedness Innovations (CEPI) and the WHO. It aims to secure two billion doses, one billion for 92 low- and middle-income countries and economies (LMICs), which account for half of the world’s population. The vaccines will cost these regions little or nothing. The other billion doses are for some 75 wealthier countries that will pay for their vaccines.

On Saturday, Russia began distributing its Sputnik V vaccine in Moscow, first to doctors and other medical workers, teachers and social workers, who are deemed to be at the highest risk of exposure to the disease. The vaccine will be administered in two injections 21 days apart.

Russia’s Health Ministry has fixed the maximum price of Sputnik V at 1,942 rubles for two doses (about $26.20). The price of a box with five two-dose sets was 9,710 rubles (about $131). Vaccination of Russian citizens will be free of charge and voluntary.

The UK starts today its own mass vaccination, using stock from Pfizer and BioNTech said to be 95-percent effective. The vaccine needs very special handling, as it must be transported and stored at minus 70 degrees Celsius, and can be moved only four times. People getting a shot will have a second after three weeks.

Pfizer and BioNTech have set their initial price at $19.50 a dose, which comes to $39 per patient (since each vaccine requires a two-dose regimen), in its $1.95-billion contract with the US federal government in July.

Moderna received nearly $1 billion from the Biomedical Advanced Research and Development Authority and has a $1.5-billion contract for 100 million doses, bringing its price to around $50 per patient or $25 a dose.

(First published in the Philippine STAR of December 8, 2020)

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