Ang vaccine ay sumapit!
Unlike Christmas, it will not arrive everywhere on the same date. Some concerns still remain. The vaccines will protect those who get them. For how long is not certain. Nor is the level of risk that the vaccinated may infect the unvaccinated. There is light at the end, but it is still a long and dangerous pandemic tunnel that lies ahead of us.
The Inter-Agency Task Force on Emerging Infectious Diseases (IATF) must now face intensified pressure to accelerate the process of vaccine delivery. Securing the supply of vaccine in a global market where demand has soared for internationally vetted vaccines already in use presents the first problem. The market, following the default response, will deliver the product to those able and willing to pay the going price. Rich countries have closed contracts for their supplies, some for more doses than their population required.
Enough Filipinos will have the connections to get the vaccine for themselves. A black market has reportedly opened in in unvetted Russian and Chinese vaccines. But protecting public health is a national mandate covering all 110-plus million Filipinos.
What criteria should IATF establish to determine how much of the vaccine it should buy from which suppliers? Effectiveness? Safety? Availability? Price? IATF would need to balance competing cost-and-benefit considerations to craft a plan yielding the greatest gain to the biggest number. This classic, utilitarian approach is congenial to economists because the quantitative analysis can appear conclusive and uncontroversial.
More contentious is the problem of who gets the vaccine and when. IATF follows many countries in giving priority to health frontliners. With the virus still rampaging, those engaged in suppressing its spread need protection. They are also fairly easy to locate; they will be in the health facilities. Beyond this segment, IATF hews to the presidential promise to put the poor at the head of the queue, starting with Indigent senior citizens more vulnerable to the virus and, thus, potential sources of infection themselves.
This ranking does raise some issues.
In developed countries, many senior citizens find accommodation in homes for the aged. Our seniors live widely dispersed with their families. Less mobile and exposed, recommended health practices may protect them adequately, even without vaccine. Finally, senior citizens are mainly retired, while the poor are poor because they are jobless. How does giving them priority access to the vaccine help revive the economy?
The IATF priorities suggest that the government bureaucracy, civilian and military, constitutes the productive elements of society. And assumes that the private sector must protect their own people. The conglomerates can do this.
But the lockdown triggered a multi-pronged crisis because even “essential” workers could not get to their stations. How will the economy rebound without vaccine protection for the private transportation sector, the gig/services economy, the small and medium enterprises?
The rationale for the pro-poor vaccine policy is political, not economic, supporting the administration’s populist governance rhetoric. Populist leaders claiming to champion the marginalized have tended to define this constituency as those who support them. With the delivery of the vaccine coming during an election season, fears that partisan politics will determine its distribution is not easily dismissed.
As it has done in every election, corruption complicates governance problems. Senator Panfilo Lacson observed that the virus does not stop greed. The perceived administration preference for Chinese and Russian vaccines and whatever personal interests or “kickvac” this serves require timely and thorough investigation to preserve public trust. But, setting this aside, the normal gamesmanship to gain control of vaccine procurement to grab political credit becomes problematic when it precludes more effective measures against a deadly pandemic.
Vaccine delivery cannot avoid politics, because it requires tax-funded material and personnel resources and their deployment down to the barangay level. For the same reasons, neither can it ignore the issue of equity and justice involved in determining which areas get the limited vaccine supply.
We might accept in principle that every city, based on population, should have an equitable share of the vaccine. While all are vulnerable to COVID-19, they will not equally need immediate access. IATF might develop a platform for trading vaccine rights, with the cities not availing of their supply receiving alternative but commensurate government credit/benefits.
The last mile issue is more difficult. Among the population of the poor selected for priority assistance, which poor person gets the vaccine first? It is at this retail level that partisan politics becomes more difficult to control.
Vaccine distribution is similar though less fraught than the immediate life-and-death ethical dilemma that pandemic-stricken American and European cities have confronted: which of two dying patients gets the single life-saving ventilator available? In the absence of national guidelines, which have been debated in the US, frontline medical personnel must deal with desperate, on-the-spot decisions that sometimes leave them exposed to legal sanctions – such as for omitting mandatory manual resuscitation methods deemed already futile for patients but seriously life-threatening for caregivers.
We must acknowledge the heroic challenges confronting IATF. It has enough technocrats among the decision makers, though fewer recognized and respected medical experts many would have wanted. Who takes the lead in exploring equity and ethics issues? These may not even surface explicitly in the agenda.
But it is important to recognize that IATF decisions, beyond affirming what is efficient and what is effective, also imply judgments on what is right and what is just.
This is not an easy mandate, but the vaccination program requires public trust. IATF can help itself: by ensuring transparency in its decision processes; by enabling the participation of the private sector and civil society in the supply chain; and by encouraging and developing mechanisms to enlist their collaboration in the program oversight. – Rappler.com
Edilberto C. de Jesus is professor emeritus at the Asian Institute of Management.