Philippines: PCV Introduction and

Experience

Dr. Enrique A. TayagAssistant Secretary

Department of Health

Philippines

Outline

• Evidence

• Communications and Advocacy

• Role of professional Organizations

• Role of Partners

• Barriers and how to overcome them

• Main challenges

• Key messages to other countries

Pneumococcal Conjugate Vaccines

• The World Health Organization recommended the

inclusion of pneumococcal conjugate vaccines

(PCV) in childhood immunization programs in

countries with under 5 mortality of >50/1,000 births

• The World Health Organization recommended the

use of two pneumococcal conjugate vaccines: PCV

10 or PCV 13 based on country’s circulating

serotypes

Health Statistics

Number of children born every year (NSO 2010) 1,782,981*

Number of poor children <5 years old (NHTS 2011) 3.6 million

Top causes of death in children <5 years old (DOH, 2009) **

1. Pneumonia 4,570

2. Diarrhea 2,063

3. Accidents 1,162

* Births based on civil registration and does not cover under registration.

Thus, to cover unregistered births, NSO estimates the 0-11 months old

infants nationwide by multiplying 2.7% to the total population.

** Excludes neonatal causes

Pneumonia and Sepsis

• Pneumonia was the leading cause of illness, hospitalization and deaths among Filipino children under 5 years old in 2010 & 2011.

• The average number of pneumonia cases in children under 5 years in 2010 & 2011 was over 340,000 per year.

• The estimated Case Fatality Rate for Sepsis in children up to 13 years was 44%

• The estimated Case Fatality Rate for Pneumonia in children under 5 years was 1.8%

Vaccine Costs

• It costs <$50 to protect a child from

disseminated tuberculosis, hepatitis B

infection, diphtheria, pertussis, tetanus, polio,

and measles.

• In 2012, roughly $42 million was allocated to

cover costs for childhood vaccines including

syringes and needles.

Philippine Experience

Communications and Advocacy

• Philippine Foundation for Vaccination, Inc.

organized yearly campaigns on World Pneumonia

Day and World Meningitis Day.

• Burden on Pneumonia and Pneumococcal

Invasive Disease contextualized on achieving

MDGs and Universal Health Coverage.

Philippine Experience

Partnerships and Linkages

•Universal Health Care espoused Public-Private

Partnership even for Public Health

•Recommendations on inclusion of PCV vaccines

fostered by WHO recommendations, independent

local researches, childhood immunization

schedules from foreign and local vaccination

advocates

Philippine Experience

Overcoming Barriers and Challenges

•Enhancing disease surveillance for Invasive

Pneumococcal Disease

•Designing Cost-free PCV impact study

•Balancing Benefits of Vaccination with Integrated

Management of Childhood Illnesses

•Accessing Cheaper Vaccines from World Market

•Promoting Social Benefits of Vaccination

•Engaging Partners to achieve common Goals for

Child Survival

Philippine Experience

Program Implementation

• In 2013, PCV 10 2-dose, single syringe vaccine

was introduced following prevailing WHO

requirements

• Initially, only 300,000 eligible infants in 2 regions

with high burden of illness were identified because

vaccine was not cheap ($55 per child).

• In 2014, another 300,000 eligible infants from 4

regions with high burden of disease will be given

PCV 13

PCV 10 or PCV 13?

Actual Procurement

2012 PCV 10 was procured through UNICEF

when it was a cheaper then than PCV 13.

2013 PCV 13 was procured also through

UNICEF when a WHO WPRO study

demonstrated that PCV 13 was more cost-

effective than PCV10.

Incremental outcomes of (i) using PCV10 (compared to no

vaccination), (ii) using PCV13 (compared to no vaccination)

and (iii) using PCV13 compared to PCV10.

Abbreviations: b, billion; m, million. *

year)

Major hearing loss (per

year)

0.12 “Deafness”  i

n

 Ma

t

h ers  2006

Major motor deficit (per

year)

0.38 “Motor  de ficit”  in  Mathers  20 06

Major visual disturbance

(per year)

0.6 “Blindness”  in  Ma

t

h ers  2006

Major clinical impairment

(per year)

0.097 “Seizure”  in  Mathers  20 0 6

Results

Base case: national programme

Table 2 shows a comparison of the main incremental outcomes of introduction of

PCV10 compared to no PCV use, introduction of PCV13 compared to no PCV use,

and introduction of PCV13 compared to introduction of PCV10, under base case

assumptions, and assuming that the entire birth cohort is targeted. More detailed

outcomes are given in the Appendix.

The  Philippines’  gross  domestic product (GDP) per capita in 2011 is $2,370 (World

Bank, 2012), and three times this value is $7,110. Since the incremental cost-

effectiveness ratio of introducing either PCV10 or PCV13 is below this, introducing

either vaccine would be considered cost-effective, although only PCV13 would be

considered highly cost-effective (ratio below the GDP per capita; Tan-Torres 2003).

Introducing PCV13 prevents more DALYs and is cost-saving (from a health care

provider perspective, which excludes patient and family member productivity costs)

or cost-neutral (from a societal perspective) compared to PCV10, so would be

regarded as a better use of health care resources.

Table 2. Incremental outcomes of (i) using PCV10 (compared to no vaccination), (ii)

using PCV13 (compared to no vaccination) and (iii) using PCV13 compared to

PCV10. Abbreviations: b, billion; m, million.

PCV10 vs

nothing

PCV13 vs

nothing

PCV13 vs

PCV10

Number vaccinated with 3 doses 55.6 m 55.6 m -

Total vaccination cost $3.14 b $3.33 b $0.19 b

Health care costs saved $0.27 b $0.473 b $0.203 b

Productivity costs saved $70.1 m $51.2 m $-18.9 m

IPD cases prevented 36300 63200 26900

Non-IPD pneumonia cases prevented 303000 621000 318000

Deaths prevented 12900 24400 11400

Acute otitis media cases prevented 28 m 18.3 m -9.66 m

DALYs prevented (undiscounted) 1.15 m 1.37 m 0.215 m

DALYs prevented (discounted) 0.711 m 0.839 m 0.128 m

Total net costs (undiscounted) $2.8 b $2.81 b $5.85 m

Total net costs (discounted) $1.84 b $1.84 b $4.56 m

* WHO WPRO study

Philippine Experience

Key Lessons

• Before trying All Things New, Answer these

questions: Can It Work? Will it Work? and

finally, Is It Worth It?

• Vaccines will NOT save Lives. Vaccination

saves Lives.

• Survival from any endeavor entails Variation,

Selection and Adaptation.

Fun walk for World Meningitis Day April 24, 2010

The Finish Line