COVID-19 NATIONAL VACCINATION PROGRAM (CNVP)

What COA Found

The COVID-19 pandemic presented an unprecedented global health challenge, significantly impacting the Philippines and straining the government's resources. In response, the government implemented the CNVP as a crucial preventive measure to curb the spread of COVID-19 variants and safeguard the lives of Filipinos.

COVID-19 Vaccination Accomplishments and Challenges

From 2020 to 2022, the CNVP received a total funding of ₱74.68 million from various sources. The program initially aimed to vaccinate 70 million individuals, or 63% of the eligible population, in 2021. However, the target for 2022 was revised to 70% of the eligible population, approximately 77 million individuals, focusing on achieving both full vaccination and booster shots.

Despite these efforts, the CNVP faced various challenges: (a) Vaccination Coverage: While the Philippines achieved a 45.37% vaccination rate in 2021 and increased it to 66.12% in 2022, narrowly missing the target, booster dose uptake remained low. Only 27.10% and 4.81% of the target population received the 1st and 2nd booster shots, respectively, in 2022. Vaccine hesitancy, fueled by fear, misinformation, and concerns about adverse effects, contributed to this low uptake; (b) Demand Planning and Vaccine Distribution: Inefficiencies in demand planning and vaccine distribution posed significant hurdles. Concerns arose regarding the accuracy of the nationwide masterlisting data, as submission was not mandatory at the provincial level. This resulted in discrepancies between projected and actual vaccination targets, further complicated by off-residence vaccinations and variations in population records across LGUs. Additionally, a significant number of vaccine doses (21,529,470) remained undistributed due to factors such as LGU non-acceptance, lack of clear reallocation guidelines, recipient preferences, and delayed vaccine arrival; (c) Vaccine Wastage: As of September 8, 2023, the Philippines recorded a substantial wastage of 68,668,405 vaccine doses, representing 25.18% of the total vaccine supply (251,774,460). This high wastage rate highlighted inadequate planning in vaccine procurement/acquisition, receipt, utilization, and distribution; and (d) Vaccine Information Management System (VIMS) Issues: The VIMS encountered significant data management challenges, including errors, duplicates, and unrecorded individual health declarations in the line list entries. These issues, coupled with control weaknesses such as the absence of Non-Disclosure Agreements and inadequate security controls, exposed sensitive personal data to potential breaches.

Succesful Practices

Despite these challenges, the COA commends the DOH for its proactive communication efforts, successfully reaching vulnerable groups like pregnant women and those in geographically isolated and disadvantaged areas. The COA also acknowledges the commitment of LGUs in providing incentives to encourage vaccination and procuring Ultra-Cold Freezers for vaccine storage. In future similar programs and taking from the CNVP experience, the following may address the identified challenges: (a) Strengthening data management and accuracy: Ensuring the reliability of masterlisting data and addressing discrepancies in VIMS records; (b) Enhancing vaccine distribution and cold chain management: Implementing clear reallocation guidelines for undistributed vaccines and improving adherence to National Vaccination Operations Center (NVOC) allocation lists; (c) Addressing vaccine hesitancy: Developing targeted information campaigns to counter misinformation and build public trust in vaccines; and (d) Improving VIMS security: Implementing robust security measures to protect sensitive personal data.

Alignment with SDGs

The CNVP contributes to the attainment of SDG 3, which focuses on ensuring healthy lives and promoting well-being for all ages. However, to effectively monitor progress, it is crucial to adapt indicators and target, particularly for SDG 3.d, which emphasizes strengthening the capacity of all countries for early warning, risk reduction, and management of national and global health risks.

Why COA Did This Study

The Coronavirus Disease 2019 (COVID-19) pandemic prompted the establishment of the COVID-19 National Vaccination Program (CNVP) in 2021, as mandated by Republic Act (RA) No. 11525. This program aimed to mitigate the impact of the virus through the procurement and administration of safe and effective vaccines by the Philippine government. To achieve this, the government, through the Department of Health (DOH) and the National Task Force Against COVID-19 (NTF), utilized various funding sources, including multilateral and bilateral agreements, domestic Government Financial Institutions (GFIs), and bilateral negotiations. Specifically, multilateral loans were secured from institutions like the Asian Development Bank (ADB), World Bank (WB), and the Asian Infrastructure Investment Bank (AIIB). Consequently, the ADB, through the DOH, requested an examination of the CNVP's overall performance.

In response to this request, the Commission on Audit (COA) conducted a comprehensive audit of the CNVP. This audit focused on several key areas: (a) Immunization Goals: Assessing the program's attainment in its target of vaccinating 77 million individuals by the end of 2022; (b) Cold Chain Adherence: Evaluating the implementing agencies' compliance with cold chain requirements to ensure vaccine efficacy; (c) Vaccine Wastage: Examining measures to minimize vaccine wastage and ensure proper disposal; (d) Data Management:Analyzing the timeliness and accuracy of data monitoring and reporting systems; (e) Vulnerable Populations: Evaluating the program's responsiveness to the unique needs of vulnerable populations throughout all stages, from planning to reporting; (f) Internal Controls: Assessing the effectiveness of internal controls in mitigating the risk of irregularities; and (g) Sustainable Development Goal (SDG) Alignment: Determining the program's alignment with SDG 3, which focuses on ensuring healthy lives and promoting well-being for all ages.

Apart from reviewing legal frameworks and documents, COA engaged in extensive consultations with key stakeholders at various levels, including local government officials, community groups, and program beneficiaries. This multifaceted approach, which included interviews, site visits, and surveys, provided valuable insights into the program's implementation and effectiveness. It validated the program's integration with national and local vaccination strategies and confirmed the active participation of multiple stakeholders in its planning, implementation, monitoring, and reporting phases.

What COA Recommends

COA emphasizes the importance of continuous improvement and learning for future vaccination programs. To enhance preparedness and response to global health risks, COA recommends that the DOH prioritize the following: (a) Strengthening of public health emergency preparedness: Address the strengthening of capacity for early warning, risk reduction, and management of national and global health risks, and adapt indicators and targets to monitor and report on the progress towards attainment of relevant SDGs; (b) Demand and Continuity Planning: Develop comprehensive demand and continuity plans to ensure the uninterrupted supply and administration of vaccines even during emergencies; (c) Targeted Information, Education, and Communication (IEC) Strategies: Implement tailored IEC strategies to address specific concerns among different population segments. This will help combat vaccine hesitancy and improve overall vaccine acceptance; (d) Responsive Distribution Plan: Formulate a distribution plan that is responsive to the needs and challenges faced by Local Government Units (LGUs); (e) Stakeholder Involvement in Software Development: Ensure that all relevant stakeholders, especially the endusers of any application or system, are actively involved in all phases of software development to ensure that the resulting tools are user-friendly and meet their needs; and (f) Strengthened Application Controls and System Integration: Enhance and rigorously enforce application controls and system integration to maintain data integrity and security.