Back-to-back announcements by cities in the Philippines about agreements inked with developers of COVID-19 vaccines have brought a glimmer of hope to many Filipinos weary of the pandemic.

Finally, there was something somewhat solid for Filipinos amid enviable news from other countries, where health workers and the elderly are already getting the sought-after jabs.

Many could not help but compare the speed by which cities signed deals with British-Swedish pharmaceutical firm AstraZeneca against the fact that the national government itself had yet to enter into any agreement. (LIST: Local governments’ plans for COVID-19 vaccines)

“Many local government units opted to go on their own. They buy, because they have the money, and they chose their own vaccine,” acknowledged President Rodrigo Duterte on Wednesday, January 13.

Before cities began signing their vaccine deals, the only other signed agreement to secure doses was initiated and financially backed by private corporations like Udenna Corporation, Aboitiz Foundation, BDO Foundation, and others. 

Though all these agreements could not have been signed without the participation of the national government, it was the efforts of mayors and corporate executives that catalyzed and quickly shepherded the process.

How did the mayors of several cities in Metro Manila and across the country secure these agreements? What can other mayors or governors learn from their experience?

Rappler reporters spoke with the following local officials to find out:

• Mayor Rex Gatchalian of Valenzuela City
• Mayor Francis Zamora of San Juan City
• Mayor Joy Belmonte of Quezon City and Joseph Juico, co-chairperson of Quezon City’s vaccine task force
• Mayor Sara Duterte of Davao City

How their efforts began

Deals were finalized and signed in early January, but most mayors began initial efforts to scout for a vaccine supplier months before.

Mayor Duterte said she began sending unsolicited letters to various vaccine makers in October 2020.

Around this time, Quezon City had also begun scouting around, according to Juico. By late November, Quezon City had begun talks with vaccine developers and had asked national government agencies on how they could proceed, Mayor Belmonte said.

In these months, mayors were walking blind, with the national government not having cascaded any clear plan on coordination for vaccine procurement.

It was only in early November when vaccine czar Carlito Galvez Jr publicly presented an initial National Vaccine Roadmap, where the only mentioned involvement of the local governments would be in identifying recipients, distributing vaccines, and rolling out information campaigns.

But, by the end of that month, private firms managed to ink a deal with AstraZeneca for 3 million doses. The national government was part of the deal since AstraZeneca had told corporation executives it needed the government involved. 

It was also in November when firms like Pfizer, AstraZeneca, Moderna, and Russia’s Gamaleya Institute began announcing efficacy rates from Phase III trials of their vaccines, creating excitement and then clamor from the public. A 70% efficacy rating was found for AstraZeneca’s vaccine in a study published on December 8.

So, without the national government’s hand, mayors moved independently to contact vaccine makers. Belmonte got a number of an AstraZeneca executive from private doctors. Mayor Duterte, in an October meeting with the British embassy on another matter, discussed vaccines and was told to write to AstraZeneca for access, a suggestion she took.

Duterte had also asked officials at the Chinese consulate in Davao City “for options,” which led them to put her in touch with Sinovac. In the same way, a United States embassy official sent her an email, asking if they could help the city, and she responded. The embassy then endorsed a meeting with US firm Johnson & Johnson, whose pharmaceutical company, Janssen, is slated to conduct vaccine clinical trials in the Philippines.

Matters speed up in January

As of late November and early December, mayors like Belmonte and Valenzuela’s Gatchalian had still been hesitant to sign anything solid or make any orders with vaccine firms.

For Belmonte, this was because they didn’t think it wise to finalize an order without the guidance of the Food and Drug Administration, the agency that would identify which vaccines could be administered and distributed in the country.

San Juan’s Zamora said he also wanted to keep their options open for the possibility of sourcing vaccines from other providers. He said he did not want to “over-order” either, as they anticipated the national government to allocate vaccines for them.

It was in early December when Galvez had meetings with Metro Manila mayors where he explained the national government’s vaccine plans.

According to Zamora, Galvez had given local government units (LGUs) the go signal to procure vaccines on their own as long as mayors would coordinate with the national government.

But, in Davao City, Mayor Sara, the President’s daughter, had not yet heard of any vaccine coordination plan from the national government.

On December 10, she said the national government should let LGUs access vaccine deals on their own.

“In my opinion, if they allow LGUs to move on their own to access vaccines approved by the national government, then the LGUs may be able to help the national government move the vaccines to a large segment of the population,” she said over Davao City Disaster Radio.

It was on December 15 when Quezon City was able to get in touch with AstraZeneca officials. The firm sent them the next day a non-disclosure agreement (NDA), which was reviewed by the city’s legal department then sent back to AstraZeneca on December 17, said Juico.

A few days before Christmas, December 22, city hall and AstraZeneca officials sat down for a meeting to discuss the vaccine.

After a lull due to the holidays, the United Kingdom regulatory agency (Medicine and Healthcare Products Regulatory Agency) announced its emergency use approval for AstraZeneca’s vaccine on December 30.

When Juico called up AstraZeneca after the news, he was told things would have to move faster.

“That’s when they said we have to move quickly because it’s approved by the UK and they need to talk with Mayor because a certain number of doses is available for allocation for QC,” Juico said.

Belmonte swung into action, calling up Galvez on January 1 to get clearance from the national government.

“Secretary Galvez acted quickly. On the same day, he texted the parameters and then called Mayor to say the President has already agreed that LGUs can enter into tripartite agreements as long as national government takes the lead,” said Juico.

Valenzuela City and San Juan City had a similar experience, though they had reached out to AstraZeneca weeks after Quezon City.

From a wait-and-see stance in early December, things moved quickly once the cities had contacted AstraZeneca on the first week of January. The entire process, from first contact to signing of an agreement, took just one week, according to Zamora and Gatchalian.

What Gatchalian found helpful was how efficient AstraZeneca was, the guidance from the Metropolitan Manila Development Authority, and the framework provided by the tripartite agreement.

Another reason why deals with AstraZeneca pushed through faster than the rest was because the firm had agreed to the tripartite agreement model with national government.

This type of agreement has proven crucial to locking in vaccine doses because it entails an assurance of payment and orders that the national government has been hesitant to make due to procurement laws.

For LGUs, engaging in a tripartite agreement also assures them that the deals they are signing comply with the national government’s guidelines, which have not been clear.

Presidential Spokesman Harry Roque had said this about the first such tripartite deal, the one with private corporations. He said it was one way to reserve vaccines without fear of violating procurement regulations since it was another entity promising to pay for the supply.

The other work-around devised by Galvez was to use funding from the Asian Development Bank for advance orders since procurement laws don’t cover international aid. But for this funding to be released, the ADB requires that the vaccine to be procured must have approval from a mature regulatory agency.

What local governments commit to do in vaccine deals

According to the tripartite agreements, the local governments will take charge of the vaccines they order – from payment to administering doses to their citizens.

“They will buy, they will pay, they will pay for all the expenses, including delivery of vaccines, and they will also vaccinate their constituents in accordance with the National Vaccination Plan,” said Roque in a press briefing on Tuesday, January 12.

Roque had bared provisions in the agreements entered into by cities, AstraZeneca, and the national government during the briefing. One of these provisions says payments of local governments need not pass through the national government, but will go straight to AstraZeneca.

Local governments are also in charge of paying for and coordinating the delivery of the vaccines to their areas.

This level of involvement of local governments was nowhere to be found in Galvez’s initial November 3 vaccine plan.

It was later on, absent more concrete moves from the national government, when mayors “offered” this level of involvement.

“It was the LGUs who offered their help to the NTF (National Task Force), the national government, to buy vaccines for their constituents,” said Roque.

In meetings with Metro Manila mayors, Galvez had expressed gratitude to the local chiefs for their initiative.

How about LGUs without resources to secure vaccine doses?

The mayors of Metro Manila and other highly-urbanized cities like Davao City, Bacolod City, and Antipolo City have big budgets. Davao City is even led by the President’s daughter. But what of smaller or less influential cities or provinces?

Malacañang has given assurances that they won’t be left behind.

“No! Because the national government, the NTF, is prepared to buy for everyone,” said Roque in Filipino.

Finally, on Monday, January 11, the national government signed an agreement with US firm Novavax for 30 million doses of its vaccine. Soon after, it also signed a deal with China’s Sinovac for 25 million doses.

Yet all these agreements – whether signed by the national government, cities, or private firms – are hinged on the all-important emergency use approval by the FDA. Without this approval, the agreements can’t be implemented. So far, only the Pfizer vaccine has been granted emergency use approval.

In the coming months, all eyes will be on how well the Duterte administration coordinates with mayors and governors to ensure an efficient and equitable vaccine roll-out. – with reports from Rambo Talabong and Jodesz Gavilan/Rappler.com