Willy Pulia, who turned 58 this week, is scared of getting COVID-19 – and for good reason. He's a nursing assistant at a hospital in Manila, which means he inevitably comes in contact with patients who've contracted the virus. He lives with his 96-year-old father. And he's not been vaccinated.
In fact, as of this week, not a single health worker in the Philippines has been vaccinated. And the fear and anxiety among these workers has led more than a few to take a leave or quit their jobs during this public health crisis, according to colleagues. The Philippines has roughly 1,700 new cases of COVID-19 each day, with more than half million total confirmed cases, second only to Indonesia in the region.
Why is the Philippines in such dire straits when it comes to vaccines?
"The problem is that rich countries bought all the supplies," says President Rodrigo Duterte. "There's a scramble [for vaccines] now," he said.
The future looks a bit brighter – but with caveats.
The Philippines is preparing for the arrival of its first COVID-19 vaccines with Duterte confirming the country's ultra-cold storage capacity needed for the vials and promising delivery by the end of the month.
As a lower middle-income country, the Philippines is getting its first doses of the Pfizer vaccine at a reduced price thanks to the World Health Organization initiative known as COVAX.
The assistance program was set up to ensure that the scramble for vaccines among rich countries did not leave poorer nations out in the cold and expects to deliver 2 to 3 billion doses this year. COVAX is helping 92 low- and middle- income countries overcome global vaccine inequity; rushing the Pfizer product to the Philippines is part of that stratagem.
Thirty-two hospitals in Metro Manila, one in Cebu, and another in Davao City have been selected as the first recipients.
However, the spokesman for the Philippine COVID-19 Task Force told NPR the 117,000 doses of the two-dose vaccine that COVAX arranged are enough to vaccinate just 56,000 of the some 1.7 million health workers who top the country's priority list for vaccination. It's now emerged that even that small allotment will not be finalized until lawmakers approve legislation that indemnifies the vaccine maker from responsibility in the event of death or adverse reaction from taking the shot.
The lack of a more aggressive rollout has produced high anxiety among many frontline workers, according to Dr. Charles Marquez, a community doctor in the southernmost island of Mindanao. He told NPR that doctors and nurses putting their lives on the line daily to save COVID-19 patients are battling "fatigue, depression and stress."
Marquez is no exception. Last month, his blood pressure soared so high the 41-year-old doctor admitted himself to the hospital, saying the episode was brought on by work.
Marquez treats patients in the barrios of the mountainous area of Cagayan d'Oro, "the epicenter of COVID-19 in northern Mindanao," he says. Marquez says the fear of contracting the virus is ever-present, and he worries about transmitting it to his elderly mother and aunt, who live with his young family. "So, I have to be extra careful not to get infected with COVID," he says.
Marquez says the stress of working in such "a dangerous environment" has taken a toll on the health of many of his colleagues. He says they're calling in sick and not because they have the coronavirus but because of "stress and anxiety."
Willy Pulia is the president of the Alliance of Philippine Workers, which represents 5,000 health workers in twelve mainly Manila-based hospitals. He told NPR that many members have developed deep distrust of a government vaccine campaign that he says has been marred by delays, confusion and back-tracking about which vaccines they'll use.
"The health-care workers have lost confidence and trust with the government," says Pulia, who adds that the people making vaccine policy are "not the right people to handle this pandemic." He says scientists and medical experts ought to be coordinating and supervising Philippine operations to combat COVID-19, rather than military generals who are unfamiliar with epidemiology, immunology and virology and who currently call the shots.
And these concerns have led health workers to leave their current hospital job to work in another health-care facility that pays better. "Every week, every month there's resignations in our hospitals," says Pulia. He says his post-surgical unit at the 600-bed Makati Medical Center in Metro Manila has gone from 15 nurses to just seven. He says the nursing staff that used to work 8-hour shifts now routinely works 12-hours shifts, something Pulia says he's not seen in 38 years on the job.
Both Marquez and Pulia say workers are especially worried that the Chinese vaccine Sinovax will be rushed into the country. Currently only Pfizer has been given emergency use authorization in the Philippines.
Retired General Carlito Galvez, the country's vaccine czar, has confirmed that the Philippines has already secured 25 million doses from the Chinese manufacturer Sinovac with a small consignment due to arrive this month. But the company has not divulged detailed efficacy data or shared findings through an international peer review. And the FDA indicated today that Sinovax has yet to provide it with key documentation needed in order to receive Emergency Use Authorization.
That lack of transparency has made Philippine health-care workers as well as senators apprehensive.
Senator Risa Hontiveros told NPR: "Government hasn't helped our people with this opaqueness. Why is it now so difficult to get to plain and simple, basic data particularly about this vaccine? People are becoming anxious not knowing."
Hontiveros is also wary of China's ambitious diplomatic and business efforts to distribute Chinese vaccines. As part of Beijing's "vaccine diplomacy," Chinese leaders pledged a gift of 600,000 doses of vaccine to the Philippines, which were expected by the end of the month. (The Presidential Palace reports that Sinovax has put off sending the doses until it receives emergency authorization).
Hontiveros sought assurances from vaccine czar Galvez that Philippine interests and claims in the South China Sea would not be traded away to secure China's vaccine.
There can be no "quid pro quo," she told him.
Earlier President Duterte indicated a clear preference for the Chinese and Russian vaccines, saying Western ones were made for profit. Indeed, the Philippine FDA has just granted the president's security detail a "compassionate" permit for the use of 10,000 doses of the Chinese vaccine Sinopharm.
Public doubts persist as cases climb. Dr. Marquez believes that the longer the vaccine rollout drags on, the more front-line health workers will be contemplating change. The older ones, he says, will retire out of frustration. And the young ones will leave the Philippines.
"Younger front-line [workers] are really considering to go abroad. Even if they think that the dangers are still there worldwide, at least they will be having a better pay," he says.
The pandemic has exposed years of underinvestment in public health in the Philippines that has encouraged the country's medical professionals to go overseas for better-paying jobs. The result has been an acute shortage of health care workers at home.
Recently, Willy Pulia has seen colleagues who leave their health jobs in the Philippines turn up on social media working in another country. He says the pandemic could produce the one thing the Philippines can least afford: a further brain drain of skilled health-care workers. "It's really happening already," he says.