(This is the third part of a special report by SunStar Philippines on efforts to defeat the Covid-19 pandemic through vaccination.)

NEARLY 24.7 million Filipinos, or about 23 percent of the population, will receive the free vaccine against coronavirus disease 2019 (Covid-19) first.

Among them are the frontline health workers, senior citizens, indigent population and the uniformed personnel, Department of Health (DOH) Undersecretary Myrna Cabotaje said.

The priority list, or Group A, includes:

• 1,762,994 frontline health workers in both public and private hospitals, and barangay health workers;
• 3,789,874 indigent senior citizens;
• 5,678,544 remaining senior citizens;
• 12,911,193 indigent population; and
• 525,523 uniformed personnel of the Armed Forces of the Philippines (AFP), Philippine National Police (PNP), Philippine Coast Guard, Bureau of Fire Protection and Cafgu.

Next in line, or Group B, are the teachers; social workers; government workers; essential workers outside health, education, social welfare sectors including agriculture, food industry, transportation, tourism, manufacturing and construction, among others; special groups such as persons deprived of liberty, persons with disability and those living in high density areas; overseas Filipino workers and other remaining workforce.

They comprise 10.15 percent of the Filipinos.

After everyone on this priority list is inoculated, the rest of the Philippines’ 109.58 million population will receive the vaccine. This would be Group C.

Cabotaje assured that all Filipinos will be vaccinated. For 2021, the target is to vaccinate up to 70 million Filipinos.

“Lahat mababakunahan, may mauuna nga lamang (Everyone will be vaccinated, some people ahead of others),” she said in a virtual press conference on Tuesday, January 27, 2021.

DOH, however, has stressed that vaccination is not mandatory. The vaccine will be administered only on those who sign a final consent form.

The priority sectors and areas for the deployment of vaccines were identified in the three-year National Deployment and Vaccination Plan, which was approved by the Inter-Agency Task Force (IATF) for the Management of Infectious Diseases on January 21.

The plan was adopted for implementation by the National Task Force (NTF) Against Covid-19 on January 26, less than a month before the expected arrival of the first shipments of Covid-19 vaccines.

Deployment

Under the plan, the vaccines will be deployed by phases depending on the time of delivery, available doses and logistical requirements.

Since the delivery of vaccines to the country would be in tranches, deployment would be based on the number of active cases of infection per region and the attack rate per 100,000 in the recent four weeks.

As of January, the country’s 17 regions are prioritized as follows:

• National Capital Region
• Calabarzon (IV-A)
• Central Luzon (III)
• Central Visayas (VII)
• Ilocos (I)
• Western Visayas (VI)
• Bicol (V)
• Davao (XI)
• Northern Mindanao (X)
• Zamboanga Peninsula (IX)
• Soccsksargen (XII)
• Eastern Visayas (VIII)
• Cagayan Valley (II)
• Bangsamoro Autonomous Region
• Mimaropa (IV-B)
• Caraga Administrative Region
• Cordillera Administrative Region

This priority list will be reviewed monthly and recalibrated based on the active cases and attack rates.

Local government units have been directed to draw up their own vaccination plans aligned with the national plan.

As of January 31, the cities of Manila, Taguig, Pasig, Valenzuela, San Juan, Muntinlupa, Mandaluyong, Quezon and Iloilo, and the municipality of Carmona in Cavite have completed their local plans.

Cold storage

Three major cold storage hubs for the vaccines have been initially identified.

The cold storage facility of United Laboratories Inc. (Unilab) in Biñan City in Laguna can store around five million doses of vaccine at a temperature of 2 to 8 degrees Celsius.

Zuellig Pharma Corporation in Parañaque City, Metro Manila can store up to 6.5 million doses at ultra-low temperatures of -80 degrees Celsius. Its walk-in freezers, capable of temperatures ranging from -50 to -25 degrees Celsius, can hold 40 million doses. Its cold rooms, with temperature of 2 to 8 degrees Celsius, can store up to 629 million doses.

The Research Institute of Tropical Medicine (RITM) in Muntinlupa City, Metro Manila has committed its storage facility with a temperature of as low as -80 degrees Celsius. It also has four cold rooms at 2 to 8 degrees Celsius and one -20 degrees Celsius walk-in freezer.

Prior to the arrival of the vaccines, the LGUs should prepare the master list of the eligible vaccinees to determine the number of doses that should be delivered to an area.

The deadline for the master list for Group A was on January 31. Patient profile and consent for the frontline health services under Group A should be completed by February 15.

The master list for Groups A and B should be completed by March 31 while the master list for Group C should be done by June 30.

Vaccination sites

Vaccination sites should be identified a few weeks or days prior to the arrival of the vaccines.

The plan recommends the following as vaccination sites: rooms in health facilities such as conference rooms, auditoriums, theaters and gymnasiums.

If these are not available, tents or temporary buildings may be put up in parking lots and open spaces.

A vaccination site must be spacious enough to allow physical distancing and must have several sanitation areas.

It must have a waiting area, a vaccination area that can accommodate at least three vaccination teams and three AEFI (adverse event following immunization) composite teams, and a post-vaccination monitoring area.

The LGU must also identify the vaccination processes and teams prior to the delivery of the vaccines.

A vaccination team should have six members:

• 2 physician/nurse/midwife for screening and assessment;
• 1 health educator (volunteer teacher, social worker, medical student);
• 1 vaccinator (physician/nurse/midwife); and
• 2 documenters and vital signs taker (midwife/barangay health worker/ health staff or volunteer teacher, social worker, medical student).

An AEFI composite team will have two members: a paramedic/nurse/midwife to monitor and provide response; and surveillance officer/nurse/midwife/pharmacist to conduct surveillance.

There should be a vaccination team supervisor, preferably a physician, for every three vaccination teams as well as a supervisor for the implementing unit and a supervisor for the entire LGU.

Other personnel needed in the implementing unit are cold chain and logistics officers, barangay captains, security personnel (police), drivers and safety officers (barangay tanods).

In community or health facilities, the barangay health worker (BHW) and hospital staff will serve as social mobilizers while BHWs and local officials will oversee transport.

Under the plan, the national government aims to engage other professionals to become part of the vaccination workforce.

Vaccination process

Eligible vaccinees will be required to register, after which they will be provided with a vaccination date and time schedule, as well as an immunization card with a QR code that should be presented at the vaccination post.

Walk-in persons will be told to follow the process since vaccines would be enough for those scheduled for the day.

After a temperature check at the waiting area, each vaccinee shall be assigned to a specific vaccination team.

The immunization card with QR code must be presented for scanning at the registration area and the vaccinee must present a government ID.

He or she will then be directed to the health education area, where he or she will be given information on the vaccine. The vaccinee will then be asked to sign the Final Consent form.

The vaccinee will undergo physical examination at the screening area before he or she can proceed to the vaccination area.

After inoculation, the QR code will be scanned and the vaccination details (date of vaccination, vaccine manufacturer, batch number, lot number, name of vaccinator and signature) will be recorded on the immunization card.

“Since karaniwan double dose ang vaccine sa immunization card, ilalagay kung ano ang vaccine na tinanggap ng isang vaccine dahil ‘yun din ang tatanggapin niyang second dose,” said Cabotaje.

(The name of the vaccine must be indicated in the immunization card because the same vaccine must be used for the second dose.)

She said there will be no allergy test prior to the vaccination.

"As a routine we have never been testing for (allergies). We just rely on the patient's health history based on investigation during the pre- registration and registration itself," said Cabotaje.

Monitoring

Vaccinees will be monitored for 30 minutes to one hour after inoculation for any adverse reactions.

Cabotaje said first aid will be given to patients experiencing adverse effects before they will be referred to a hospital, if further management is needed.

The government will activate an incident command system, which will monitor all vaccination-related concerns.

She said they were also looking at setting up a vaccination tracker to determine the number of people who have been vaccinated and monitor the volume of vaccines deployed.

In general, Cabotaje said there will be no need for an RT-PCR test prior to vaccination.

However, she said the DOH will issue specific guidelines on the vaccines based on information submitted by the manufacturers to the Food and Drug Administration.

"What is being recommended for Pfizer-BioNTech is, if you have a history of positive Covid based on RT-PCR, you defer the vaccination for 90 days, but this is still being studied if it is applicable with the Filipinos," she added. (SunStar Philippines)

Next: Part 4: Building vaccine confidence

Back to Part 2: A matter of choice