How will COVID end in the Philippines?

Photo sourced from the World Health Organization

Three years into living with COVID-19, the virus’ path toward becoming endemic is clear, with the World Health Organization (WHO) saying that at some point in 2023, “we will be able to say that COVID-19 is no longer a global health emergency,” especially with cases now manageable across the globe. However, we are not there just yet.

WHO Director-General Tedros Adhanom Ghebreyesus said after a key advisory panel on January 30 that the pandemic may be nearing an “inflection point” where increased immunity would reduce virus-related deaths.

Globally, the virus so far has killed over 6.8 million people in the world. In the Philippines, COVID-19 has claimed 66,000 lives as of today, and at the height of it, many have died in their homes due to a strained healthcare system.

No one would want to go back to that period of global health crisis again.

Most countries have dropped pandemic restrictions and are learning to live with the virus. But the question still lingers: how will COVID end in the Philippines?

Situation in the Philippines

While cases have plateaued and are beginning to show a downward trend, the daily average of administered vaccines has also slowed down.

This slow rollout can be attributed to several reasons, including limited vaccine supplies, vaccine hesitancy among some Filipinos, and logistical challenges in administering vaccines to remote areas.

The government’s booster program is also stalling, and only 29% or about 21.5 million of the 73.8 million fully vaccinated individuals have gotten their first booster shot.

Earlier this month, President Ferdinand Marcos Jr. was hesitant to extend the state of calamity in the country, a decision opposed by the DOH.

While the WHO decided to lift the global health emergency, DOH officer-in-charge Maria Rosario Vergeire in a press conference said that the Philippines is also ready.

“If and when the public health emergency will be lifted, we know that the virus will be here to stay. The Philippines will continue to be cautious and vigilant and we will still be imposing these same restrictions we have right now, which [are] not so much strict, but the safeguards are there that any time the cases will increase, we have our safeguards that we can rely on and we can impose so Filipinos will be more protected,” she said.

Recent History

Prior to COVID-19, we had managed to deal with viruses such as swine flu, measles, and polio. All of these diseases were controlled, but none had the same sociological impacts as COVID-19.

In 2009, the influenza A (H1N1) virus, also known as the swine flu, re-emerged and entered the Philippines, and in that year, the DOH recorded a total of 3,207 cases with 28 deaths.

The virus had spread to 74 countries with 144 deaths, leading the WHO to declare it a pandemic. The government responded by implementing measures such as school closures, travel restrictions, and increased surveillance and testing for the virus.

After a year, on August 10, 2010, WHO announced its endemic phase. But the virus continued to circulate as seasonal flu, and it re-emerged again in 2019.

Since 2013, cases of Measles have decreased ever since vaccination was introduced through the DOH Expanded Program on Immunization, and eliminating the virus is still underway. But despite high vaccine coverage, a nationwide outbreak re-occurred in 2017 and 2019.

To mitigate measures on controlling the spread of the virus, the DOH worked side by side with other government agencies to quickly respond to the Measles outbreak.

Their efforts included maximizing immunization schedules in local governments beyond regular working hours, involving daycare workers in distributing beneficiaries to parents and their children in accordance with the Pantawid Pamilyang Pilipino Program, distributing vaccines and deploying medical personnel in geographically isolated and conflict areas, as well as advocating and promoting awareness crafted in the local vernacular of every barangay.

Then in 2021, the WHO declared that the polio outbreak had ended in the country, as the virus had not been detected in any children or in the environment for 16 months. In September 2019, the DOH declared an outbreak of polio in the country after 19 years of being polio-free.

Despite the fact that some of these diseases are continuously spreading around us, questions about the so-called end are yet to be determined medically.

Nevertheless, comprehensive outbreak response measures, such as increased immunizations and surveillance, have led to these outbreaks near endemic status.

In contrast to the previous viruses, COVID-19 exposed the weaknesses in the country’s healthcare system, including a lack of hospital beds, healthcare workers, and medical equipment.

In light of COVID-19's near endemic status, the government must prioritize investments in healthcare infrastructure, training and hiring healthcare workers, and expanding access to medical supplies and equipment.

Yet, according to The New York Times report back in 2020, pandemics often have one out of two outcomes: a medical or social one. The article said that a pandemic will occur socially when people are no longer terrified of the virus and medically when the incidence and death rates decline.

In other words, a pandemic ends not because it has been cured but rather because individuals grow tired of fear and learn to live with it.

Hopeful but not there yet

In the most recent Social Weather Stations (SWS) survey from December 10 to 14, 2022, 93% of Filipinos expressed optimism that the COVID-19 pandemic's worst is over. Meanwhile, only 6% say that the worst is yet to come.

Medically, the end of COVID-19 is still far from reach, and Vergeire expressed that the healthcare response in the country should be fortified.

“This is because we are now seeing that our cases are manageable, our hospitals are well prepared and our occupancy rate for our COVID-19 cases is very low,” she said.

Vergeire also added that even with the expiration of the state of calamity, the country can still push through with the purchase of bivalent vaccines.

“We just need to go through the usual process of procurement. This is what we call competitive bidding and we have discussed this with the President already and he told us to go ahead,” she said.

However, not all members of the Cabinet agree with the decision that the country should already acquire bivalent vaccines.

During the forum hosted by the Makati Business Club last February 3, Finance Secretary Benjamin Diokno said there are 70 million unused vaccines; therefore the Philippines should not rush to obtain bivalent vaccines just yet.

Some researchers from the WHO also think lifting public health emergencies on a national or global scale could trigger governments to redirect their sources.

According to Mark Woolhouse, an epidemiologist at the University of Edinburgh in the UK, “Declaring the public-health emergency over would give governments and some public-health agencies permission to look away and move on to other things.”

Regarding the issue of the President appointing a new health secretary, Vergeire said that there was no offer from the Office of the President for her to become the DOH secretary.

COVID-19 will likely remain a public health concern and efforts to mitigate its impact must be sustained. The government and health authorities must also continue enforcing public health measures and improve testing and contact tracing capabilities to contain the virus's spread.

Although it is certain that COVID-19 will end sociologically before it ends medically, the public health systems still have a lot of work to establish comprehensive post-outbreak response measures to ensure a smooth transition period from the public health emergency. Madeleen Saguid