The men and women of science supporting the Philippine pandemic response
CLINICAL MATTERS
On April 29, 2022, the Department of Health (DOH) held a recognition program for the DOH All Health Experts with the theme: “Looking Back, Marching Forward: DOH All Health Experts Convening from Covid-19 to UHC.” This program was held to give appreciation to the many scientific experts who guided the DOH, the Inter-Agency Task Force (IATF) for the Management of Emerging Infectious Diseases, and the Philippine government in the successful pandemic response over the last two years.
The program featured a speech by the World Health Organization (WHO) regional director for Western Pacific Dr. Takeshi Kasai, who commended the Philippines for its rigorous science-based approach. He also highlighted how the Philippine government was one of their models in the region for its innovative response of rapidly adopting the latest scientific findings into policy. For instance, the early decision to deploy boosters at three months from the second dose was seen as an integral strategy in tempering the BA.2 wave in January 2022.
Compared to many countries with vast resources and robust healthcare systems, the Philippines has done quite well in managing Covid-19 cases in the country. The approximately 60,000 Covid-19 Filipino deaths over the course of over two years are tragic, but are nowhere near the more than 1,000,000 Americans who have died in the US. Cases have remained flat since the January 2022 Omicron wave, even as the country has quickly reopened its economy. A large part of this success is due to the continued scientific guidance from the health experts, which underpins government policies.
From the very start of the pandemic, the DOH and the IATF have relied on scientific advisers to guide their outbreak response. These scientific advisers make up the All Experts Group. Within the All Experts Group are several groups, committees, and subcommittees that specialize in different aspects of the pandemic. These include the Technical Advisory Group (TAG), the Covid-19 Laboratory Experts Panel (CLEP), the IATF Taskforce for Covid-19 Variants, the IATF Sub-Technical Working Group for Data Analytics, the Health Technology Assessment Council (HTAC), the National Immunization Technical Advisory Group (NITAG), the Vaccine Experts Panel (VEP), the National Adverse Events Following Immunization Committee (NAEFIC), and the Philippine Covid-19 Living Clinical Practice Guidelines Group.
Technical Advisory Group
The earliest experts’ group to be formed was the TAG. The current TAG is made up of three people: Dr. Edsel Maurice Salvana (adult infectious diseases/ molecular biologist), Dr. Anna Ong-Lim (pediatric infectious diseases/ vaccinologist), and Dr. Marissa Alejandria (adult infectious diseases/ clinical epidemiologist). Other persons were invited to participate as part of the TAG in the early phase of the pandemic. Public Health expert Dr. Kathy Reyes represented the College of Public Health in March 2020 when the recommendation to lock down was made to the government. The current TAG is made up of infectious diseases doctors who are also scientists and administrators. It was particularly useful for policy making since we had eyes and ears at every level of the pandemic response. We were able to integrate all the data from these different sources into our recommendations. As practicing infectious disease doctors, we were on the frontline and in the trenches. As scientists, we handled technical information coming from the laboratories and ongoing clinical trials. As administrators, we were keenly aware of the implications the policies we were vetting would have on the big picture.
The impetus for the formation of the TAG was the detection of the three Covid-19 cases among Chinese tourists in January 2020. At that time, very little was known about the virus that was then called the novel coronavirus or nCoV. There was a lot of fear at that time, and any travelers from China who developed respiratory symptoms were to be immediately isolated. This was the beginning of the transformation of emergency rooms into isolation areas, with people roaming around in full PPE. The TAG was convened shortly thereafter and we began to help develop policy for testing, isolation, and designation of persons under investigation (PUIs) and confirmed cases.
After the initial three Covid-19 cases, there were no further cases for two long incubation periods, at which point the WHO commended us for containing the virus. Of course, a few days later, we ended up with Patient 5 who did not have a history of travel or exposure. The genomic data later showed that the first three Chinese cases were lineage A (1 case) and lineage B (the next 2 cases). Patient 5 ended up having lineage B.6, which is a Southeast Asian/Indian lineage. B.6 was responsible for the first instances of community transmission. It was not related to the first three cases, which were truly contained. By then, flights to and from China had been banned, but Covid-19 sneaked in through a different country, which gave us one of our first lessons in proactive border control. Shortly thereafter, we recommended the community quarantines, which eventually became the alert level system.
The TAG constantly advised the government throughout the ups and downs of the pandemic and we continue to attend IATF meetings regularly. The TAG members also sit on some of the other Expert Groups. For instance, because of my laboratory experience, I am also on the CLEP. Dr. Alejandria with her epidemiology background and being president of the Philippine Society for Microbiology and Infectious Diseases sits on the Philippine Covid-19 Living Clinical Practice Guidelines Group while also running clinical trials under the WHO SOLIDARITY trial. Dr. Ong-Lim as a pediatrician sits on various vaccination committees and technical working groups for resumption of face-to-face classes. All of us are on the IATF Taskforce for Covid-19 variants, the Sub-technical Working Group for Data Analytics, and we usually sit in on the meetings with the NITAG. We are frequently called to be resource persons on other committees and executive sessions as well as ad hoc meetings in Malacañang with President Duterte. We have attended over 500 meetings during the pandemic, with more than 150 of those being IATF meetings alone.
Other Expert Groups
The Covid-19 Laboratory Experts Panel oversees testing policy and policies covering Covid-19 testing laboratories and new diagnostics. The IATF Taskforce for Covid-19 Variants was formed when the first variant of concern (VOC) Alpha was reported in December 2020. It includes the DOH, the Department of Science and Technology. The Research Institute for Tropical Medicine, the National Institutes of Health, and the Philippine Genome Center. It monitors the prevailing Covid-19 variants in the country and makes recommendations on travel policies such as quarantine and pre-departure testing.
The IATF Sub-Technical Working Group for Data Analytics met every week at the height of the pandemic to determine community quarantine and alert levels for the different local government units. The policies underlying community and localized lockdown were generated by this group. An important component of the Sub-TWG for Data Analytics is the FASSSTER group, which used state-of-the-art modeling to make case projections looking at different scenarios depending on factors such as vaccination levels, prevailing variants of concern, and community quarantine and alert levels.
The Health Technology Assessment Council analyzes the science and cost-effectiveness of different interventions throughout the pandemic, including vaccines and medications. The NITAG makes recommendations on vaccine policies, including target groups, schedule and type of vaccines and boosters. The Vaccine Experts Panel reviews different vaccine brands and makes recommendations for primary series and boosters based on clinical trial results. They also review vaccine clinical trials being conducted locally. The National Adverse Events Following Immunization Committee investigates possible vaccine-related reactions during the mass immunization campaign. Finally, the Philippine Covid-19 Living Clinical Practice Guidelines Group formulates clinical practice guidelines on the diagnosis, treatment, and prevention of Covid-19 as new clinical evidence on interventions came in.
All these expert groups were integral to the Philippine pandemic response and saved countless Filipino lives. Even with our advice, it was still up to the government to listen to the science and to the people to comply. All Filipinos working together against the virus was the reason we were able to defeat Covid-19 as a people.
The All Experts Group of DOH. (Picture courtesy of DOH)
The Technical Advisory Group with DOH Undersecretary Maria Rosario Vergeire who oversees the TAG.