How can the Philippines secure enough drugs or vaccines against coronavirus?

MANILA, Philippines – The COVID-19 pandemic continues to wreak havoc across the globe, infecting millions and killing over 200,000.

There are no specific treatments or vaccines yet for the coronavirus. All that's available is supportive care for patients. While several drugs have shown promise in treating patients, they are still undergoing clinical trials and research.

But what happens when the treatment is finally discovered? Can the Philippines secure enough supply of the drugs or vaccines?

Researchers from the De La Salle University have recently published a study in an international peer-reviewed scientific journal Resources, Conservation and Recycling appealing to decision-makers to come up with sustainable and resilient strategies that anticipate the huge demand once the drugs and vaccines become ready for production.

Derrick Etherlbert Yu, Luis Razon, and Raymond Tan said in their paper that once effective treatments against COVID-19 become available, there will be a challenge to produce enough supply to match worldwide demand.

"Discovering treatments and vaccines for COVID-19 will just be the first step. We need to prepare for the likely scenario that those pharmaceutical products will be in short supply," Tan told Rappler in an email.

Based on US Food and Drug Administration records, the top countries with pharmaceutical manufacturing plants are the United States, China, and India.

The Philippines, while it has drug manufacturing facilities, is mainly an importing country with over 700 drug importers nationwide, according to a report.

"Active ingredients in drugs sold in the Philippines are largely imported and then compounded into user form. It is the supply of these actives that the Philippine government must work on," said Razon, who used to work in one of the big pharmaceutical companies in the Philippines.

"As it is, there's already an AP story about 22 US states stockpiling hydroxychloroquine, one of the drugs in WHO's Solidarity trial, even though the trials themselves are still ongoing," he added. 

Meanwhile, as early as March, India, the number one exporter of generic medicine worldwide, has restricted the exportation of 26 common medicine, including paracetamol.

The researchers suggested that to prepare for the drug shortage scenario, actions should be in place early on.

Safeguarding the pharmaceutical supply chain

"There are different sectors in this effort – the industrial chemical firms, the pharmaceutical manufacturers, the health sector (medical centers and drug stores) and the government (IATF). Each sector can exercise their capacities and influences in safeguarding the different stages of the supply chain," Yu explained.

He added: "The local pharma manufacturers or subsidiaries which usually import the drug components, can make an advance and favorable arrangement with their foreign suppliers or parent companies."

"The industrial chemical companies (foreign) meanwhile can step up their sourcing of raw materials such as petroleum, alcohols, and other chemical reagents for the drug precursors. These chemical firms may also take part in synthesizing the initial steps of the possible drug precursors to lessen the manufacturing stages undertaken by the pharma firms."

CNN Philippines report on March 11 said that the Philippine pharmaceutical industry is already bracing for the worst-case scenario on drug shortage in the country.

"The health sector firms (such as the Metro Pacific Hospital Group as well as Mercury Drug and Watsons) can take part in the capitalization of their financial and logistical resources by stockpiling and distributing inventories of several candidate drugs and vaccines throughout their nationwide network," Yu also said.

Yu said that the government, through the IATF or the Inter-Agency Task Force, may facilitate the seamless flow of transactions throughout the supply chain by easing restrictions on regulated chemicals, lowering or waving of import tariffs, and creating an express lane for efficient movement of materials from the ports up to their distribution points such as health centers.

"The government must also craft and take charge of a national policy for the effective and rational distribution of the drugs and vaccines to prevent or temper a supply constraint scenario," he added. 

The researchers have also developed a computer model to determine the optimal allocation of drugs and vaccines under supply constraints. This model is documented in a paper currently undergoing peer review.

Betting on the future

Razon explained that as of now, the Philippines has two options: secure contracts for the drugs and potentially waste money if the drugs fail, or wait for the trials to end and then look for suppliers.

"We recommend the first one so that we do not end up begging the richer countries for the drugs they've already stockpiled ahead of time," Razon said.

The risk is high, as Razon cited that during the H1N1 pandemic in 2009, countries stockpiled on flu drug Tamiflu and ended up wasting money.

"The options are naturally limited because the world is dealing with a new virus for which there is no confirmed cure and no vaccine. However, there is information available on pharmaceutical products that are being developed and tested. Those are the options to choose from, but we won't know for sure which ones will work until the trials are done," Tan said.

The Philippines is currently part of the World Health Organization (WHO)'s Solidarity trials for 4 possible therapies in treating COVID-19:

According to the WHO, more than 100 countries have joined the Solidarity trials. The Philippines has also expressed its readiness to participate in the clinical trials of Japanese-developed flu drug Avigan.

However, participating in clinical trials does not guarantee getting prioritized for future drug supply.

"Solidarity is part of the first step – the scientific process of determining whether the drugs in the trial are effective. These drugs are already commercially used for other conditions. After that comes the business side of things of making and selling the drugs," said Tan.

He added: "The decisions will be largely made by the pharmaceuticals industry, but governments can influence where these products become available. For example, high-level talks between national governments may help."

As of Monday, April 27, the Philippines has 7,777 confirmed COVID-19 cases. At least 511 have died while 932 have recovered, according to the Department of Health. – Rappler.com