FILLING THE GAP
Even with gains made in the expanded program on immunization, some potentially life-saving vaccines are still out of many Pinoys' reach
By Alma Anonas-Carpio, Contributing Writer
While new vaccines to fend off invasive pneumococcal disease (IPD), the diarrhea-causing rotavirus, and the human papilloma virus (HPV) that triggers cervical cancer come highly recommeded by agencies like the World Health Organization (WHO) and are now available in the market, the Department of Health (DOH), through its expanded program on immunization (EPI), does not offer these vaccines.
Because of this, there emerges a "vaccination gap" between the rich who can afford these new vaccines (through private practitioners) and the poor who cannot-and so the poor become more likely to face the risk of becoming sick or dying from what would have otherwise been preventable diseases.
This vaccination gap is a direct result of funding issues at the National Immunizaton Program (NIP). Dr. Joyce Ducusin, NIP director, said that the EPI has funding of only PhP440 million, PhP300 million of which is earmarked for the procurement of vaccines.
Ducusin stressed that this budget is already a significant improvement, since this amount of money has improve the coverage for one of the more important public-health risks that Pinoys face-hepatitis B. With the increase in the budget for vaccination, the DOH is now able to vaccinate newborns against the hepatitis-B virus within 24 hours of birth. This amount also provides for "booster shots" at six week and 14 weeks.
The vaccines that Pinoys can avail themselves of for free at their neighborhood health centers every Wednesday are: the monovalent oral polio vaccine (OPV), measles vaccine, BCG vaccine, DPT (diphteria, pertussis, and tetanus) vaccine, and the hepatitis-B vaccine.
For adults, only the tetanus toxiod is available at health centers, and it is administered only to women of child-bearing age, This is done to bring down the rates of one of the country's top killers.
Long process
Before a new vaccine is included in the EPI, it must go through a long and arduous process.
First, studies must be conducted, said Ducusin, to "establish the burden of the disease" against which a new vaccine aims to protect people. In other words, the diease must be considered a highly significant threat to public health in the country.
After this, the DOH must study the "cost-effectiveness" of including additional vaccines to its vaccination schedule. This is done to determine "who will be prioritized" in the immunization program, Ducusin said.
The third step to adding vaccines to the EPI list is to study the "issue of availability of funding" for additional vaccines, given that the vaccines are already available locally.
As things stand, Ducusin pegged the cost of adding the Haemophilus influenzae type b (Hib) vaccine to the EPI at PhP150 million. If this particular vaccine becomes widely available through the EPI, the cost of immunizing at least 95 percent of the population against vaccine-preventable diseases shoots up to over PhP500 million. Then there is the problem of the "sustainability of funds" for the EPI if more vaccines are added to its list.
She also said that adding Hib and MMR (combination measles, mumps, and rubella) to the EPI drive up the program's funding requirements PhP1 billion-more than double the meager allocation the DOH must work with now.
As for adding an IPD vaccine to the EPI, Ducusin said: "There are many strains of IPD and we don't know which vaccines are effective. [The IPD vaccines] are also costly."
For now, the DOH relies on the United Nations Children's Fund (UNICEF) for funding assistance and vaccine procurement for infants-and then only for the primary series of immunization against childhood diseases, which cause 85 percent of the country's infant deaths.
While the national rate for total immunization ranges from 88 percent to 92 percent-the differrences depending on the availability of vaccines-a 95-percent immunization rate "is ideal," said Ducusin, adding that this vaccination rate will provide "80-percent protection for the affected communities." She added that she hopes that life-saving vaccine will be included in the cheaper-medicines bill now pending before Congress.
"If we had the luxury of money," she said, "we still have to identify the diseases, age groups, and then we will go for the combination vaccines over monovalent vaccines because this will save us the cost of syringes and spare the patients additional discomfort." The "acceptability" of combination vaccines, she said, "is very high" as far as the EPI is concerned.
Fighting more deaths
Writing for the Philippine Foundation for Vaccination (philvaccine.org), Dr. Carina Frago noted that based on National Statistics Office and UNICEF data, "35 out of 1,000 Filipino infants die annually from vaccine-preventable diseases such as measles, tetanus, pertussis, hepatitis, and meningitis."
The Philippines, she added, still has a long way to go before the task of safeguarding the populace from disease through immunization is complete.
Vaccines for other potentially deadly diseases-Hib, MMR, varicella, influenza, pneumococcus, rotavirus, meningococcus, hepatitis A, and typhoid-are still not available in health centers and can only be had by those who can afford them. "Sadly, only the middle-to-upper income groups are able to afford and, thus, avail [themselves] of these equally important vaccines," Frago said.
She also said "most parents are unaware of or misinformed about vaccines in general, resulting in missed vaccine schedules. They should be educated about the importance of immunization so that it will be among their list of priorities."
She added: "A fully immunized nation is an attainable goal-but it will take the combined efforts of the health care workers, government, legislators, non-government organizations and the media."
Potentially life-saving medicines and vaccines can only live up to their potential if access to them is made easy for all who stand to benefit-yet Congress has yet to resolve the issues surrounding the cheaper-medicines bill, and government funding for health-care services is not increasing fast enough to keep pace with the nation's needs.
And so at present, if Filipinos are to completely fill the vaccination gap, it must be done the costly way-by going to the doctor and paying for the vaccines not covered by the EPI.
For parents, this entails paying the pediatrician for vaccinations and combination vaccinations for their infants, children, and adolescent offspring. Adult vaccination is also available and can be had the same way-by going to the doctor to get shots for flu, HPV, and other vaccinations applicable to adults.
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