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Yves Miel H. Zuñiga, FRSPH, AFCHSM, CHM, CPH

By Yves Miel H. Zuñiga, FRSPH, AFCHSM, CHM, CPH

No one left behind:

A roundtable discussion on the Philippine experience

on vaccine equity and mental health

More than a year has passed since the onset of COVID-19, and the world has mobilized efforts to mitigate the pandemic’s impact, such as mass vaccination to reach herd immunity. In the Philippines, as of mid-October 2021, over 24 million Filipinos have been fully vaccinated (or approximately 22% of the total population). Despite this progress and efforts to accelerate nationwide vaccination, there still are 28 million Filipinos yet to receive their full dose and another 21 million — of the 70 million target vaccinations — who remain unvaccinated to date. 

 

While COVID-19 vaccination plans have prioritized vulnerable groups, such as the elderly and those with comorbidities, in order to curb COVID-19’s impact, the inclusion of other vulnerable segments of the Philippine population, such as those with mental health conditions, remains unclear.

 

To understand this dynamic better, local experts were invited to a roundtable discussion (RTD) about the current direction of the Philippines in advancing vaccine equity and mental health during COVID-19. Four experts joined the RTD, namely Department of Health (DOH) Undersecretary for Health Dr. Maria Rosario Singh-Vergeire, Health Technology Assessment Council Core Member Dr. Maria Cariness Alejandria, National Immunization Technical Advisory Group Member Dr. Nina Castillo-Carandang, and Philippine Alliance of Patient Organizations Board Member Mr. Chris Muñoz (see bottom for expert bios).

Roundtable discussion on vaccine equity and mental health participants [Department of Health Undersecretary for Health Dr Maria Rosario Vergeire (upper left), Philippine Alliance of Patient Organizations representative Mr Chris Muñoz (upper middle), National Immunization Technical Working Group member Dr Nina Castillo-Carandang (lower left), and Health Technology Assessment Council Core Member Dr Maria Carinnes Alejandria (lower right)]

"Vaccine equity means addressing barriers to access and ensuring that the distribution of vaccines is widespread, fair, and equitable." @DOHgovph

— Dr. Maria Rosario Vergeire (DOH) Tweet

Dr. Castillo-Carandang and Mr. Muñoz shared personal accounts of the realities of different communities, ranging from vaccine hesitancy to lack of access on the ground. Dr. Alejandria clarified that these on-the-ground challenges might also be driven by the wider global context. For example, the Philippines belongs to the Global South: countries that are less prioritized to receive allocations of the global COVID-19 vaccine supply. In the face of limited supply, Dr. Castillo-Carandang elucidated how vaccine equity should also start at home by diversifying the vaccine brands available, supporting the idea that there should be no preference between vaccine options.

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Courtesy: Mungkhoodstudio's Images

Ensuring vaccine equity is indeed a complex process that the DOH cannot do alone. Acknowledging the Department’s limitations, the DOH convened a cadre of different experts to guide its policies and recommendations for the COVID-19 response. These are discussed briefly in the table below.

Expert groupSupport provided to the DOH
National Immunization Technical Advisory GroupGuidance on COVID vaccine prioritization and equity considerations
Technical Advisory Group (TAG)Overall strategies in COVID response which includes vaccination
National Adverse Events Following Immunization Council (NAEFIC)Causality assessment and safety of COVID vaccines
Health Technology Assessment Council (HTAC)Equity considerations and societal and cost implication of COVID vaccines
Vaccines Expert Panel (VEP)Early insights on COVID vaccine clinical trials and evidence
National Clinical Practice Guidelines Group (NCPGg)Appraisal of published COVID vaccine clinical evidence

As emphasized by Undersecretary Vergeire, discussions within the said roster of experts are extensive, ensuring that no stones are left unturned in distilling the best recommendations. To date, the DOH has expressed confidence that all of its released policy recommendations and decisions were based on the experts’ comprehensive deliberation. 

Meanwhile, Mr. Muñoz echoed the stance of patient communities, which anchors on the co-creation of policies —  the process where patients and communities participate in the development of a public policy or program. Adding onto Mr. Muñoz’s point, Dr. Castillo-Carandang emphasized how the policy space needs to be navigated with informed and proactive co-creation.

“While expertise is needed, let us also include in the picture the value of co-creation with patient groups and communities in policymaking.”

— Mr. Chris Muñoz (PAPO) Tweet

In addition to co-creation, Dr. Castillo-Carandang discussed the value of meaningfully engaging public officials and politicians as partners in addressing the “infodemic” and reaching the most vaccine-hesitant at the grassroots level. Alongside the most vaccine-hesitant, Filipinos diagnosed with mental illness are of paramount importance within the COVID vaccine prioritization scheme, as highlighted by Dr. Alejandria. Persons diagnosed with mental illnesses are at a higher risk of hospitalization and death due to COVID-19 compared to those without mental health conditions. Undersecretary Vergeire also acknowledged that systems and processes are underway to prioritize persons with mental health conditions in the COVID vaccine roll-out.

“Mental illness is a silent epidemic happening right now at the height of COVID-19, and we need to consider persons with lived experience in our decision-making on vaccines.”

— Dr. Maria Carinnes Alejandria (HTAC) Tweet

In closing, all experts shared what gives them hope and highlighted the need to keep holding onto the line amid the uncertainty. With a reminder that vaccination is an anxiety-provoking process, Dr. Castillo-Carandang raised an excellent call to action: the different sectors should collaborate to make the vaccination process less anxiety-provoking, starting from education and promotion to implementation.

“We are on Day 566 of a seemingly forever lockdown. The longer we are on lockdown, the more losses we have in terms of productivity, life experiences, economy, and most importantly, our mental health and psyche - the fabric of our nation.”

— Dr. Nina Castillo-Carandang (NITAG) Tweet

Lastly, Undersecretary Vergeire expressed hope, based on the knowledge that the scientific community continues to rally behind the DOH to guide the Department and national officials in the country’s COVID-19 response. 

Key takeaways

From this insightful roundtable discussion, the following key points emerged:

  1. We cannot address COVID-19 in a silo without acknowledging other vital considerations, such as addressing vaccine inequity and mental health inequity, needed to build back better in the COVID recovery period.
  2. We also learned in this discussion that different vulnerable groups continue to face exacerbated impacts in the context of COVID, including persons with lived experience of mental health conditions and other patient groups who are disproportionately vulnerable to varying determinants of health. These, in turn, contribute to widening disparities in health outcomes, including mental health. 
  3. There are layers of complexities in addressing mental health as part of vaccine inequity. Nevertheless, we remain hopeful that a more inclusive prioritization scheme can be done through the openness of different partners towards the whole-of-government and the whole-of-society approach. 

Finally, amid all uncertainties, there is still hope. The debate among the multiple stakeholders, including interdisciplinary experts and community representatives, is often robust. Still, there is always the opportunity to improve and co-create policy options to reach both vaccine equity and mental health equity.

About the experts

  • Dr. Maria Rosario Singh-Vergeire
    • Dr. Vergeire is the current OIC-Undersecretary for the Public Health Services Team and the official spokesperson of the Department of Health (Philippines). She was previously the OIC-Undersecretary for the Health Regulation Team and the Assistant Secretary in charge of the Public Health Services Team.
  • Dr. Nina Castillo-Carandang
    • Dr. Castillo-Carandang is a member of the National Immunization Technical Advisory Group (NITAG) and a professor at the University of the Philippines Manila College of Medicine.
  • Dr. Maria Carinnes Alejandria
    • Dr. Alejandria is a Core Committee member of the Philippine’s Health Technology Assessment Council. She is an associate professor at the University of Santo Tomas and a Global Fellow of Brown University Center for Human Rights and Humanitarian Studies. 
  • Mr. Chris Muñoz
    • A patient advocate of nine years, Mr. Muñoz is one of the board members of the Philippine Alliance of Patient Organizations (PAPO).

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