MANILA, Philippines – At the height of the 2019 novel coronavirus (2019-nCoV) crisis, a lawmaker in the House of Representatives proposed a bill that would create a Centers for Disease and Control and Prevention (CDC) in the Philippines.
Albay Representative Joey Salceda’s proposal came amid criticism leveled at the Department of Health (DOH) for its apparent lack of proactive response to prevent the spread of the new disease, which has so far killed over 1,500 and sickened at least 67,000 across more than 20 countries, mainly in China. A recent Senate hearing showed that the DOH had been struggling to track down people that confirmed 2019-nCoV carriers interacted with, exposing lapses in a vital process known as contact tracing.
Health Secretary Francisco Duque III himself said during the same hearing that manpower was among the health department’s problems when it came to contact tracing. The DOH eventually had to enlist the Philippine National Police (PNP) to expedite the process, but not without a push from the Senate.
Aside from manpower, there also appeared to be organizational blunders, as the health chief hit the DOH’s own Epidemiology Bureau (EB) for its incompetence in handling the health emergency. (READ: TIMELINE: The novel coronavirus epidemic)
Though the DOH has not admitted to any budget shortages amid the 2019-nCoV crisis, some lawmakers are proposing to give at least P2 billion to the agency for the purchase of surgical masks and personal protective equipment for health workers. The DOH has welcomed the calls for the supplemental budget.
According to Salceda, there is a “lack of institutional capacity to implement comprehensive public health management programs,” particularly in dealing with communicable diseases like the coronavirus disease of 2019 (Covid-19). “Clearly, the country’s reactive, bureaucracy-challenged approach to communicable diseases no longer serves to adequately protect the country from serious, often fatal infectious diseases,” Salceda’s explanatory note read.
So what would it mean for the Philippines to have its own CDC?
What is the CDC? The CDC is a widely-known US agency whose mission is “to protect America from health, safety and security threats, both foreign and in the U.S.” It also “conducts critical science and provides health information that protects our nation against expensive and dangerous health threats, and responds when these arise.”
The US CDC, which is under the Department of Health and Human Services, began in 1946 as an initiative of the health ministry to combat the spread of malaria in war-torn areas. In the succeeding decades, it broadened its research and efforts to cover other communicable diseases like tuberculosis and sexually transmitted diseases.
Now, the CDC’s focus has expanded even more to deal with chronic or noncummunicable diseases like diabetes, heart disease, and cancer, to name a few. It also does studies and has programs on disabilities, workplace hazard, environmental health threats, and even bioterrorism.
US law also authorizes the CDC to “detain and medically examine persons arriving into the US who are suspected of carrying communicable diseases.” The CDC is allowed to quarantine anyone suspected to have diseases like cholera, diphtheria, tubeculosis, smallpox, yellow fever, viral hemorrhagic fevers, as well as severe acute respiratory syndromes like SARS and COVID-19.
The CDC in the US also has sophisticated laboratory capacities, being home to the few biosafety level 4 laboratories in the world. Laboratories of this grade are used to handle pathogens that cause hemorrhagic fevers like the Marburg virus and the Ebola virus.
How would having a CDC help the PH? According to infectious disease expert Edsel Salvana, having a CDC here would help “centralize the response to emerging infectious diseases threats and will coordinate the different responding agencies under its umbrella.”
Currently, CDC functions are distributed among various bureaus in the DOH. The closest thing we have to a CDC is the health department’s Public Health Service team, under which the Epidemiology Bureau works. But the Epidemiology Bureau is mainly devoted to disease surveillance and has to coordinate with other departments for quarantine and research functions.
“The Bureau of Quarantine (BOQ) is on another team, and the Epidemiology Bureau does not have its own laboratory facilities so they have to coordinate with Research Institute for Tropical Medicine (RITM) to address public health emergencies,” Salvana points out.
Under Salceda's bill in the lower house, the BOQ and RITM would be absorbed into the CDC.
If these functions are concentrated in an agency like the CDC, Salvana says the government would be “agile enough to control a rapidly evolving threat by having a strong public health team with adequate resources, quarantine powers and state of the art laboratory facilities all within its control and with funds that it can mobilize in the event of an emergency.”
But according to Salvana, the Philippines would not have to completely duplicate the CDC in the US. “The most important function we should set up is detecting and responding to emerging health threats. For instance, in this 2019-nCoV epidemic, the health system is reeling under a significant burden and there is some difficulty in ensuring the availability of funds for personal protective equipment, hospital isolation rooms, and testing kits.”
In Salceda's bill in the lower house, for example, he proposes that the Philippine equivalent of the CDC only deal with communicable diseases. He cites health events like dengue, polio, tuberculosis, and Covid-19 as threats that a health agency solely focused on infectious diseases could effectively deal with.
"The reorganization would allow the DOH to focus on noncommunicable disease, which require broad day-to-day coverage and intervention, while a specialized agency tackles communicable disease prevention and control, which require the latitude and efficiency of a smaller but broadly empowered body," the bill reads.
Salvana says it would be best to consider this once the 2019-nCoV crisis subsides. "It may take a few years to set up (a CDC) but the most important (thing) is that it has a dedicated baseline budget with access to emergency funding if it has to suddenly scale up. Cost will be dependent on the final functions, and there need to be contigency funds but it will not be cheap."
For now, the Philippine government is dealing with the 2019-nCoV health emergency mainly through the DOH and the Inter-Agency Task Force for the Management of Infectious Diseases, which the health department leads. It is the inter-agency government body that decides on quarantine protocols and travel restrictions. The Department of the Interior and Local Government is also involved, as barangay health workers will be considered front-liners in the response against COVID-19 once local transmission is reported in the Philippines.
So far, the country has recorded 3 confirmed cases of the disease. One of them died after complications caused by the virus, while the other two have recovered and been discharged from the hospital. The DOH is actively probing 154 patients for suspected infection, though at least 386 of the over 480 samples tested turned up negative for the virus.
Even so, Health Secretary Francsico Duque III said it was too early to say that the situation is stabilizing, and that the government is always expecting and preparing for the worst case scenario. – Rappler.com