Philippines is battling one of the worst coronavirus outbreaks in Southeast Asia but many are reluctant to get the jab.
Just days after the first COVID-19 death due to the Delta variant was announced in the Philippine southern island of Mindanao, Khim Caermare, a volunteer teacher for the deaf, gathered 15 of his students to convince them to get vaccinated. The province had recently experienced a surge in infections that filled hospitals and more than 170 deaths. The Delta variant was first identified in India.
His students needed the COVID-19 vaccine fast, Caermare figured.
But convincing them to get the shot was not easy.
Online misinformation had made them hesitant. Some had heard of false but widely-circulated claims that vaccines would turn people into zombies – fictitious flesh-eating monsters popularised in horror movies. Others had read unverified posts claiming that vaccines could be fatal.
Language was another barrier.
“You have to remember that the deaf have a different way of consuming information and data. Pictures work better than text,” he explained. It helped that he had earned their trust and friendship, said Caermare, who is himself studying to become a Catholic priest.
Over a meal after morning prayers, Caermare made his pitch to the class. He also asked for consent from their parents, writing them letters and visiting their homes to explain the vaccination process.
When the day to get vaccinated came, Caermare and all 15 of his adult students got their shots.
“I’m hoping for a second batch soon,” he told Al Jazeera, crediting the support of his church for making his “silent ministry” possible.
A community-based approach built on trust is what President Rodrigo Duterte urgently needs if he wants his COVID-19 response to succeed, medical and public health experts say, urging his administration to quickly ramp up vaccinations and significantly improve contact tracing and testing.
Duterte, who prides himself on his tough-guy image, had previously threatened to shoot quarantine violators and send to jail those who refused to get injected but as he prepares to deliver his final annual State of the Nation Address (SONA) on Monday, the Delta variant is testing Duterte’s leadership yet again.
Duterte barely made mention of any health issues in his first address to Congress in July 2016. But now he has to contend with a pandemic that has shrunk the country’s gross domestic product (GDP) by 9.5 percent – the worst since post-World War II – and left more than 27,000 dead.
— Tony Leachon MD (@DrTonyLeachon) July 25, 2021
Dr Anthony Leachon, a former adviser to Duterte on COVID-19 policy, told Al Jazeera that he has “serious concerns” about the government’s response to the variant.
As of Sunday, 55 more Delta cases were confirmed, bringing to 119 the total number of cases formally linked to the strain. Many of the cases were detected weeks after infection, so it is unclear how far it might have spread.
“I think we are not ready,” Leachon said, as he listed the reasons for the lack of preparedness, including the late enforcement of travel bans on Indonesia, Malaysia and Thailand. where cases linked to the Delta variant have set off new outbreaks.
“The Delta variant cases are now here in the Philippines with local transmission. So a sense of urgency is needed,” said Leachon, the former president of the Philippine College of Physicians.
More than a year into the pandemic, he says the testing and contact tracing infrastructure in the country remains “weak”, while the genome surveillance necessary to detect mutations of the virus is “limited” – delaying timely identification of new variants.
He also pointed to the “sluggish” vaccination effort as another main concern.
As of Saturday, the government’s COVID-19 emergency response team said 5.5 million individuals had completed their vaccinations, equivalent to about five percent of the country’s 110 million people.
It also said that about 10.8 million have received their first dose or 9.8 percent of the population. A record 472,000 received their doses on July 22, according to the health department.
Last week, Harry Roque, the president’s spokesman, told the media that the president will use his final SONA to highlight his accomplishments during his five years in office.
Among those listed by his administration is the passage of the universal healthcare law in 2019 and free college education at 112 state universities and colleges.
According to the Philippine News Agency, Duterte is also expected to call for an end to temporary labour contracts – something he promised as early as 2016 when he first came into office.
A 2019 security of tenure bill passed by the House of Representatives and the Senate was vetoed by the president amid pressure by the business community.
‘Delta transmission could be happening now’
But while Duterte might want to focus on his achievements, he will be unable to avoid discussing the pandemic.
While the vaccination rate is accelerating Edson Guido, an economist and data analyst from the University of the Philippines, says it could still take up to 1.3 years for the government to vaccinate 70 million Filipinos in order that herd immunity can be achieved by October 2022.
“To reach our government target by end of the year, the pace should now be around 750,000 doses administered per day,” he said.
Guido had earlier warned that if a surge driven by the Delta variant happens, “the outcome will be bad” because the number of cases in the last few days has been hovering between more than 5,000 and 6,000 and genome surveillance is “lagging behind.
“Looking at the details of the additional Delta variant cases, these were infections that happened weeks ago. So transmission could be happening now and we’ll be reporting them weeks from now.”
Guido is calling on officials to monitor areas where the COVID-19 positivity rate is rising, step up testing and impose localised lockdowns to contain the variant. He is also calling on the government to cover the cost of testing. Currently, the government only offers free testing for returning overseas Filipino workers and healthcare workers.
As of Sunday, the health department had reported 5,479 new cases. Testing typically slows down during weekends. The latest number is slightly lower than Friday’s 6,845 new cases, which was the highest since June 26. Meanwhile, the number of people being tested – a measure of how well the government detects carriers and stops the spread – dipped below 50,000, giving a positivity rate of about 13 percent.
Since the pandemic began last year, the Philippines has reported more than 1.5 million cases, with 27,224 confirmed COVID-19 deaths as of Sunday.
However, the Philippine Statistics Authority (PSA) reported more than 30,000 COVID-19 deaths as of the end of 2020. In contrast, the health department only registered 9,200 deaths. The PSA total included almost 21,000 deaths that were “not identified” immediately being as COVID-19 related.
‘Weathering out a pandemic’
Dr Jaifred Christian Lopez, a public health expert and medical doctor from the University of the Philippines, says he is also “not as optimistic” that the country is ready for another surge, pointing out that even better-equipped countries are also scrambling to deal with the new wave of Delta infections.
But if people follow public health rules and vaccinations pick up, he says the country “may see a way out of the pandemic and weather out the Delta variant”.
He said the response of the government should be data-driven, adding that officials should be “agile enough to keep up with emerging trends as regards the spread of variants and increase in cases”.
While crediting the Duterte administration for the passage of the universal health care law 2019, he said its partial implementation would make it harder to cope with a Delta surge.
At the central hospital for COVID-19 patients in the southern province of Zamboanga del Norte, top health officials are not taking any chances.
Last June, the same hospital and other affiliated public health centres were faced with a sudden surge in cases.
“We need to be ready for such eventuality on the entry of the Delta variant,” Dr Esmeralda Nadela, the provincial health chief, told Al Jazeera.
“Healthcare workers are still on alert status. Although the situation have subsided, they are not putting their guard down,” she said.
They have ensured that they have enough portable x-ray machines, high-flow oxygen concentrators and mechanical ventilators as they wait for oxygen tanks to arrive from bigger cities in Mindanao.
Nadela says more medicines have also been requested, including Remdesivir and tocilizumab as well as cartridges for haemoperfusion, a procedure that filters the blood and removes toxins from the bodies of COVID-19 patients.
To avoid congestion in the main hospital, affiliated medical centres have also been ordered to increase their bed capacity for possible COVID-19 cases and improve their patient- referral system, Nadela said.
The Zamboanga del Norte which has a population of more than one million has received an additional 40,000 new doses of the Johnson and Johnson vaccine. Vaccinations for the elderly and people with comorbidities started last Wednesday.
Nadela has also pushed for stricter border controls with neighbouring provinces, as Delta cases surface in the rest of Mindanao. In neighbouring Cagayan de Oro, a regional online website Minda News reported that a birthday party was responsible for the spread of the Delta variant there.
On Sunday, the health department said that more than 70 percent of the intensive care (ICU) beds in the Northern Mindanao region, which includes Cagayan de Oro, have been occupied. A data-analytics group OCTA Research says Cagayan de Oro is now in the “critical risk” category.
The neighbouring Davao Region’s ICU occupancy rate is at 75.7 percent. In Davao City, Duterte’s hometown, the rate was 83 percent between July 18 to 24, OCTA Research noted.
The government last week said it expects the delivery of at least 136.1 million doses within the next six months.
With about 28 million doses of vaccines already available, supply is no longer an issue, said Guido, the data expert from the University of the Philippines.
“We can administer 500,000 per day and we will still have enough supply for the next 25 days.”
In recent days, Vice President Leni Robredo had urged a faster rollout of the vaccine, warning that another surge could be worse than previous ones.
“We have to be ready. We don’t want another surge.”