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