The Philippine CDC and improving pandemic resiliency

After months of low COVID-19 positivity numbers, the Philippines is starting to see an uptick in cases. As of April 27, our weekly positivity rate is 14.3%, up from 9% on April 20. This comes after the detection of the more transmissible COVID-19 variant called Arcturus in the country.

While there has yet to be a reported change in severity, this development means that to prevent another surge, we need to reinforce the importance of COVID safety measures like wearing masks and ensuring good ventilation in public places.

At this point in the pandemic, we should ideally be confident in our health system’s ability to handle COVID cases. The virus has evolved and the illness has become less severe. Vaccine uptake in the Philippines is relatively high, although inequities exist among geographically isolated and poorer regions. We can only hope that the worst is over.

Despite all the learning moments and the three years we’ve had to build up our health systems, the Philippines’ ability to respond to pandemics, COVID-19 or otherwise, leaves much to be desired.

COVID is something we will be dealing with for years to come, whether in the form of the disease itself (long COVID, while still being studied in the Philippines, was reported to be experienced at one point by at least 15% of US adults as of January 2023, according to the US Centers for Disease Control and Prevention) or the repercussions of the lockdowns and pandemic policy.

In many ways, the pandemic held up a mirror to the Philippine government’s existing failures, especially those within our healthcare system.

The government’s pandemic response was painfully slow. The economy collapsed because of the one-size-fits-all lockdown, a policy decision which could have been avoided if we had a centralized contract tracing system and strong coordination between local government units and the National Government.

Perhaps the most important lesson that the pandemic taught us is that the voice of science and evidence in crafting policy cannot be belittled.

Science writer Philip Ball, in a 2021 article for Interface Focus, wrote that COVID required policymakers to work with scientists and doctors more closely than in any other recent event. However, he noted that science never operates in a vacuum; during the pandemic, science has been viewed as a savior (especially when vaccines emerged), and at times a villain or an inconvenience (when science ran into conflict with political leadership).

During the COVID-19 pandemic, the Philippine government, especially the highest-ranking officials, saw science and the scientific community as more of an inconvenience than an indispensable source of guidance.

Inevitably, political decisions do not rely on science alone; they need to have a wide range of considerations, including economic ones. But too often, in the most critical moments, the scientific community was shunned, and policies were not driven by data.

Our pandemic response was highly politicized. We saw the effects of the politicization of pandemic response many times: when local politicians endorsed and gave away ivermectin, a drug which was proven to be ineffective against COVID-19, to their constituents; when misinformation and inconsistent policies thrived; and when vaccine prioritization was pushed aside in favor of the well-connected and powerful.

Civil society and the medical community became a broken record, constantly calling on the government to listen to the doctors. But rather than listening to their critics, the highest-ranking government officials threatened them, even going as far as insulting the very doctors who played a crucial role in our pandemic response.

In an effort to address these shortcomings and prepare the Philippines for future public health emergencies, Congress proposed a bill creating the Philippine Centers for Disease Control and Prevention (CDC).

The bill was passed on third reading in the House of Representatives in December 2022. The counterpart in the Senate, Senate Bill 1869, containing Committee Report 28, has been sponsored by long-standing health champion, Senator Pia Cayetano, and is expected to move to the plenary floor soon. Health advocates are confident that Senator Pia, a staunch ally of the medical community and an advocate for data-driven policymaking even before the pandemic, will ensure the passage of the best possible version of the CDC bill.

The proposed CDC is a science-based organization with technical autonomy under the Department of Health (DoH), which uses data to drive decision-making. It is defined as “the technical authority on forecasting, analysis, strategy, and standards development for the prevention and control of all diseases of public health importance.” It also aims to clarify governance, decision-making, communication, and coordination processes with respect to public health threats.

One of the issues constraining the DoH in relation to COVID-19 response has been the lack of funding and positions for the ad hoc groups created, including the groups of technical experts crafting pandemic policies. The CDC addresses this by institutionalizing and creating offices, positions, and funding for the said units. Our technical experts who tirelessly worked pro bono for years deserve to be remunerated for their invaluable service. Hopefully, this will also strengthen the authority of our technical experts to contribute to policy discussions.

To further strengthen the voice of science, the bill needs stronger language, which emphasizes that the CDC’s decision and guidance must be given primordial consideration in coming up with health and health-related policies and decisions in times of a public health emergency.

We also believe that the Senate should reconsider a concerning provision found both in the House version and Senate Committee Report that undermines the Health Technology Assessment (HTA) process and gives the DoH the flexibility to bypass HTA for essential commodities.

The HTA process, carried out by the Health Technology Assessment Council (HTAC) and institutionalized in the Universal Health Care Act, plays an indispensable role in balancing the strength of clinical evidence with cost effectiveness, acceptability, social impact, and urgency of procuring health technology. Contrary to the criticism of the HTA process as a cause of unnecessary delay to the immediate implementation of measures to address public health emergencies due to the lack of suitable evidence, the HTA can actually recommend technology even when evidence on clinical effectiveness is of low quality, precisely because it weighs the urgency of a certain intervention. Without this process, recommendations from the World Health Organization and other international bodies would be adopted without proper evaluation of their feasibility within the Philippine context. International recommendations alone are not sufficient without assessing the health technology’s feasibility in the Philippine context.

The HTA process must be protected, especially during public health emergencies. Instead, the creation of a joint emergency HTA council during a public health emergency will streamline the evidence review process and guard against corruption.

Lastly, the current version of the bill simply provides that the appropriations be charged against the current year appropriations of the offices and agencies concerned. This could possibly constrain the budgets of the said offices and agencies. What resources CDC may get will be a loss of resources for other programs and vice versa.

More than anything, we need credible commitment that the CDC will be adequately funded and be able to fulfill its responsibilities. We can create this by enacting a baseline budgetary appropriation for the CDC, which will be the starting point for future appropriations.

The CDC will also absorb a number of offices of the DoH, some in full, including the Epidemiology Bureau. However, for the CDC to make an impact on our public health strategies, we hope that it will go beyond a mere reorganization or transfer of boxes on the DoH’s organizational chart, and truly strengthen the voice of science in crafting policy.

Pia Rodrigo coordinates the health policy team of Action for Economic Reforms.