By Jenina P. Ibañez, Reporter

ARLENE P. CALLEJA, a pediatrician in Legazpi City southeast of the Philippine capital, has been spending the past few months responding to patients’ fears about the coronavirus pandemic.

“Doctor, is there still no vaccine for COVID-19?” is the usual question she gets from them.

The government has provided free vaccines for other illnesses in her area. But she had to treat some poor patients for diseases that could have been prevented by pricier vaccines they couldn’t afford.

Scientists have yet to find a vaccine for the coronavirus and it’s not clear how ordinary citizens will get it once it becomes available.

“I’m sure certain groups of the population will have to get the vaccine for free,” Ms. Calleja said by telephone. “That’s how it should be.”

President Rodrigo R. Duterte in his yearly address to Congress on Monday said he pleaded with Chinese President Xi Jinping eight days ago to prioritize the Philippines for supply once it finds a vaccine for the coronavirus.

“If they have the vaccine, can they allow us to be one of the first or if it’s needed, if we have to buy it, that we be granted credit so that we can normalize as fast as possible?” he said, adding that he expected a vaccine by September.

The coronavirus has sickened more than 80,000 and killed almost 2,000 people in the Philippines, more than double from end-June and the second-highest number of infections in Southeast Asia even if Mr. Duterte had enforced one of the world’s earliest quarantines starting in mid-March.

“His reference to a request to Xi Jinping seems to imply that his confidence that a vaccine will be available by September comes from sources in China,” Herman Joseph Kraft, an associate professor and chairman of the University of the Philippines Political Science department, said in an e-mail.

“Unfortunately, China’s record on quality control does not invite confidence especially since the expectation is that a proper vaccine won’t be available for commercial use until March next year,” he added.

‘MIND-BOGGLING’
Experts are already predicting a shortage of vaccines. Manufacturers have said they could increase production. Chinese firm Sinovac Biotech, for example, said it was building a facility to mass-produce vaccines.

But Luis F. Razon, a chemical engineering professor at De La Salle University, said the production scale needed is “mind-boggling.”

“China built a plant that can manufacture a hundred million doses per year,” he said in an online video interview. “Until you realize that China has 1.4 billion people, so it’s going to take 14 years to inject everyone in China even with that scale of a plant.”

Mr. Razon co-wrote a paper in the journal Resources, Conservation and Recycling on the global pharmaceutical supply chain’s ability to scale up during the crisis.

“Shortages may also prompt countries in the spirit of self-interest to impose restrictions on the export of these drugs or their chemical precursors,” according to the study.

Wealthier countries are already ahead in the vaccine race. The United States in May ordered 300 million doses of a vaccine produced by AstraZeneca, while the UK has ordered 90 million doses of vaccines produced by various companies including Pfizer, Inc., before it is proven to be effective.

Meanwhile, some organizations are making sure that developing countries have access to the vaccine. Global public-private partnership Gavi plans to order vaccines in bulk to lower prices for poor countries.

The Philippine government said it would allot P1.5 billion for the program, but it may not be enough.

“We don’t know how many doses the Philippine government wants to go for and how many citizens it wants to protect,” Beaver R. Tamesis, president of the Pharmaceutical and Healthcare Association of the Philippines, said by telephone. “What would be the final negotiated price?”

A P1,000 vaccine, he said, could cover 1.5 million citizens. “That’s just the senior citizen cohort,” he said. “Maybe they’re going to prioritize the poorest of the poor.”

While vaccines and drugs are still being developed, the Philippines should “gamble in advance” and order drugs with promising results, Derrick Ethelbert C. Yu, a La Salle chemistry professor who co-wrote the paper with Mr. Razon, said in the same video call.

“Now the gamble is surer because we have scientific evidence that, for example, Remdesivir is effective,” he said. He added that procurement becomes less risky with more evidence that the drug could work, although that means other countries are also starting to get ahead.

PRICING
Mr. Razon, who has worked in the pharmaceutical industry, said the Philippines should decide whether it’s willing to take the risk. “The thing is, when it’s sure already, other countries start hoarding.”

He added that the country’s access to drugs isn’t only a matter of supply and demand but one of diplomacy.

“The government must improve its relationship with countries that essentially control these things because our only leverage is the moral imperative — they shouldn’t hold it back from us even though we hardly had a hand in developing these,” Mr. Razon said.

One of the most promising vaccines is ChAdOx1 nCoV-19 developed by Oxford University. Trials on more than a thousand people showed that the vaccine could produce antibodies and T-cells that could fight the COVID-19 virus.

The Philippines has expressed interest in the Oxford vaccine and might buy it once it’s proven effective, Philippine Ambassador to London Antonio Lagdameo said at an online briefing last month.

The country is also participating in multi-country clinical trials, including the testing of Remdesivir, a drug that has been used to treat severe coronavirus patients.

The Philippines has reached out to drug makers in  China and Taiwan for a possible deal once their vaccines become available, Health Undersecretary Maria Rosario Vergeire told an online news briefing this month.

Speaker Alan Peter S. Cayetano has said the government would allot vaccine funds in next year’s national budget. Mr. Duterte has also said he planned to borrow money and sell state assets so he could buy more vaccines.

Mr. Tamesis said pricing for vaccines was already being discussed among top corporate executives.

Pharmaceutical companies are split on how they would price their potential COVID-19 vaccines, with some pledging to US lawmakers that they wouldn’t seek a profit from the shots, while others indicated that they would, the Wall Street Journal reported last week.

The local Department of Health did not respond to questions about the funding for COVID-19 vaccines and how many people will be covered.

The vaccine doesn’t have to be given to all Filipinos based on herd immunity, when a large portion of the population becomes immune to the disease, making its spread unlikely. “If 80% are vaccinated, the 20% will be protected,” Ms. Calleja said.

Jean Reni D. de Guzman, who participated in the government’s Doctors to the Barrios program in Samar province, said red tape sometimes delays the distribution of medicines  to far-flung areas to a point where supplies are nearly expired by the time they reach the people.

“It’s more important to prioritize people in crowded areas,” the doctor, who helps bridge medicine and vaccine distribution from regional centers to remote areas where one has to hike for up to four hours to reach residents, said in an online call.

“Once we establish herd immunity, people from hard to reach areas will benefit as well,” he added.

Mr. Tamesis said drug distribution is an issue of equity. Wealthy Filipino families flew to Singapore to gain access to the controversial Dengvaxia vaccine when it was banned here.

“What about those who can’t afford to even take the bus?” he asked.

Ms. Calleja, the doctor from Legazpi, expects senior citizens and other vulnerable groups to be prioritized for the vaccine. “Hopefully, the rest of the population will be given free shots later.”