In the Philippines, the COVID-19 pandemic is a new chapter in an old story of threats to progress with immunisation services and children's health. Before the pandemic, immunisation (DPT3) coverage in the country decreased by 14 percentage points between 2010 and 2019,[1] and this has led to the recent resurgences of polio, measles, and other vaccine-preventable diseases.[2] Key challenges confronting the country's immunisation programme include stock-outs and vaccine hesitancy due to suspected or actual adverse events from vaccination. A critical task was to rapidly resume implementation temporarily halted by initial COVID-19 pandemic restrictions.

Amid the COVID-19 pandemic, in the national fights against deadly vaccine preventable diseases, the government of Philippines has demonstrated strong commitment, leadership and resilience, and contributes in-kind and up to 85% of operational costs.  Ensuring immunization goals are met and maintained is an important contributor to the GPW 13 goals and to achieving the SDGs.

WHO facilitated safe delivery of immunisation services while curbing COVID-19 pandemic transmission by supporting in-country strategic planning at national, regional, and local levels. A notable outcome of this coordination effort was inclusion of WHO guidelines on maintaining essential immunisation services as part of the national protocol for Coordinated Operations to Defeat Epidemic (CODE). Based on this guidance, WHO advised the Philippines Department of Health (DOH) in issuing guidelines on implementation of routine immunization, measles outbreak response immunization, polio outbreak response immunization and conduct of the National Measles-Rubella-Polio supplementary immunization activities (SIA) during the COVID-19 Pandemic,    Furthermore, WHO provided medical supplies and personal protective equipment (PPE) to enable health workers to comply with hygiene and physical distancing requirements.

WHO also provided operational support to deliver planned interventions in line with CODE. For example, in place of the face-to-face model of training health workers, WHO played a critical role in adopting internet based virtual platforms to conduct training for health workers and volunteers. This shift enabled the continuation of a wide range of public health functions, including disease surveillance, data management, and community engagement. By the end of February 2021, over 3400 frontline workers and volunteers had been trained in close coordination with local community leaders, enabling the synchronisation of efforts for both polio, measles, and COVID-19 pandemic control.

It was also essential to address misinformation and vaccine hesitancy through effective communication and community engagement approaches. WHO worked with the Philippines' government at all levels to develop communication guidance, messages and materials to address these issues while closely engaging with local chief executives, community leaders and communities.  This close engagement at the local level allowed the bridging of resource gaps for robust surveillance and case-finding within communities.

These WHO-supported efforts have resulted in resumption of routine immunisation as well as essential polio and measles outbreak response activities despite challenges imposed by the COVID-19 pandemic.  On 20 July 2020, the Sabayang Patak Kontra Polio (SPKP), the national immunisation campaign which had been halted due to the COVID-19 pandemic, resumed in a phased approach for children under five years in Mindanao, Region 3 (Central Luzon), and provinces of Laguna, Cavite, and Rizal in Region 4A.

In the Mindanao region, 98.1% (3 400 000) of eligible children aged under 5 years were immunised, surpassing the WHO epidemiological threshold of 95% vaccination coverage to respond to outbreaks. Children aged under 10 years in selected areas in Mindanao also received polio vaccination. In Central Luzon, 81.6% (1 093 317) of eligible children were immunised, while more than 80% (2 000 000) of eligible children were vaccinated in the more challenging region 4A with a higher incidence of COVID-19. WHO provided on the ground critical technical support for the planning, training and monitoring of this campaign and all the subsequent campaigns.

The second round of the SPKP campaign for the measles-rubella and oral polio vaccine campaign was conducted on 14 – 27 September 2020. More than 85% (1 185 005) of eligible children aged under 5 years were immunised in the three provinces (Laguna, Cavite, Rizal) of the Calabarzon region.   The country also embarked on 26 October an even more challenging injection campaign against measles-rubella disease with the inclusion of oral polio vaccine for all eligible children less than 5 years old.  The first phase included 11 of 17 regions. This campaign resulted in over 92% national immunisation coverage for measles-rubella vaccine and 89% for oral polio vaccine.  The last phase of the national campaign in the remaining 6 provinces started February 2021 and will soon be completed again reaching 90% of the target population. It should be noted that all these campaigns were hindered by typhoons, other inclement weather and compromised security situations, in addition to the on-going COVID-19 outbreak.  This makes the achievement all the more remarkable.

The Philippines experience shows that with political commitment and coordination, immunisation programmes can be quickly restored and maintained following unexpected disruptions. WHO's efforts in the Philippine contributed significantly to make this happen.

[1]. WHO and UNICEF. Immunization coverage: are we losing ground? Available at https://data.unicef.org/resources/immunization-coverage-are-we-losing-ground/

[2]. WHO. Polio outbreak in the Philippines. Available at Polio outbreak in the Philippines (who.int)

Photo caption: In Dilasag, Aurora Province, polio vaccination teams integrate COVID-19 case finding as they go from house-to-house to vaccinate eligible children.

Photo: WHO/J. Orbina