A public-private sector gathering for a public health forum entitled ‘Kapihan sa Manila Hotel‘, through Samahang Plaridel, was recently held at the said venue on the topic of vaccine scare in the Philippines, including the law-based insights behind the process of competitive bidding on procurement.
Key personalities in the panel included Dr. Lulu Bravo, Executive Director of the Philippine Foundation for Vaccination and Atty. Tom Syquija, former Executive Director of Procurement Service- Philippine Government Electronic Procurement System (PS-PhilGEPS).
One of the main issues discussed was what caused the alarming vaccine scare in the Philippines in the past few years leading to a lot of health outbreaks due to a sudden lowered vaccine confidence coverage. Today, the Philippines is unfortunately considered as the “No.1 anti-vaccine country in the world“, as mentioned by Dr. Lulu Bravo based on her recent experiences in international conventions.
In reaction from a lawyer and government perspective, Atty. Tom Syquia emphasized the importance of proper handling of competitive bidding in light of any Department of Health (DOH) Vaccine Procurement.
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Dr. Bravo pointed out the real vaccine scare is not in the vaccine per se, that years and years of studies has been conducted, and passed through a process, before a certain vaccine is approved by the World Health Organization (WHO). To add to this, specific countries also has its own systems and management to distribute a vaccine.
On the other hand, the mis-education leading to the vaccine scare resulted in a huge drop after putting the Philippines at the helm of the vaccine campaign as led by Dr. Juan Flavier in the 1990s until 2015 including an outstanding statistics when we had zero (0) measles case in 2010.
Among the specific consequence of this include hundreds of deaths caused by the polio outbreak resulting to 500+ deaths in 2019; which could have been prevented if not for the vaccine scare lowering the vaccine coverage.
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There is also a concern among health experts that the resurgence of diseases and the potential exacerbation of currently prominent sicknesses, like pneumonia and meningitis, will become a larger problem should the public’s fear towards vaccines continues to persist.
Experts believe that vaccine confidence is a critical issue, especially since pneumonia is a very common disease in children here and abroad. Of the hundreds of countries in the world, the Philippines is included in the top 15 countries in terms of pneumonia deaths, and those 15 countries are responsible for 75% of all deaths from pneumonia.
“In the last year or so we had so many outbreaks. Since 2018, nawala ang vaccine confidence ng Pilipinas. Isa tayong country na naging number one anti-vaccine country in the world,” said Dr. Bravo, “The vaccine confidence of 93% in 2015 plunged to 30 percent in 2018.”
“Patients, people, and the community, would drive away the healthcare workers. They were being stoned, they were being driven away, and were even called child-killers,” she added.
In an earlier statement, the DOH pointed to vaccine hesitancy, or the refusal of vaccines despite availability, as one of the reasons for the recent measles outbreak in some regions of the country.
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A stronger push towards more competitive bidding is also key to regaining public confidence in vaccines.
“It’s always best to have a public bidding, because competition will give you the best price. It is transparent. You get the same quality but at the lowest price. It’s always best for the public if you have competition,” noted Atty. Syquia.
The budget for pneumonia vaccines alone is P4.9 billion, allotted for Pneumococcal Conjugate Vaccines (PCVs), which aim to guard against Invasive Pneumococcal Diseases (IPDs), the largest cause of death for Filipino children under five.
Currently, there are two vaccines available for the government to procure during the next budget allocation, PCV 10 and PCV 13, two vaccines that global health experts claim are comparable in performance.
In February 2019, the WHO reaffirmed an earlier position saying that the two available PCVs are equally effective in preventing overall pneumococcal diseases in children. The position paper also states that there is at present insufficient evidence of a difference in the net impact of the two available PCVs on overall disease burden.
“The WHO has already come out saying that there’s really no difference between the two,” said Dr. Bravo, when discussing the efficacy of the two PCVs. “Many developing countries have already procured PCV 10.”
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Similarly, the Pan-American Health Organization (PAHO) in its own study said that available evidence to date indicates significant impact of both PCV10 and PCV13 in the outcomes studied, with no evidence of the superiority of one vaccine over the other on pneumonia, IPD, or meningitis hospitalization reduction in children under 5 years old.
In turn, the International Vaccine Access Center (IVAC), in their 2017 PCV product assessment which was based on a comprehensive review of published data, also declared that current evidence does not indicate an added benefit with one vaccine over the other.
“The first thing to ask is, what is appropriate for the Philippines? How many manufacturers make PCV13? How many PCV10?” said Syquia. “You need a decision on an expert level. What product do we need? Then it will dictate the modality of the procurement.”
Even when the procurement process is transparent, there is a danger in the way it is implemented, claimed Syquia. The bid posted by the government is required to list specifications regarding the item to be procured. It is possible to “tailor-fit” the bid by listing specifications that unnecessarily cut other options out, making it difficult to protect the sanctity of the contract.
“Do we need a PCV10? If that is sufficient, and has multiple suppliers, why would you go for 13 if there is only one (supplier)?” he said.
Atty. Syquija added an insight that in cases when there is only one unique supplier for a product (just like Apple Inc. is the only tech company that can provide ‘Siri’), or a vaccine in this case, competitive bidding turns into a ‘Direct Contracting‘.