MANILA, Philippines — The Department of Health (DOH) is pushing for a “brand agnostic” COVID-19 immunization campaign, after huge crowds turned up for limited doses of Pfizer vaccine in Metro Manila early this week, a scenario feared to be a possible superspreader event driven by preference for a particular brand.
“What we’re going to enforce now is brand agnostic [vaccination]. What should [only] be announced [by local officials] is: ‘go [to the site] and whatever vaccine will be available, you get it,’” said Health Undersecretary and Vaccination Operations Center chief Myrna Cabotaje in a television interview on Wednesday.
“If [vaccine recipients] do not like the vaccines given during that time, then they go to the end of the line,” Cabotaje added.
Another reason not to announce the brand, the DOH official said without elaborating, was that “[people were] reserving doses.”
Dr. Tony Leachon, health reform advocate and former government adviser, made a similar call for “brandless vaccination,” but said it must be coupled with public education that “all vaccines approved by the (Food and Drug Administration) are efficacious and safe.”
“Vaccine hesitancy is related to brand preference,” Leachon added.
The National Task Force for COVID-19 expressed alarm when large crowds swarmed vaccination sites in Manila and Parañaque cities after local officials announced the night before that they were offering Pfizer doses.
The “octopus queues,” as one observer put it, showed vaccinees largely disregarding social distancing.
Immediate objection
But Dr. Albert Domingo, a health systems specialist, cautioned that not announcing the vaccine brand “or any medical product a person is about to be given risks violating the principles of informed consent.”
The intention is “noble, but we must still respect patient autonomy,” he added.
“To avoid crowding, we should strictly implement appointments … [We may also] offer another vaccine brand alongside the ‘in-demand’ brand to gently nudge [walk-in] vaccinees to an equally safer alternative,” Domingo said, comparing the process to a pharmacist offering a generic brand if the branded drug is unavailable.
Also on Wednesday, the DOH logged 4,700 new cases of COVID-19 infections, which brought the country’s total case count to 1,159,071 cases.
In its daily case bulletin, the DOH said there remain 49,951 active cases or currently sick individuals. Wednesday’s figures mark the lowest number of active cases in the country in over two months, since the health department reported 47,804 cases on March 14.
Of the active cases, majority, or 92.8 percent, are mild cases, 2.2 percent are asymptomatic, 1.5 percent are in critical condition, 2.1 percent are severe, and 1.36 percent are moderate cases.
Meanwhile, 6,986 new patients have recovered from the disease, bringing the total number of survivors to 1,089.613. However, another 136 individuals have succumbed to the virus, pushing up the total death toll to 19,507.
Seven labs failed to submit their data on time, the health department said. The DOH also removed 17 duplicates from the total case count, while another 88 cases previously tagged as recoveries were reclassified as deaths following final validation.
Schedule important
According to Cabotaje, it was important for vaccine recipients to follow their schedules so that queues will not be disrupted.
She also said there would be no more right of first refusal, which was offered to health-care workers under the A1 category in the early days of vaccination when only the Sinovac vaccine was available. The vaccine was initially not recommended for health workers, so those who chose not to be inoculated with Sinovac got the AstraZeneca vaccines that arrived later.
‘Special sites’
Cabotaje said all vaccine brands used in the country have passed the scrutiny of experts. “All vaccines have efficacy levels. What is important is for you to go back for your second dose and just watch out for any adverse events. They’re all the same in giving protection to those who get vaccinated,” she said.
There is a “special arrangement” and “special sites” all over the country for AstraZeneca recipients because one of its side effects is blood clotting. But so far, no blood clotting incidents have been reported, Cabotaje said.
As for Pfizer, “the probability of allergic reactions are higher” so there should be strict screening of recipients to determine if they have a history of allergies and can be monitored for such, the DOH official said.
Adverse effects
“Other than that, I think all the vaccines have similar side effects that should be monitored postvaccination, like flu-like [symptoms], such as headaches and joint pains,” Cabotaje said.
So far, some 30,000 adverse events have been recorded for all vaccines, with 10 to 20 considered serious, she said. “But no serious side effect was traced to the vaccine; many of them were coincidental … As of now, our side effects are almost very minor [ones],” she added.
The government has also set up a National Adverse Event Following Immunization Committee that looks at the overall picture of side effects, with regional committees that investigate those that are reported, Cabotaje said.
According to committee head Dr. Lulu Bravo, cases of serious adverse events that reached them were of people who had unknowingly contracted COVID-19 at the time they were vaccinated. Some of those who died after getting the vaccine turned out to have underlying medical conditions that were not treated or given attention. As far as Sinovac and AstraZeneca vaccines are concerned, the reported serious side effects turned out not to be connected to the vaccination at all, she said.
Expiring AstraZeneca
The country’s stock of AstraZeneca vaccines have been distributed to vaccination centers, which have been instructed to prioritize their use, Cabotaje said, adding that the government target is to administer by June 15 the AstraZeneca vaccines expiring on June 30, and by July 15, those that would expire on July 31.
As for the Pfizer vaccine, Cabotaje said the 193,000 donated doses were divided into two, meaning there will be 96,500 recipients. More than 30,100 people have been given the first shot of the vaccine since last weekend, she said.