The Spy in the Sandwich

Monday, July 05, 2021

11:49 PM | Vaccine Envy, Part 2

First part, here.

In Contagion, the 2011 film by Steven Soderbergh that gained notoriety in our times as an unlikely prophet to the current pandemic [it was subsequently watched by millions, especially in the beginning months of 2020], the virus-ravaged world the film depicts starts going back to normal when a vaccine is finally found to be successful in combating the fictional MEV-1. By this time, the pandemic’s death toll in the story has reached 2.5 million in the U.S. and 26 million worldwide. [As of this writing, COVID-19—our real-life equivalent of the film’s MEV-1—has an official death toll of 3.98 million worldwide out of 184 million cases, including 605,000 dead in the U.S. and 25,149 in the Philippines.]

In the Matt Damon starrer, the Centers of Disease Control and Prevention [CDC] awards the vaccinations by lottery based on birthdates. I kept thinking about that.

Vaccination by birthdates decided by lottery.

And in fact, I’m not the only one who found that detail fascinating. On 2 February 2021, The Guardian reported that the United Kingdom’s health secretary Matt Hancock was obsessed with the film’s prescience, and “constantly reminded advisers … to heed the movie’s depiction of the complexities of an international race for limited vaccine supply.” According to the report, Hancock kept referring to the film’s ending, which made him aware from the very start that, “first, the vaccine was really important, [and] second, when a vaccine was developed we would see an almighty global scramble for this thing.”

The report went on: “Hancock was particularly struck by a scene in which a lottery based on birthdates is used to ration supply—not as a policy prescription but as an indication of how precious the vaccine would be.”

What is now going on, given this race to hoard vaccines, is what experts have termed “vaccine nationalism.” Dr. Amir Khan defined “vaccine nationalism” in a 7 February 2021 article for Al Jazeera as something that “occurs when governments sign agreements with pharmaceutical manufacturers to supply their own populations with vaccines ahead of them becoming available for other countries.”

Dr. Khan wrote: “According to a new report, published in the British Medical Journal, the U.S. has secured 800 million doses of at least six vaccines in development, with an option to buy about one billion more. The U.K. has purchased 340 million shots: approximately five doses for each citizen. Although, on the surface, it may seem these countries have ordered more doses than they need, the truth is many of these orders were put in during trial phases of the vaccines when they did not know for sure which vaccines would be successful. Essentially, countries like the UK have put their eggs in several baskets, which has now proven to be a good idea.” Khan also echoed W.H.O. Director Ghebreyesus’ plea from August 2020: “Whilst there is a wish amongst leaders to protect their own people first, the response to this pandemic has to be collective.”

The Guardian article also quoted Ian Lipkin, Columbia University’s director of the Center for Infection and Immunity and chief scientific consultant on Contagion, about the importance of finding the right formula for distribution, equitable for all the world: “The whole idea [of the film] was to try to inform people about what they needed to anticipate. We have to vaccinate the entire world, there’s absolutely no question about that. As long as there is a population that has not been vaccinated, there is a high likelihood that this thing is going to continue to evolve. So, people who don’t understand or appreciate that—it’s not only unethical, it’s also not in your self-interest.”

If we take away “vaccine nationalism” as a factor in distribution, the question remains: How do we exactly go about vaccinating people?

What system must be followed?

Is Contagion’s birthday lottery proposal a good plan to follow?

Lipkin also gave some insight—this time for Telegraph—about the vagaries of distribution: “Once you have covered the priority groups, health workers and the most vulnerable, and you try to roll it out to the remainder of the population, there has to be some acceptable and equitable way to do that. You could use a random number generator, or you could select birthdays as we did in the film. We used birth date lotteries for the [military] draft in the United States—who was going to go to fight and who wasn’t. This is obviously a different kind of lottery.”

No one, as far as I know, is doing the birthday route for COVID-19 vaccination.

What seems to be the system most nations are going for is distribution via groups stratified by age, occupation, and medical risk. In the Philippines, this stratification covers the following:

A1 includes frontline workers in health facilities both national and local, private and public, health professionals and non-professionals like students, nursing aides, janitors, barangay health workers, and others.

A2 includes senior citizens aged 60 years old and above.

A3 includes persons with comorbidities not otherwise included in the preceding categories.

A4 includes frontline personnel in essential sectors, including uniformed personnel and those in working sectors identified by the IATF as essential during the ECQ.

A5 includes indigent populations not otherwise included in the preceding categories.

B1 includes teachers and social workers.

B2 includes other government workers.

B3 includes other essential workers.

B4 includes socio-demographic groups at significantly higher risk other than senior citizens and indigent people.

B5 includes the Overseas Filipino Workers.

B6 includes other remaining workforce.

And finally, C includes the rest of the Filipino population not otherwise included in the above groups. As of this writing, we’re covering A4 in many places, including Dumaguete.

But vaccine prioritization in the Philippines has also taken in another factor: prioritization by regions, which means supplying the vaccines first to specific areas in the Philippines deemed an “emergency,” especially with surges in COVID-19 infections. In February 2021, when the vaccination program was first unveiled, the prioritized regions came as follows, in order of COVID-19 burden: NCR, Calabarzon, Davao Region, Cordillera Administrative Region, Eastern Visayas, Central Luzon, Cagayan Valley, Western Visayas, Northern Mindanao, CARAGA, Ilocos Region, Central Visayas, Soccsksargen, Zamboanga Peninsula, Bicol Region, Mimaropa, and BARMM.

By June 2021, however, new realities of COVID-19 surges in certain places have disordered this priority list by regions—something Philippine Daily Inquirer journalist Cristina Eloisa Baclig aptly called “the shifting sands of vaccination in the Philippines.” She wrote in her report: “Metro Manila and the provinces of Bulacan, Cavite, Rizal, Laguna, Pampanga, Batangas, Cebu, and Davao now compose a new geographical grouping that authorities called NCR Plus 8 for pandemic response purposes,” and that “a surge in infections outside the capital is redrawing the mapped strategy.” That redrawing has become a constant pressure and an endless challenge—and sometimes politics comes in to suggest further shifts in the prioritization.

In that Baclig report from 11 June 2021, we get the general picture of the national effort at vaccine distribution: “According to the National Task Force [NTF] Against COVID-19, around 64 percent, or 6,580,000 doses, of total vaccine supply were procured using the P72.5 billion allocation for the vaccination plan. Several manufacturers, led by China’s Sinovac, had already delivered vaccines to the Philippines resulting in these brands being available: Coronavac by Sinovac [7,500,000 doses], AstraZeneca [2,556,000 doses], Pfizer-BioNTech [2,472,210 doses], and Sputnik, the Russian vaccine by Gamaleya Research Institute [80,000 doses]. NTF data said that as of June 7, at least 8 million doses had already been distributed nationwide.”

By 29 June 2021, we get this update from Inquirer’s Krissy Aguilar: “[The] vaccine deliveries expected [are the following]: 5.5 million doses of Sinovac; 1,170,000 doses of AstraZeneca arriving between July 5 to 12; 250,800 doses of Moderna arriving on July 12; 500,000 doses of Pfizer arriving on July 12; 4 million doses from COVAX; 800,000 to 1 million doses from the U.S. government; and 1.1 million doses donated by the Japanese government… According to the Department of Health, over 10 million doses of the COVID-19 vaccine had been administered as of June 27. More than 2.5 million individuals were already fully vaccinated—that is, they have received two doses.”

As of July 2021, there are more than 111 million Filipinos.

Given the disparity between vaccination rate and total population, can herd immunity ever be reached? Herd immunity could indeed be achieved if 85 percent of populations were vaccinated, also taking into consideration the emergence of the Delta variant first detected in India in February. But in a report posted on 21 June 2021, the U.K.-based think tank Pantheon Macroeconomics said that the Philippines would be among the last to reach herd immunity: “The relatively slow pace of vaccination in the Philippines implies that early 2023 probably is the best the archipelago can hope for.”

2023.

Is peace of mind only possible in 2023?

So when I got the call from the City Health Office while I was preparing to do work in the afternoon of June 25, I knew I had to jump at the chance. Waiting was no longer an option, I thought. This call was a promise to some semblance of peace of mind.

Actually, I got two calls.

First, it was a male voice who intoned with some authority: “Can you be here at Robinsons Place Dumaguete before 4 PM?”

I said yes.

“Good,” the voice said. “We will be waiting for you, sir.”

“What should I bring?”

“Bring a medical certificate, if you have one with you. And bring your own ballpen.”

“That’s it?”

“That’s it.”

“Okay, then. See you!”

I must have danced the jig in my office.

And then my phone rang again.

This time, it was no longer an unknown caller: it was Gem, the City Health Office frontliner who was my guide and angel when I went through COVID-19 in December and had to isolate myself.

“Hi, Sir!”

“Hi, Gem! Long time no hear.”

“Sir, we’re calling about your vaccination—”

“Yes, I just got the call a few minutes ago!”

“You did?”

“I did!”

“Oh, that’s good! So you’ll be going to Robinsons Place later today?”

“I’m ready to go! Will you be there?”

“I’ll be at the office—but there are other CHO people there who will help you!”

I said my thanks, and then immediately called up the significant other to tell him the good news. We already planned for this: he was going to drive me to the vaccination center, he was going to document every single phase of the process, and he was going to be my yaya in my post-vaccination state—whatever that meant. I already surrendered to the inevitability that I was going to get Sinovac, and I’d read up on its reported side effects: injection-site pain, fatigue, diarrhea, and muscle pain—most of which would be mild, and last only for two days.

Going to get my first jab felt like a birthday.

I arrived at the vaccination site close to 4 PM. At Robinsons Place’s Movieworld—which made me think of all the movies I had missed (was this their way of making us nostalgic enough for the old normal so that we’d opt for getting vaccinated?)—I sensed a controlled busyness: beyond the reception desk, you could see people milling about among the carefully distanced chairs, but there was a certainty of process in the atmosphere—something I’d quickly get acquainted to.

At the reception, I had to give my ID to check against their list of appointments made for the day—the policy of no walk-ins remained enforced “to prevent chaos”—and once that was done, I was handed a clipboard filled with forms, five in all, including a procedural checklist and sign sheet, a general information sheet that also tackled allergies and comorbidities, a health declaration screening form in Filipino, an informed consent form, and a health assessment algorithm form. Filling out the forms took the longest time. Then someone began giving us an orientation—what COVID was all about, how vaccination can help, and what the process was in getting one in the center. There was Phase 1—getting your vital signs, then Phase 2—getting counseling, then Phase 3—getting a final go-over by the physician on duty, then Phase 4—getting the vaccination, and then Phase 5—getting monitored post-vaccination. Each phase was marked by a desk manned by people from the City Health Office, and consists of a trail that looped around the area of the Movieworld lobby, with the Movieworld arc being both entrance and exit. I eyed the “photo op” area at the exit with its “I Got My Vaccine Today!” slogan emblazoned in red.

“I am definitely doing that,” I told Renz.

“But you’re not a joiner,” Renz said.

“Well, this is also about fighting misinformation. Me posting my photo on social media might convince some people they could also go for this. This is a bandwagon I’m joining in,” I said.

My number was finally called, and I headed towards the Phase 1 desk, and had my temperature checked, my blood pressure checked, and my blood oxygen saturation level checked. All my vital signs were normal. I chatted a bit with the health workers at this table—but only just enough: there were other people waiting their turn. The process felt smooth.

At Phase 2, the health worker on duty scanned my forms, and took me through a questionnaire, making sure I knew what it was I ticked and wrote down in my sheets, and making sure I knew I was getting Sinovac. “I’m fine with it,” I said. “The best vaccine is the one that’s available,” I intoned the common—but informed—line.

I actually preferred some other brand of vaccine—but now was not the time to be choosy.

“How many times have you gone through this exact questionnaire?” I asked the health officer at the Phase 2 desk.

She laughed. “What priority number do you have?”

“I’m #265,” I said, quickly looking down at my forms.

She laughed again. “That means I’ve given this whole spiel 265 times today already.”

“Oh, dear God,” I said. “How’s your voice?”

“I lost my voice last week!”

“Are you okay?”

“We’ll be fine.” She laughed again.

At Phase 3, at the very end of the Movieworld lobby, I waited to get my final consultation with the doctor on duty. He was alone in his little table, surrounded by dim light, and he looked like a forbidding figure in a mystical quest, the quiet mage who got to determine your fate. He soon motioned for me. I quickly sat in front of him—and got a battery of medical questions, most of which I could not remember now. All I could remember was the comedy of our consultation: with both of us in our garbs of face masks and face shields, we could barely make out what the other was saying. It was a whole conversation filled with, “Come again?” and “What was that?”

But I got through that—and then sat in wait for Phase 4: vaccination proper.

I’d seen the viral videos circulating: the one in Makati, where the health worker on video doing the injection did not in fact plunge the injection’s plunger, hence unable to deliver the content of the vaccine into the vaccinee; and the one in Brazil, where health workers were accused of using empty syringes—a scandal that had given rise to the term “wind vaccinations.”

As I sat in my chair waiting for the jab, Renz knew what to do: document the entire procedure, including the plunging of the injection. But I also did my part, just in case: I watched the nurse on duty take a vial, inject the syringe inside to take in the vaccine, and then do that preliminary plunge into the void to get rid of air, sprinkling tiny liquid droplets in the process. My paranoia assuaged, I waited for the bite of the needle to pierce my arm.

It was the usual needle prick pain.

But in my thoughts, this one felt eventual: I just had my first dose, my thoughts raced. I have the COVID-19 vaccine running in my veins!

For sure, it was just the first dose.

But it was one step closer to achieving the elusive peace of mind I’d been seeking for so long in this long season of the pandemic.

I thanked the jabber, and went to take my place in Phase 5—the final monitoring post-vaccination. I was told this could take as long as thirty minutes. They were going to observe if I was going to get adverse reactions to the vaccine—and in the meantime, they’d check my vital signs once more: my temperature, my blood oxygen saturation level, and my blood pressure. Then a few minutes later, they’d check everything again.

“How many times are you going to check my vital signs?” I asked.

“Twice, sir. But actually before, we used to follow the protocol of checking at least three times.”

“This means then that I’d be getting out of here early?”

“Yes, sir.”

Fantastic. Everything in less than an hour.

Many of the nurses on duty were former students of mine—which felt nice.

One of them, Jake, finally came up: “Sir Ian! This is your vaccination card.”

“Thank you, Jake. I’m glad to see you here.”

“Congratulations on your first dose, sir! Your second dose will be scheduled on July 30. The City Health Office will call you to remind you about your appointment, and also whether there will be changes in the venue.”

“Fantastic! Can I go now?”

“You can go now,” Jake smiled.

And I went, to satisfy my post-vaccination donut munchies, but not before I got my “I Got My Vaccine Today!” photo op.

To be continued…