Decline in pneumonia incidence

While we have gotten used to this continuing COVID-19 scourge, there is some good health news somewhere, particularly the decline in other infectious and communicable diseases like pneumonia incidence.

While checking data on comorbidity and leading causes of death in the Philippines, I noticed an interesting trend — the decline in pneumonia incidence in the country from 12.3% of total deaths in 2013 to only 9.6% in 2018, according to data from the Department of Health (DoH) and Philippine Statistics Authority (PSA, see the table).

Effective anti-pneumonia vaccines, particularly against pneumococcal diseases caused by the bacteria Streptococcus pneumonia, are among the reasons for this good news. This bacteria can affect people from all ages and pneumococcal diseases are a leading cause of death among children below five years old. When the bacteria reach the lungs, they can cause pneumonia and death. When they invade the bloodstream or the tissues and fluids surrounding the brain and spinal cord, they can cause meningitis and death.

Thanks to continuing health innovation, pneumococcal conjugate vaccine (PCV) against the bacteria was invented. PCV10 is among the early and effective vaccines, it protects against 10 strains of the bacteria and the DoH procured the vaccine in 2012.

In 2014, the DoH shifted to tridecavalent PVC13 as it protects against 13 strains of the bacteria including serotypes 3, 6A and 19A which are not covered by PCV10. This is after World Health Organization (WHO) cost-effectiveness studies showing that PCV13 is more cost-effective than PCV10. Serotype 19A in particular is a serious bacteria, can lead to meningitis, invasive diseases and severe pneumonia. As shown in the table above, pneumonia has killed about 57,000 people in the Philippines yearly from 2016-2018, it is the fourth most deadly disease in the country.

Then late last year, some controversy arose when PCV procurement of nearly P5 billion for 2020 was questioned by some individuals.

I searched several scientific studies on the comparative medical advantages of PCV10 vs PCV13. These two papers I found to be cool and useful.

1.) “Do Pneumococcal Conjugate Vaccines Represent Good Value for Money in a Lower-Middle Income Country? A Cost-Utility Analysis in the Philippines” by Manuel Alexander Haasis, Joyce Anne Ceria, Wantanee Kulpeng, Yot Teerawattananon, and Marissa Alejandria (PLoS One. 2015; 10(7): e0131156. Published online July 1, 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488861/). They noted that “PCV13 achieves better value for money compared to PCV10, thus, PCV13 should be a better choice in the Philippines…. PCV13 is superior to PCV10 in terms of its broader coverage of serotypes; a universal vaccination program with PCV13 would lower the potential for serotype replacement….”

2.) “Comparison of the Impact of Pneumococcal Conjugate Vaccine 10 or Pneumococcal Conjugate Vaccine 13 on Invasive Pneumococcal Disease in Equivalent Populations” by Pontus Naucler, Ilias Galanis, Eva Morfeldt, Jessica Darenberg, Åke Örtqvist, Birgitta Henriques-Normark (Clinical Infectious Diseases, Volume 65, Issue 11, Dec. 1, 2017, Pages 1780–1790.e1, https://academic.oup.com/cid/article/65/11/1780/4061316). They observed that “Invasive pneumococcal disease incidences decreased between 2005 and 2016 in vaccinated children (by 68.5%), and in the whole population (by 13.5%), but not among the elderly (increased by 2%)… serotype 19A increased in PCV10 counties… Serotype 6C increased in PCV10 counties, but not in PCV13 counties, suggesting cross-protection with 6A, which is included in PCV13.”

These and other studies show the medical superiority for PCV13 but it has a higher cost, about 10% higher than PCV10 or about P500 million. Comparing this additional cost with protecting additional thousands or millions of children from more virulent and fatal diseases, the health advantage should be higher than the fiscal disadvantage. This should be an important consideration for the Health Department and the Department of Budget andManagement in vaccine procurement.

Meanwhile, new treatments and vaccines against COVID-19 may be available by late 2020 or early 2021. The bad news is that while these will be quickly available in the US, Europe, Japan, Singapore and other developed and emerging countries, they may be available in the Philippines only after one or two years delay. We have drug price control policies (EO 821 in July 2009, then EO 104 in February 2020) which discouraged many innovator companies from entering the Philippines or staying here, or, among those that stay, the registering and launching of new medicines and vaccines are delayed by about 26 months on average.

Ensuring quicker and greater access to more modern, more effective new medicines and vaccines should be a higher priority than per unit cost. People value their health and lives more than monetary savings from old, less effective treatments.

Bienvenido S. Oplas, Jr. is the president of Minimal Government Thinkers

minimalgovernment@gmail.com