An ounce of prevention: Use of stronger vaccine vs pneumonia by PH gov’t hangs

MANILA, Philippines — The saying that an ounce of prevention is better than a pound of cure may have inspired the development of modern vaccines for a host of the world’s most fearsome but preventable diseases, among them pneumonia.

In the Philippines, the vaccine called PCV-13 has been in use by the Department of Health (DOH) since 2014. It was so named because it offered protection against 13 types of pneumococcal bacteria, one of the causes of pneumonia which is common among cases of the disease among children aged 5 and below in the country.

In November 2019, however, the DOH announced it was suspending bidding for new supply of PCV-13 which would have been used in 2020.

Another vaccine, PCV-10, has entered the picture but is still up for tests, according to multiple reports and documents from the DOH.

This has opened the door for interest in the health sector about the vaccines that could reduce, if not eliminate, child deaths in the Philippines.

The health sector party-list group Anakalusugan, which won a seat at the House of Representatives in the May 2019 elections, said it was studying and looking closely at the issue.

“I am willing to listen and understand the case from the DOH perspective,” said Anakalusugan Rep. Mike Defensor in a text message.

“We will study the issue carefully,” he added.

The group, Defensor added, would look at the experience of countries using either PCV-13 or PCV-10 “to know the situation.”

Three deadly serotypes

Research made by INQUIRER.net showed that three deadly microbes, or serotypes, that cause pneumonia among children 5 and below are prevalent in the Philippines.

These serotypes, according to multiple health websites, cause serious infections but the serotype called 19A was most prevalent and resistant to antibiotics.

Another microbe, called serotype 3, is also prevalent in the Philippines and is commonly associated with complicated pneumonia.

The third, serotype 6A, is cause of “invasive” pneumonia.

Pneumonia, according to different studies, is the top killer of young children worldwide.

Data from various online sources showed that the three strains are present in nearly 20 percent of samples taken from Filipino children with pneumonia in the past.

In its website, the DOH cited the World Health Organization (WHO) as saying that in 2015 alone, nearly 1 million children five-years-old and below had been killed by pneumonia or pneumonia-related diseases worldwide.

In the Philippines, the ratio of deaths to children as a result of pneumonia is 23.4 per 100,000, making the country among 15 in the world that account for three-fourths, or 75 percent, of all childhood pneumonia cases, according to multiple reports.

In reports about the DOH announcement to suspend the bidding for 2020 supply of PCV-13, different news sites quoted DOH officials as saying the bidding had been suspended because of questions about terms of the bidding being specific only to PCV-13, a generic name for the vaccine.

A memo of the bidding suspension issued by the DOH said the pause in bidding would give a chance for a review of “technical specifications” of PCV-13 although the Philippine public health sector had been familiar with the vaccine since 2014.

Multiple reports also said that at the time of the suspension of bidding, tests are being planned on the other pneumonia vaccine, PCV-10, that has entered the picture.

DOH officials had been quoted as saying PCV-10 would go through further study in the Health Technology Assessment Council (HTAC), an agency attached to the DOH which was created by the Universal Health Care Act of 2018.

The pause in bidding for new supply of PCV-13 is now unlocking research data and information about the efficacy of the withheld vaccine.

According to the US website Medline Plus, PCV 13 is “routinely given to children at 2, 4, 6 and 12-15 months of age.”

“It is also recommended for children and adults 2 to 64 years of age with certain health conditions,” it said.

The website, however, warned that those who have had allergic reactions to other vaccines should first clear with their doctors if they wanted to get PCV 13.

What prompted the suspension of bidding for P4.9 billion worth of PCV-13 good for the entire 2020 were calls for an “open and competitive” bidding, according to several DOH officials quoted by different reports.

Philippine Health Secretary Francisco Duque III, in a report shortly after the suspension of PCV 13 supply bidding was announced, said the study for the vaccine has been referred to the HTAC as a matter of procedure and in line with the 2018 law on universal health care.

But multiple reports said the withheld vaccine, PCV-13, is being used in 126 out of 159 countries which have ongoing national immunization programs.

Two of the world’s biggest First World countries—United States and Canada—are exclusively using PCV-13, according to the reports.

Since 2015, the reports said, PCV-13 use globally has been on the rise because of the broader protection it offered.

From 2015 to 2019, the reports added, at least 18 countries introduced PCV-13 into their immunization programs.

These were Spain, Cambodia, Portugal, Solomon Islands, Uzbekistan, Eritrea, Lebanon, Namibia Mauritius, Algeria, Kyrgyzstan, Iraq, India (5 states), Romania, Haiti, Mongolia and Seychelles and Bhutan.

Several other reports said the DOH also suspended bidding for PCV-13 to allow tests on PCV-10, which has just been offered to the public health sector at the time of the bidding suspension.

Health Undersecretary Eric Domingo in multiple reports was quoted as saying Duque had given the HTAC one month for a review.

“The bidding is on hold until the review is completed,” Domingo was quoted as saying by multiple reports.

The DOH, following the suspension of bidding for PCV-13, said the move would have no effect on supply.

Domingo, had also been quoted as saying he had been informed by health officials in charge of immunization programs that there is enough supply of pneumonia vaccines at least in 2019.

There was interest in introducing PCV-10 as an alternative vaccine but it was yet not on the Philippine National Formulary, a list of medicines in generic names that had passed rigorous tests and approved for distribution and use by the Philippine government.

Assistant Health Secretary Maria Vergeire was cited in different reports as saying PCV-10 was “still undergoing health technology assessment.”

According to the reports, this was being done through the HTAC which had been expected to complete the process in weeks instead of the six months to more than a year it often takes the process to complete.

A strain of pneumonia resistant to all antibiotics, however, might not be covered by PCV-10. The 19-A strain had been found in the National Capital Region which has not been covered by previous immunization programs for lack of funds, according to different reports.

Studies made in the US and United Kingdom showed that use of a vaccine that did not cover 19-A helped instead in spreading it, adding to government expenses and exposing more children to risks.

In a February 2019 paper, the World Health Organization (WHO) had said switching vaccines was being discouraged.

Switching to another vaccine, the WHO added, would be safe only if there were changes in studies of the disease for which the vaccines had been developed.

In the paper, which lauded the Philippine immunization program, the WHO, however, said in cases of pneumonia where antibiotic resistant-strains had emerged, the use of the vaccine PCV-13 was advisable as it has coverage for strains uncovered by other vaccines.

In an independent cost-effectiveness analysis in 2015 by the National Center for Pharmaceutical Access and Management and the Institute of Clinical Epidemiology—University of the Philippines National Institutes of Health, PCV-13 was found with better cost-effectiveness.

The study said while both PCV-13 and PCV-10 were “cost-effective compared to no vaccination,” PCV-13 was rated with the better value for money.

A 2019 study funded by the WHO and Gates Foundation found that PCV-13 was cost-effective in 92 percent of markets where it was introduced, including in the Philippines.