A Shot for All!: Addressing the Barriers to Pneumonia Vaccination Program in the Philippines

Dear Editor,

In a recent article published in this journal, the authors interestingly assessed the enablers and barriers to introducing Pneumococcal Conjugate Vaccine (PCV) in India during the coronavirus disease 2019 (COVID-19) pandemic. The study identified potential enablers, including social acceptance, lower cost of the vaccine, and intensive communication activities. At the same time, the identified barriers pointed to poor physical access, insufficient social mobilization, limited advocacy, and a stretched workforce. ¹ These findings, especially the barriers to the PCV vaccination, are crucial for formulating an effective intervention against pneumonia and, thus, improving the healthcare system. With this, I want to compare such findings using the Philippine context, another developing country like India, to prepare and equip the healthcare system not only during a health crisis but all year round.

Pneumonia is a lung infection caused by bacteria, viruses, or fungi that enter the lungs, causing the air sacs to fill with fluid. Inflammation results and produces the symptoms of pneumonia—cough, fever, difficulty breathing. It is more serious—and potentially deadly—in infants, adults over 65, and people with existing health conditions or a weakened immune system. Getting vaccinated for pneumococcal pneumonia is the best defense against becoming ill. ² In the Philippines, pneumonia is the third leading cause of death across all ages and is the most common cause of death among children below 5 years of age. According to the Field Health Services Information System Report in 2021, a total of 41,761 children under the age of 15 died from pneumonia. These deaths include: 256 deaths among newborn babies and 6-day-old infants; 520 deaths among 7 to 28-day-old infants; 10,515 deaths among babies aged 29 days to 11 months; 20 104 deaths among children aged 1 to 4 years; 7378 deaths among 5 to 9-year-old children; and 2988 deaths among children aged 10 to 14 years (see Figure 1). ³ Last year, 2022, about 31 395 Filipino children who are under 5 years old died, and nearly 60 500 children were infected with the disease in 2022. ⁴ As the study of Hora et al. revealed, physical restriction on the movement of beneficiaries and vaccinators for immunization and limited accessibility of the novel vaccine was a barrier to vaccination during the pandemic. This is similar to the Philippines since the country was in lockdown for over 2 years, which slowed down the vaccination program for other diseases except COVID-19.

Figure 1.

Pneumonia deaths in 2021 in the Philippines (DOH).

In addition to this scenario, even before the pandemic, many Filipinos still did not grab the opportunity to get vaccinated with PCV due to several barriers. First, some locals treat PCV as another additional expense less important than food or other essential needs. It is important to note that many Filipinos live below the national poverty line. PCV is only free for babies, and 60 years old and above at barangay health centers. The price range for a pneumonia vaccine is from P3000 to P4500, which is expensive for a typical Filipino family. ⁵ Thus, the government must find a way to provide a free vaccine for all ages. Second, the Dengvaxia controversy is still causing severe hesitancy for some parents, which hinders them from getting their children vaccinated against any diseases. Dengvaxia is a vaccine against dengue fever and was rolled out in many public schools to vaccinate a million students in 2016. The country is still reeling from the consequences of this controversy, which some parents claimed was the cause of the death of their children. This led to the erosion of public trust in leaders and significant damage to vaccine confidence in the country. ⁶ Lastly, another problem is the need for a massive vaccination campaign regarding the disease. There should be a strategic program that will effectively disseminate vital information regarding the disease and the essentiality of the PCV. This can be done starting in the respective health centers, then expanded on a house-to-house basis, and utilizing all forms of media, especially various social media platforms.

These barriers must be addressed with the government's full initiative and collaboration from the private sector and other institutions. A healthy nation always considers the well-being of everyone else, regardless of age and whether there is a health crisis or none.