 Hello, good morning, good afternoon, good evening everyone asan manpukayo sa Parti ng Mundo. Welcome to our 77th installment of the Stop COVID Debt Webinar Series brought to you by the University of the Philippines. Maraming salamat po for being part of our credible online community and to all those who have just discovered us for the very first time today. Welcome po at sana pumasayan pukayo sa pag-join sa ating online community. Yung pung ating mga balita, lalo na po sa social media, maraming na po ang informasyon na lumalabas po, kawgnai po sa mga boosters, those three or third shots, mix and matching of the vaccines. Maraming na po mga kuru-kuru at mga balita po tungkol dito, but as the Philippines begins to secure larger and larger volumes as we have also known from the news in order to reach more and more people or to vaccinate as many Filipinos as possible, the question of giving an additional dose in order to protect certain populations po natin and also to improve the general welfare of Filipinos come into play. Ano po ba ang booster at bakit po ito kaiba sa tinatawag po nilang third shot? Pwede po bang makatanggap ng additional vaccination dose na kung ang natanggap po ninyo ay Chinese brand, may pwede na po kayong tumanggap ng ibang platform using po na vaccine. Mayro po ba tayong sapat na mga bakuna sa bansa to create a good level of protection sa ating population and to bring ito po mga transmission rates very low so that we will not be fearful na makakoron po na mga surge na napapabalitaan po sa mga bansang katulad ng Singapore and others po in the Eastern European region. Ano po ba ang pinakadabes na vaccination schedule para po sa ating mga frontline health worker? So yun po ang mga katanungang susubukan po natin sagotin sa ating webinar for today and if you want to get the answer straight from the most credible experts, please stay tuned. Dr. Raymond Francis Sarmiento, director of the National Telehealth Center, National Institutes of Health, University of the Philippines Manila, always a pleasure to be with all of you during our regular Friday lunch date. I always look forward to our Fridays, I get to share hosting duties with my partner and also our adjunct research faculty at the National Telehealth Center. She is also the president's envoy for global health initiatives, Dr. Susie Pineda Mercado. Dr. Susie. Hi, good afternoon Raymond. Magandangapon po sa inan lahat, saan man kaya naran. We welcome you to the webinar for those of you who are watching on the playback. Magandangarose ninyo and we are looking forward to a very exciting discussion. Sabingan ni Raymond, pag-uusapan yung booster. Raymond, may nakita ako mga words dito na nahirapan din ako. Primary series, heterologos, homologos, wining efficacy, ano ba itong mga ito? So we are going to talk about what happens after you. Do you need one more? Who needs one more and how and why is this going to be important for us? Raymond, tama rin yung sinabi mo, ako I always watch out for what's happening internationally. Yung Pong United Kingdom, andami na po nilang nabakonahan, naysurge po sila ngayon, isang lingun na, na tumataas yung numbers of cases nila and apparently there's some kind of a mutation of the Delta variant and we will do some research para we can bring you more information. Singapore is the same. Biglang nagkaroon sila ng surge, biglang liman libo yung mga cases nila and so we were just talking about this before we came on air. We really have to think about some kind of a routine vaccination program for COVID na ayon para ang reactive tayo. Which is understandable because it's very new, but over the long haul we will have to start a real vaccination program that is continuing and itong a few days ago the US CDC also and the European Drug Agency also approved the use of vaccines for five to twelve years old children. So padating na lahat yung mga yan, kailangan meron tayong pag-ahanda sa ating kaalaman bukod sa pag-ahanda ng health sector natin. Anyway, today we're going to talk about anubay yung booster, anubay yung pakaiba ng booster, and additional shot. At third dose mga ganano sa ano-ano ba yan? So alamin natin yan and we have excellent speakers. As always we are mapalad to tayo, we're able to get really good speakers who really like you, our audience. So we're really thankful to all of you, especially those who are watching from outside of the Philippines na I know the time must be very difficult for you but and dito pa rin kayo and we are here because you are here. Over to you Raymond. Thank you doctor Suzy and for those who are joining us for the very first time, we usually start off with a very brief video, interviewing po just to get the pulse of the common folk on the street po which is what we call person on the street video and for this pot's interview video we will be asking them ano po ba ang inyong pagkakaintinde sa mix and matching na mga vaccines para sa mga booster shots. Take it away. Pagkakaintindi ko sa mix and match yun yung babakonahan ka na ang iba't, hindi ka mga bakonahan ang iba't ibang brand. Personally feeling ko yung mix and match dahil na yung vaccines kasi ano di ba, from chemicals naman talaga, hindi naman talaga siya natural para pagdudulot niya siya ng chemical imbalance sa katawan. Since ano e parang hindi pareho kasi yung gamot. Yung mix and match kasi may iba'ng vaccine na yung efficacy mas mababakong perd to other and I think mas pinapa, taas lang yung efficacy kapal nag mix and match tila, depende ko ang vaccine na natangdap mo. Sinaberitin naman din sa aming na nung unang nabakonahan ako parang bawal din naman, bawal daw magkaroon ng iba'ng vaccine. So nung narinig ko na mayroong mix and match na vaccine parang medyo hindi ako tiwala. Kasi nasabi niya sa aming na hindi dapat mag-booster shot ng iba'ng vaccine. But na kasi nasabi niya sa aming na mag-mix and match ng vaccine. So parang medyo sa akin, parang medyo nalito ako doon. Yung pagmix and match, yes, okay siya sa akin kasi may extra protection tayo from the other brand ng vaccine. I think mas okay, mas nabubus yung immune system natin. Kung makakaroon ng booster shot, mas preferred ko yung same brand para siyempre. Possibly, wala nang magiging side effect. With regard sa mix and match, puwede naman, basta nag-conduct na sila ng clinical trials then wala naman magiging problem. Okay naman sa akin. Kung I would be favorite for third booster, mas pimpinigin ko yung naunang bakuna. For safety lang, kasi hindi mo rin talaga sure kung ano effecto sa yun ng iba'ng bakuna. Kung ano mas okay na nereport based sa sain, doon tayo. For me yung kukuhapa lang ng bakuna yung kailangan i-prioritize ng government. Kasi mas okay na mas maraming nabakunahan kasi sa may bakuna ka nga and may booster ka nga, pero ilan pa lang tayo. Wag kayo magsettle for less kasi unas sa lahat, kalusugan niya yan, katawan niya yan. Alam niyo kung ano yung nananapat sa inyo. Masano magpavaxing na kayo para normalize na tayo this coming Christmas and para merge na natin yung herd immunity. Okay, thank you very much TV UP. It's always very interesting to see what ordinary people are thinking about boosters, mix and match and so on. And I think in this webinar we will be enlightened. Mayintindihan natin kung ano ba ito at ano yung dapat asangan natin. So Raymond, over to you. Thank you Dr. Suzif, thank you also TV UP for that interesting person of the street video po ano. As mentioned our webinar at least for Zoom we are able to accommodate a maximum of 3,000 participants. Currently we are a little less than 900 participants in the Zoom, but for those who are joining us in YouTube of the TV UP channel and also in the Facebook accounts for the University of Philippines, TV UP and stop COVID deaths, please let us know, give us a shout out. Don't hesitate to tag us, especially if you are doing those watch parties that we all know you are taking part of. So if you are able to join us in the Zoom in order for you to be able to get the full experience of the online community, please do so and encourage your friends, families and your coworkers. Oftentimes po, we also have these fun quizzes or fun polls and for those who are outside of Zoom, please join us noon po sa ating Menti meter. For our Menti for today, here it goes, just go to www.menti.com and then enter the code if you are prompted, 7139-5557, that's 7139-5557, the same set of questions being asked in Menti are also the same set of questions being asked sa ating Zoom poll. We will have only just two questions as always. So please if you are available and you're inclined, please join us in this fun quiz. Over to you Dr. Suzie. Thank you very much Raymond and of course we have very interesting speakers and we will be having a discussion later. So if you have questions already, you can put them in the Q&A box para masakita namin tapos we can probably ask them later. Sige, go ahead Raymond. Thank you Dr. Suzie. We also would like to share especially for those who are joining us for the very first time we will be like in our immediate past webinar, we will be reverting to the standard panel discussion format which is comprised of having a main speaker present, well give us presentation and then a set of reactions from members of our esteem panel of guests for today. That will be followed by a Q&A session wherein we will be entertaining questions coming in. Not just from the Zoom po, no? Pwede po kayo magtanong kung na andon po kayo sa Facebook at sa YouTube channel po natin. And for those who are asking, we all know you are asking about this, the certificates of attendance ang ating mga certificates will be sent out at least to those who have attended 50% of the webinar duration. That's how we do it for Zoom and for those who are watching in YouTube and in Facebook, please let us know so that we could send you your certificate of attendance. And without further ado, Dr. Suzie will now introduce our opening remark speaker. Okay, so before I introduce our speaker, I just want to meet everyone. Atutuman naman akong sa chat box may mong tingnan mga. People are greeting, have a good weekend, di ba God bless you. I hope you're having a nice day mga ganan. Sometimes these little greetings for all of us really are very uplifting and we have to do that para matatag tayo, tulay-tulay tayo. Okay, our main speaker, no, not our main speaker, our introductory opening remark speaker. Hindi na na iibase nyo, sya po ay ang special advisor to the National Task Force on COVID-19 and as we've always said, he was one of the first ones who put forward this webinar series. We welcome Dr. Ted Herbosa. Hi, good afternoon Suzie and Raymond. And also to our distinguished guests, our organizers, our regular webinar followers and all of you online via Zoom, YouTube and Facebook. Welcome to our 77th special topic on COVID-19 boosters na mix and match pa. We are now on our time wherein our gains in the national COVID-19 pandemic response are already palpable. This 77th webinar of the stop COVID deaths has become an important part of a source of information that is updated about the COVID-19 and our country's pandemic response. Truly, we are now succeeding with the solidarity of all Filipinos in following the public health standards and getting vaccinated. Let us talk a little bit about our progress on vaccination. We have many milestones after eight months of our national COVID-19 vaccine deployment program. We have delivered 106 million doses of the COVID-19 vaccines at brands by the end of October 2021. Last October also, we were able to reach our highest number of vaccine deliveries at 34 million doses in a single month. We used to have only deliveries of about 10 to 15 million per month. So we doubled that for the month of October. We also achieved the highest number of vaccinations per month at 13 million doses deployed for the month of October alone. Last October 15-2, we started vaccinating 12 to 17 years old with comorbidities in the National Capital Region. Last November 3, we already allowed the vaccination of all 12 to 17 years old in the National Capital Region and today we are now launching the nationwide vaccination of children in Baguio City. We continue to discuss this governance level at the feasibility of third doses for healthcare workers and the immunocompromised following recommendations by the World Health Organization's strategic advisory group of experts on immunization. There is continuing debate on the use of heterologous doses as third doses and with this background at hand, I do hope that the discussions this afternoon from our experts will enlighten our viewers of all the issues about third doses and heterologous vaccinations. Sit back, listen and learn from our experts. Thank you very much. Back to you Susie and Raymond. Thank you very much Ted and we look forward to you joining us in Q&A later. Okay, so Raymond, we do have a, meron tayong fun, please. Yes, we do. Yes, we do Dr. Susie. But before that, as early as now, we'd like to encourage everyone, at least dito po sa ating Zoom and also dito po sa ating YouTube and Facebook, to key in your questions. If you have any questions, especially dito po sa ating Q&A, we are seeing five questions right now sa ating Q&A sa Zoom. Hopefully mas maraming ba pumasok na mga katanungan para po sa ating panelist for today. We encourage you to start typing those questions now. Especially if you are outside naman po of Zoom, please put it in the comment section and we will be picking out which questions to ask. In the Zoom also, you might be prompted, at least one or two of you might be prompted to open your videos po and be elevated as part of the panelists to be able to ask your questions live to any of our panelists po. So please watch out for that and hopefully you'll be able to join us during the Q&A session. Now we move on sa ating fun quiz. Thank you so much, TVUP. We are seeing two questions. May we have Menti on the, okay, White blood cell. Thank you so much. Thank you Traymon. Yes, first question. Booster shots provide stronger and longer lasting protection against COVID-19. Medyo madali lang po ito dahil dito po ay true or false question lang po. We are seeing a little over 100 of our respondents at least typing in ang kanil ang mga kasagutan to more than 200 na po ngayon. They're probably coming in from the depth ed of Pangasinan Division to Binalonan from DOH Mega Drug Abuse Treatment and Rehabilitation Center in Nueva Ecija, Unilab in Mandaluyong, Lubang District Hospital in Lubang Occidental Mindoro, LGU Ginobatan in Albay, Capis State University Pontevedra Campus in Capis, Davao Medical School Foundation Hospital and Davao City Davao Del Sur. We are also being viewed internationally. We saw a number po of our, well, located po outside of the Philippines but those who have registered are those coming in from Bangkok, Thailand, Ho Chi Minh, Vietnam, Penang Malaysia, Taipei, Taiwan, Bhopal, India, Luichi Ali University B2 in Algeria, Damam, Saudi Arabia, and Dubai United Arab Emirates. So maraming-maraming salamat po sa inyong lahat. We all know na iba po ang inyong time zone but you still stick and are still one of our avid viewers for our webinar. Question number two, what entities are allowing mix and match for booster shots of COVID-19 vaccines? Medyo mahirap po siyang makita dito sa ating mente dahil nagkakanda patong-patong nakpo siya but the options are USFDA, option two European Medicines Agency or the EMA, option three, the Canadian government, option four, the Singapore government, option five, South Korea government, option six, the government of Spain, option seven, the government of India, option eight, the Philippines Health Technology Assessment Council and the last option, all of the above. We will not be closing our fun quiz. We are seeing a little over 600 respondents who are joining and as we move on to our webinar proper. Over to you, Dr. Suzy. Okay, thank you very much. Thank you very much, Raymond. I'd like to greet everyone who's watching outside in the Philippines. Nangatawa, Raymond, ang mga health workers natin who are outside are monitoring what's going on here. Okay, so our main speaker. We couldn't bring you a better speaker than this. And we really try our best to get you the best possible speaker. So let's welcome man of the hour, our country. So fortunate that he is the person in the position he's in right now. Kung hindi nagkawindang-windang natalaga tayo. So I'd like to welcome a highly respected colleague of ours, Dr. Eric or Rolando Enrique Domingo who is the Director General of the Food and Drug Administration and he has been really working. I don't know if there's more than 24-7. Ano ba yung more than 24-7, Raymond? 25-7. 25-8 na ito. Pero you have to hear it from him. Kasi insan, pag nakigita natin sa social media, tsaka yung mga balibalita, hindi napapaliwanag ng mabute. So nandito po si Dr. Domingo, we are very, very happy and honored to have him here. Lagi niya kaming pinaglaging niya tayong pinauunlakan kasi alam niyang mahalagang nalalaman nyo mga frontliners kung anong talaga ang mayayari sa Food and Drug Administration. Okay, welcome Eric. Hi, thank you. Good morning. Ay tanghali na pala dito. Si Yom Susi parang hindi ibang time. So ang freshness. Ang ganda-ganda. Hindi naman ako makahindi lage, basta KBUP. Si Raymond isang text lang yan. Yes, agad pa yan. I just want to, of course, give information para malaman ang mga talaga. Kasi inayang tanong ngayon eh. Ano ba yung booster? Ano ba yung third dose kelan ba? And of course, yung technical information, the scientific data, mas magaling sa aking sila, Dr. Ramela dyan. Lapitan sa kadyan mga maya. But I would like to give everybody and some information on where are we now? What to expect pagdating po dito sa pinag-usakan na booster shots. Next slide, please. So, unang-unang, I just like to remind everybody, all the vaccines that we are using right now are still under emergency use authorization. So ongoing pa rin po talaga mga clinical trial ng Phase 3, ng mga yan, especially lalo na ko nagbabago ng mga age group and that we have no product yet that is completely certified or completely approved here in the Philippines. Sa buong mundo, actually, meron lang naman isa si Pfizer sa USFBA pero hindi pa rin sila nag-apply sa ibang mga bansa or at least hindi pa na-approve. At dito sa atel, wala pa kong applications. So all vaccines that we are using now aren't being used under emergency use authorization, meaning we know that the benefit outweighs the risk. It pinig na naman natin ang gusto yung safety and effective profile bago natin getting them. Next slide, please. Having said that, at this time we have eight vaccines that have EUA here in the Philippines. Ito po yung malagi natin na re-index si AstraZeneca, Pfizer, Moderna, Sputnik, Janssen, yung sa Moderna Sinopharm, tapos yung co-vaccine. Next slide. And of course, yung Sinovac, which is more than 50% of the vaccinations that have been given in the Philippines. Next slide, please. Dun sa wala 8 vaccine brands na yan na ginagamit natin. Every time we give an EUA on emergency use authorization, it's very, very particular. Nakasulag dun kung sa ang factory siya ginawa, kasi kailangan alam natin na good quality ang duman ang pasafactory na yun. Nakalagay kung ano ang dosage schedule niya, kung kailan ibigay ang kuna at yung pangalawa. Nakalagay kung ilang ML yung iniction kung ano yung shelf life niya, kung kanino siya pwede ng gamitin at kung kanino hindi. So very, very particular ang each and every emergency use authorization. Right now, we have two vaccine brands na aside from the usual adults, pwede naring binigyan natin ang amendment to include children. Ito yung Pfizer and Moderna for children 12-17. Yung 5-12 din expect natin mag-apply na rin siguro ang Pfizer sa atin within a month. And of those vaccines that are being used now, six of them have an approved dose regimen of a two-dose schedule, meaning isang ngayon and then after four or eight to twelve weeks for example, sa asasili ka ibigay yung second dose. There are two vaccine brands that are approved as a single-dose preparation. Ito yung Janssen at yung Sputnik Lite. Next slide please. So, pagsinabi ko natin na yung EUA very particular to yung meron ang pagpibig sabihin yung nang inaral natin, no na information about that vaccine, yung nakalagay din sa EUA na, yung kanyang manufacturing, yung kanyang kong kanino pwede inject, at lat ng schedule. So, every time magkakarokon ng pagbabago, when you have a violation on the product, then you have to apply for an amendment to the EUA and then you submit the data that will support that amendment. For example, at age mo, investor 18 and above, nagdag-daggang ng crop to second yield. Nag-apply po sa atin na, nagpinakita nila sa atin yung data to support it. Kung nagkaroon ka ng new manufacturing line, ngayon marami nag-expand ng production, pagbebagong factory, kailangan pa kita sabihin yung proof na good manufacturing practice, yung kanilang bagong factory at nasigurado tayong consistently, good quality product ang lalamas doon. If you have, for example, changes in product information, no-site effect na nakita, kailangan i-apply sa amin nyan at nagdag-daggang atin sa product information ng PAKUNA, including changes in dosing schedule. If you now have a third dose or a booster dose, then you have to have an amendment to the EUA. Next slide please. So ito, kailangan yun ang mag-apply siyang pre yung ating cosino yung consino yung meare ng EUA or yung government. Ngayon ang laging pinag-usapan, ano ba yung additional dose, kabukasang nga Raymond ang amamsusi kanina, ano ba yung additional dose, ano ba yung booster? When people ask me, let's just say it's a third dose, our additional dose. But if we look at the have technology assessment council recommendations, medyo pinag-iwalay nila, yung additional dose, may category siya na separate ng WHO, na inintay natin yung final recommendation nila. They have interim recommendation to give a third dose as part of the primary series ng Sinova, as eh, doon daw sa mga elderly, yung mga 60, 65 years old and above, and if you know compromised, even after the second dose, you don't get an immune response high enough after receiving the first two doses. So yun yung additional dose, parang invest na dalawa ang dose niya kung ikaw ay 65 years old, talagang ang iyung schedule ay tatlo, ang talagang iyung magiging bakuna para makuha mo yung optimum effect ng vaccine na yun. And then yung age stack, nagdagawa silang separate classification, yung booster dose. Ang pagkakaiba niya, yung booster doses na kompleto mo naman yung series mo, maganda naman yung immune response, kaya lang yung possibility na nag-wein, alibawa ang effect niya, baka kailangan magbigay tayo ng isang extra dose na booster. At ito yung tinatarget niya ng Department of Health na sa last quarter of the year kung November, December, saan na mag-plan ng magbigay sa healthcare workers at sa kaya yung elderly because they are the most likely to develop severe COVID and then for 2022, possible na magbigay dun sa A2 to A5. So hindi naman pulakat kailangan bigyan agad ng booster. Yung A2 to A5, less naman yung kanilangan chances of going to severe COVID. So pasibli kung magbigay sa 2022 pa yan. Ibig sabihin lang, magbigay na kailangan muna ang karamihan ng Pilipino kasi mas importante pa rin ang mabakunahan yung unvaccinated. Ang condition na nilagay ng H-Tac is dapat at least 50% of the population should be vaccinated before we start giving ito mga extra doses sa mga populations na A2 to A5. Next slide please. So sinong mga mag-apply ng EUA amendment para magbigay ng third dose? So yung kumpan niya na nag-develop ng produkto at siya yung EUA holder maari siyang mag-apply ng homologous vaccines. Kapalad niya na si Nabilie at isun si Kanina. Homologous is same vaccine ang ibigay sa yun na third dose. Siyempre po, yung mga kumpan niya na nag-develop, probably sila ang med-data at sila yung interested na mag-apply niyan for homologous vaccines. Kailangan yung heterologous vaccines meaning iba yung first two doses mo iba yung third dose ang mas-interesado ng yun sila ngayon yung clinical data that will support that application so that we can verify it and take a look at it and our experts can do an evaluation. Next slide please. So parong bagong bakuna naman siya ngayon kasi datit two doses siya nakita naman natin minomonitor natin for the past six months maganda naman yung safety and efficacy pero pag nagbago tayo ng schedule magkakaturd dose or magkakamix and match naman tayan ng gusto pa rin ang mga nabakonakan. We have to have very strict post-authorization monitoring and the companies and the Department of Health will have very specific pharmacovigilance obligations. Kailangan tingnan natin kung anong ngayon ngayari sa mga nabakonakan at kailangan every now and then we have to assess to make sure that the benefit to risk ratio is still very beneficial. Positive pa rin dapat yung benefit outweighs any risk. Next slide please. So may mga bansala na nababalitaan naman natin nagbibigay ng mga boosters pero of course it di naman to furlakat ng tao usually ino una yung healthcare workers tapos niya yung mga senior citizens at marami comorbidities na possible makaroan ng severe covid. So sa US, Europe, Asia and some Latin American countries have started giving booster shots. Next slide please. Of course yung mga bansang nyo na una rin naman nagumpisang bang bakuna din sa atin kaya medyo mas matagal-tagal na vaccinated yung kanilang mga first tayo na sa six to seven month palang naman tayo na mga first na nabakonahan. Kami mga first na nabakonahan sa PGH to March 1 na tapos kami March 29. So we're now on about six and a half, seven months from our completion as actually given the go signal to give a booster, a single booster dose vaccine for both Pfizer and Moderna. Yung Pfizer ang inalaon nila na booster dose is the same as the first two doses. Yung Moderna, half dose ang pidibigay na booster compared to the first two doses and it is given at least six months after completion of the primary series but it's also not for everybody. So number one, 65 years and older yung talagang mas nakatatanda kung ikaw din naman ay 18 to 64 years old and at high risk for severe COVID-19 meaning you have a lot of comorbidities. Kung malusub ka na 18 to 64 hindi ka kasama nang bimibigyan nila ng booster shots and also people who are frequently exposed to the virus meaning healthcare workers. So yung 18 to 64 healthcare worker na matasang exposure binibigyan din nyo. So select din naman, hindi naman para sa lahat. Next slide please. Yung USFDA, pwede na yung Janssen vaccine which is a single dose vaccine pwede yung bigyan ng second dose at least two months after completion because they've seen that if you give a second dose of course merong higher immune response compared to just a single dose depending on availability to do a mix and match kaya lang we have to put this into context. Pagsinabi naman kasi mix and match sa America, tandaan po natin sa America tatatlung bakunan naman ang ginagamit Moderna, Pfizer at yung Janssen. So yung nang merong silang data at inaral din naman nila yung pag-mix and match. Dito po sa atin, walung bakuna ang ginagamit possible combinations kung mix and match din lang ang pag-usapan at di iba po, hindi naman lahat merong data na enough to be able to support giving a mix and match vaccine. Next slide please. Next slide please. So yung experts group ng Department of Health nung last meeting na nila na attended po ang kanilang sentimento but let's wait for the WHO Sage final recommendations on giving a third dose kasi merong silang interim recommendation, pero in final recommendation nila sabi nila, nga yung mid-November 2021. So titignan lang din natin para ma-check natin kung magkatugma ang ating naisip na programa when it comes to boosters. And of course, the experts group of the DOH recognize the equity concerns ng COVID-19. Kasi mga 65% pa sa atin ang unvaccinated. So mas importante, mas priority na mabakunakan muna yung unvaccinated bago tayo magpigay ng added doses sa mga taon na vaccinated na kasi hindi naman tayo makakaraon ng herd immunity kung ang mga one third of the population is vaccinated. So we really have to achieve first of very high of vaccination coverage ng mga tao in the general population saka nang mga, lalo na yung mga unvaccinated pa not even a single vaccine. And they suggested the flexibility in pursuing both the homologous and heterologous vaccination strategy. Next slide please. So as of now, ang Pfizer supplied for a third dose booster ang AstraZeneca third dose then for the same vaccine. Sinova nag-applied din sila ng third dose booster amendment for the same vaccine and Sputnik also meaning homologous lahat yan. Ngayon yung Health Technology assessment council, meron silang recommendation na giniiling nila na pag-aralandin natin. Ito yung heterologous meaning kasi ang booster Pfizer. At ito may mga studies ito sa US at saka sa Euro, hinihingi din na naralin yung Sinova ang primary kasi ang booster might be Pfizer or AstraZeneca and then yung mix and match ng Moderna and Pfizer. So ito ngayon ay nasa paga-aral ng ating vaccine experts. Next slide please. So like I said, ang dami nung possible ayapod nalagyan pinasa namin last week sa vaccine experts yung ating data they ask naman for one to two weeks to look at it. So where are we now? The applications for boosters are under evaluation by our experts and I believe now we didn't one to two weeks we're going to get the recommendations and we will be able to come up with final recommendations final decisions on that. Final recommendation to expect to come out also at about around the same time siguro within the next two weeks. So para naman kumag-double-check din natin yung kanilang ang discussion at ating counter-check din natin sa ating pang recommendations and right now the DOH is preparing the guidelines on how to roll this out once maging ready na. So we do expect that possibly towards additional doses and what I expect of course is that it will be given unang-unang sa healthcare workers who are exposed to COVID and senior citizens and vulnerable individuals. Yung din siguro po ang unahin natin at later on possibly go on to the other population groups. So I think that's the end. So thank you and later on will be answering questions. Eric Domingo who is our Director General and Undersecretary for the Department of Health Director General of the Food and Drug Administration. Napakalinaw na, maganda talaga kasi minsan yung may oras tayong pakinggan yung meditalia kasi kung hindi medyo tumatalon tayo sa mga bali-balita but I thought it was a very clear explanation and thank you so much Thank you, DJ Eric. Malino po ang yung pagkaka-explain and we hope you'll be able to further elaborate po during our Q&A. Thank you also Dr. Suzie. For our next speaker who will be giving her reaction but she's really no stranger to us because she was the one who gave us like a preliminary explanation on the available evidence for COVID-19 boosters. She is a professor with the Institute of Clinical Epidemiology in Manila. Pleasure to have with us again today Dr. Marie Carmela Lapitan. Dr. Lapitan. Hello, good afternoon everybody and thank you for giving the Philippine COVID-19 Living CPG group the opportunity to share with you an update of our work. So I will just focus on what we have at the moment regarding what we call as heterologous or mix and match boosters. Of the COVID-19 vaccines. So I will really just focus on the evidence of what is this mix and match booster and also tell you what we do not know at the moment. Okay, so if you remember for those who attended the September webinar on boosters I think at that time we presented only there were only three very small studies heterologous or mix and match booster vaccination studies but unfortunately I mean fortunately there are more studies now but as of October 23 when we did our last search of course we are continuously updating our search there are only 13 studies that look into the effect of mix and match booster vaccinations not really very well very well designed studies only three were randomized trials only four were comparative cohorts three single cohorts and three case series and majority of these studies had really not very big samples no I don't think there was a study that had more than 200 per arm and then these studies looked at very different combination so as you will see later for one combination there are probably only one or two studies looking into this combination really work and none of these studies actually tell us or gave us any clinical outcome so they didn't tell us whether it actually reduced or improved protection reduced infection rates because all of them only gave us results as far as antibody titers or cellular response so puro siya immunogenicity studies none of them were actually clinical studies and all of them for short term studies the maximum or majority of them nearly all just had looked at outcomes at 28 days especially safety was looked at only for the first 28 days after the booster so no long term outcomes really in these 13 studies that we found so if you ask me so how strong is the evidence regarding heterologous or mixed-match boosters based on the types of the studies the number of samples the types of outcomes we really generally the evidence is still the number of samples that we found generally the evidence is still really of low certainty so in the next few slides I just want to tell you how the slides will appear so ganito siyang ityure niya so I will tell you which is the primary vaccine and then what is the booster in that particular study we will see what are the outcomes sorry here it will tell you how many studies as present compare study these combinations and then so it's not working we look at if there is any but I tell you now wala naman may clinical outcomes what are the outcomes in terms of antibody response what is the response as far as the cellular or T cell response and what is the safety outcomes in that particular so comparing this combination with the homologous or meaning giving a booster of the same vaccine and comparing it with another combination so you will see arrows if it's a green arrow up that means this combination up there is showed higher titers if it's a down arrow red it means it gave lower titers and giving the same booster same vaccine as a booster or equivalent titers or as far as safety if you see a pink arrow up that means there are more adverse events if you give a different booster compared to the same vaccine as a homologous booster or if it's a green arrow that means lesser side effects with this heterologous booster compared with the homologous booster or equal to similar side effects so here are the number of studies that actually gave the outcomes and the descriptions down below will tell us how certain are we of the general results of these studies that's so moderate or certain low certainty depending of course on the number of studies and what are the designs of these studies so one thing that the first observation is boosting is immunogenic because all the booster studies that we've looked into show that if you give a booster you will really have a higher antibody response cellular response compared to before your boosting and regardless of what booster you got same different vaccine so boosting increasing your immune response is more or less a given so as I said we're looking here now at what is the data about heterologous vaccination so let's look first of what if you were given so your first series your primary vaccination is a Pfizer vaccine or a Moderna vaccine what happens if you give a different vaccine as a booster so let's first look at a Pfizer boosted with a Janssen vaccine you get lower antibody titers compared to if you were boosted with the same Pfizer vaccine and lower antibodies with this combination if you were given an mRNA or a Moderna booster instead of a Janssen booster but as far as safety is concerned safety profile is the same between these two all these combinations now what if you are given a Moderna as a booster after a Pfizer vaccination and again there are only two studies and very small ones and one is a K series the results showed higher titers with this heterologous boosting compared to if you get the same Pfizer vaccine as a booster and also higher with a Pfizer Moderna combination compared to a Pfizer Janssen combination again safety profile is equivalent across all these combinations no cellular response outcomes were available in these two studies now what if you got a Moderna first followed by a Janssen so compared to getting another Moderna as a booster this heterologous combination had lower antibody titer responses and also this combination is lower compared to a Moderna followed by a Pfizer combination safety is the same again across all these different combinations what if you got a Moderna followed by a Pfizer there are two studies that look into that a Moderna followed by a Pfizer had higher antibodies compared to a Moderna followed by a Moderna and definitely much higher compared to a Moderna followed by a Janssen safety is the same across all these combinations again only two studies so our evidence is of low certainty now there is one study a randomized study that looked at adding an AstraZeneca to either a Pfizer or a Moderna primary vaccination either if you got the Moderna first you get the same or a Pfizer first you get the same a booster with an Astra showed there is one type of antibody response the titers were higher with the heterologous although the zero positivity rate was the same with the heterologous compared to the homologous cellular response was higher compared to another mRNA vaccine and there was less side effects with an Astra booster compared to an mRNA booster so that's just one study but it was a randomized trial there are no studies that look at combining either the Pfizer or a Moderna with all these other vaccines that are available in our country so we don't have any evidence we cannot tell you if you get these combinations because there are no studies about this now what if you got the Janssen vaccine first so what are the studies that looked at heterologous combinations a Janssen followed by a Pfizer vaccine there were three studies one of them was a randomized trial it showed that this combination yields higher antibodies compared to a Janssen-Janssen combination but lower antibodies comparing a Janssen Pfizer with a Janssen Moderna so the same also with your cellular response higher response with a Janssen Pfizer but lower than a Janssen Moderna safety is equivalent across all these combinations now a Janssen followed by a Moderna this showed really much much higher antibody response when compared to a Janssen-Janssen combination there's also a higher response with a Janssen Moderna compared to a Janssen Pfizer cellular response again higher with a Janssen Moderna than a homologous or a heterologous combination however there was one study that showed that there was higher combination compared to the Janssen-Janssen and Janssen Pfizer combination so there was some types of adverse responses were higher in the heterologous Janssen Moderna study combination but there are no other studies combining Janssen with all these other vaccines and also we don't know what the effect of now what about CoronaVac which is the most used vaccine in our country more studies I think there are a total of six studies that looked at heterologous vaccination with a primary Sinovac but if you look at individual combinations like for example a Janssen-Pfizer combination there was only one study that looked into that and it only looked at comparing a Sinovac Pfizer AstraZeneca combination and it showed that Pfizer booster was yielded higher antibody response than a AstraZeneca booster but the side effects were equivalent between the two groups now combining CoronaVac or Sinovac and Astra there were more studies there were three although there were only two studies that compared it with a homologous heterologous combination it showed that a heterologous vaccination with Astra showed much, much higher antibody response compared to a homologous Sinovac booster vaccination regimen however when you compare it with a Sinovac Pfizer it had lower titers this Sinovac Astra combination but side effect wise Sinovac there's a study that randomized study that looked at combining compared homologous Sinovac vaccination with a heterologous using an ad 5NCO which is unfortunately not available in our country and this combination showed very high titers antibody titers of this heterologous when compared to the homologous booster regimen and then unfortunately there are no studies to tell us what is the effect of boosting a Sinovac with all these other vaccines Moderna, Sinofarm, Covaxiniansin and Sputnik so we don't have the studies for that so and then it showed so and then for those who got these vaccines as their primary like me I'm a AstraZeneca primary vaccine there are no studies that looking at heterologous boosting with this primary vaccination series so I don't really know whether a heterologous booster will actually be beneficial to me because I don't have the studies for that so in general what our observations are heterologous boosters are highly immunogenic and they are even more immunogenic when you compare it with homologous boosting although of course there are some exceptions as you saw earlier there are some combinations that actually had lower titers and lower responses when compared to the homologous booster regimen but generally it's more immunogenic although there are also some combinations that may cause some more adverse reactions so those are general observations however they said for me as a primary as a vaccine recipient as a patient and me as a doctor I still have unanswered questions I still do not know at least to satisfy myself what is really the best combination let's say whether it's a homologous booster or even among the heterologous boosters I don't know which is the best combination and when is the best time because in the different studies the timing of the booster were different although majority of them was given around six months but in how long do the effect of the booster last we don't have the answer to that and how often I get a booster there's no answer to that as well and it's an additional dose safe we know probably it's safe in the first 28 days because we have the data for that but more than that unfortunately the evidence is not there yet and as a researcher there are still more questions now that we need to look into so what is that level of immune response that actually translates to protect clinical protection so what is this correlate of protection is and is it the same for all vaccines and with more studies coming with newer, better studies with the results of these newer studies be the same as what we have in the 13 studies that I've presented to you so when we look there are nearly 100 so marami pa ko akong trabala so what is this correlate of protection is it the same for all vaccines in the next few months there are 96 registered trials just on booster vaccination alone and 89 of them are active and recruiting or enrolling so maybe when I wake up tomorrow there's another publication that can add to our information hopefully because more information means there's more guidance for us but in the October 25 meeting of the WHO focus on what are the updates on boosters by the time it ended at around 12 midnight the last really message that it concluded with is that each dose of vaccine will save more lives if provided to the unvaccinated versus being used as a booster in a general population so given what we know what we don't know at the moment particular and I think this should this is also what the HTAC is recommending at the moment is to focus on vaccinating the unvaccinated and yes make preparations for the booster but really more information will really do us more good so again as Erika said earlier we're really watching for more data and waiting for that WHO sage recommendation by mid November so that's all that I can share so thank you very much okay thank you very much there's Dr. Mela Lapitan of the National Institutes of Health and nakikita niya na pahusay isa patang di na tutulog it's so to appreciate the process that our experts, our scientists have to do you can see na maraming pag-a-aral na kailangan di lang basta-basta mag-division at meds, mag-researchers, mag-scientists katulad min nila na talagang masinop, talagang kursigido, tinitina nilalahat na mga detail para maganda ang ang decision na so thank you so much Mela for that excellent presentation I thought that was really showing you how complicated it is hindi siya, hindi madali anyway, oh siya Mela lapis kamit pa tayo sa panel mamayano okay so now we have another speaker I'm not a stranger to you, we've always had her every time we want to have a local government voice we have our city health officer from the Bota City Dr. Kristya Padulina and we're going to ask her for a reaction kasi si Ted gini-kwento naman ito at the end of the day LGU pa rin ang magpapatak mo nito so we'd like to hear your reaction Kristya, any questions or what is the situation on the ground kasi nababalitan din natin na maraming mga bakuna na hindi na ibigigay, sabi nila hindi ko alam po duto-uto so Dr. Padulina, the floor is yours okay maganda-maganda ng hapon po sa ating dahat so I will be talking on wearing several hats the first one would be as a provider of the vaccine at the ground as the city health officer number two is provider based on my specialty for OBGYN as past president of the Philippine Obstetrical and Gynecological Society were in ideal with special specific population of pregnant women and lactating women and the third is as end user so in that regard let me first congratulate Dr. Domingo for setting the stage ang ganda ng paliwanag I wish we could invite you to give that to our people to our community so in the VOTAS we have what is referred to as FB streaming every Saturday together with the mayor we engage the community and talk to them directly so nung lumabas po ang unang statement tungkol po sa booster yun who yung number one in terms of tweets and likes ano ba tung booster so definitely we had to adjust and make a a communication statement for them because everyone was clamoring for the booster but at the same time nakikita hu namin sa mga texts that they have so many questions third dose booster mixing heterologous homologous so part of our role also is to educate them so napakimportanti po nung naging lecture din po para lapitan the science behind it and sabi ko nga mabuti rin na nahuhule dahil medyo late ang Pilipinas nagumpisan ng vaccination we also have the opportunity to learn from other countries while undertaking our own study and in that matter yun who siguro yung importante sa atin is there a need bakit ba natin pinag-usapan which I think is also present in NCR and other areas let's have reality check number one sa ngayon po as of today based on our meeting with IATF and ENVOC sa buong Pilipinas po nababakunahan lang ay 44% which means that the rest of the other population unvaccinated marami pa po we're still working on the remaining percentage second of Pilipinas is we have a lot of OFW so dun ho sa dami ng OFW na yun sa sudad ho ng nabotas ilan yun na tatanggap namin every day that they got their vaccine outside at kailangan na silang lumabas at tinatanong kung available sa amin yung bakuna na kapareho so ang sagutun namin sa kanila is kateka lang po hindi ho available pa yung vaccine in supply and demand nga yun na kakainga tayo sa ncr sa bakuna pero there was a time na talagang walaho kami may offer there were demand issues that were dealing with kung magkakaroon po ng boosters then that would provide extra flexibility in supply di na maghihikpit lahat todo bigay na po kung ano yung available as long as there is assigned consent and there is proper screening before ang issue is safety pero ngayon po ang hidahabol na is gusto ko humadagdagan pa yung protection ko lang pas na hua upo sa 6 months so especially na hihirapan po kung sumagot sa healthcare workers because sila ho yung nakaharap sa mga paciente and I know and I am aware that I need to protect them so time is up na ano na yung offer natin sa kanila and when boosters would be provided they should also be prioritized to per population the city of Navotas is also the number one fishing capital in the Philippines which means that napakamobili ng population we see people coming from Palawan lalakadu yan sa laot magkakaroan mo na interaction sa ibang lugar babalik ko dito so makikita po natin yung heterogeneity ng population and that is quite important for us to provide the vaccine sandali lang sila nandito bigyan na ba ng vacuna makatulong man lang tayo sa boosting sa national so I think there is no one solution for all but as we appreciate the evidence kung naguumpisaw tayo na mabakuna ang unan tanong ay what is the best vaccine ang sagot natin ay sabi ngayon doctora napitan what is the best booster for me so dito ho kailangan natin yung evidentia kailangan natin maeducate yung community kasi sa ngayon mo sa current state we are seeing people who are misleading the data in some of them willfully other styles sa pangangailangan dahil di tinatanggap sa ibang bansa at inang naibigay na bakuna so I think kailangan din ho itong ifa-struck because there is already a need there is an identified gap that we have seen already we appreciate the equity we appreciate the flexibility and the safety of all this issue and going into the safety I think right now because of the the society, the POGs also needs to make extra coordination and collaboration with ENVOC and DFA because we are dealing with a special group of population and these are the pregnant and the lactating women and in so doing let me be the voice na sana magkaroon din po ng atmakasama sila as being part of the expanded A3 in terms of the booster so in terms of process I think the best way is one we rely on the evidence scientific evidence population 3, provide the flexibility that is needed and for other areas NCR kasi medyo kota nandho tayo isana makahabul ang risk of the population so that we will now be able to go to the next step which is the provision of boosters in so doing I would like to thank and say mabuhay to all the people na kasama po natin ngayon maraming-maraming salamat po ok thank you monstrosy ok thanks that's Dr. Chris Padalina city health officer so we are going to call everybody back now for our panel discussion so Ted is here Eric Mela and Dr. Chris before we go into the panel discussion we have a public service announcement from Sigurado ka na ba sa reservations natin? Bakit bis na bis ka? Magiging escort mo ko eh Mukang may date si Lola Lola ilagay mo kaya ito Ang ganda naman Maganda yan Special anulakan natin Ready ka na? Mom dad Ali si Lola Lola O anak after lunch Sana lakad nyo po para sa atin lahat ito magpapabakuna kami dahil mahal namin kayo dahil mahal ko kayo magpapapakuna ako Well thank you so much TV UP the COVID communication public service announcement is one of the many outputs of the UP research and titled Communicating COVID-19 in post quarantine Philippines it's headed by our UP vice president for public affairs Dr. Nene Perna and funded by the DOSEP HRD and the Department of Health under the AHEAD HSPR project Dr. Susie O nga eh alam mo Raymond ano parang isyo pa rin yung vaccine hesitancy parang rami sa atin we're all convinced that people should be vaccinated pero hindi pa rin so siguro ito yung magandang message ng TV UP diba na parang you do it out of love yag gawin mo dahil mahal mo yung mga kasama mo sa buhay pang mimi Anyway okay So before we go into the discussion Raymond do we want to look at the questions of your mentor and get some answers Okay thank you Dr. Susie for the two questions first question booster shots provide stronger and longer lasting protection against COVID-19 96% of our respondents selected through and that's also well very very similar to what Dr. Lapitan mentioned earlier but for this one I will defer to Dr. Lapitan and or DG Domingo what and a question number two what what entities are allowing mix and match for booster shots of COVID-19 vaccines the ones listed here are I don't know if you're able to see it in the mentee but here in zoom the listed options are US FDA European Medicines Agency Government of Canada Government of Singapore Government of South Korea Government of Spain Government of India the Philippines Health Technology Assessment Council and all of the above medyo hatiipo kasi 44% selected all of the above 43% selected US FDA and then a spring clean for all the other options maybe we could call on DG Eric na lang Ano Raymond sa you can you hear me na yes sir go ahead okay so the US FDA definitely allows mix and match kaya lakat lumal ang minifix and match nila Pfizer Moderna and Johnson ang lakasin allowed sa kanila some European countries are allowing especially yung AstraZeneca pag nagkaroon ng allergy to the AstraZeneca they allow giving ang mRNA so yun yung most common na makikita natin sa most countries Singapore is allowing mix and match of Sinovac plus another ano nyo plus another vaccine for a third dose yung H-stack natin is also recommending a little linear when it comes to mix and matching so inaaral din natin nyan so possibly Pilipinas masasama siguro sa listahan nila okay so all of the above dayo no all of the above okay thank you very much so it looks like alala ko tuloy emang ko nung bata ako yung mix and match yung yung saka mone yung baka mibili ka nantel baka yung mo mix and match okay okay let's start let's get the ball rolling I think I wanted to start by asking Dr. Padulina if she had some specific questions for for the FBA kasi parang ang naririnig ko ang local governments natin ay talagang ano-no iba-iba ang kanilang iba-iba yung mga hinaharap nilang challenges so let's start with a dialogue maybe Christian do you have any questions for Dr. Eric Dr. Eric we usually depend on releases by NVoc DFA and DOH because we do not for safety issue kasi yun yung concern namin hindi kami nagpupprovide not unless authorized okay so ang tanong lang po namin is this one the releases of this as long as it is pinakamarami kasi nakariseb sa atin sign of acce so ano tanong po natin we hope that when the time comes for releases these are back up by data dahil ang unapong mabibigan I hope are our healthcare providers meron po bang ganun direction? aoyas Doktor kami sa FDA for transparency every time maglalabas tayo ng amendment sa UUA we make sure that it is posted doon sa website namin including the product information and all of the details on what is allowed for use and you are absolutely right we have to make sure for the LGUs not go beyond the emergency authorization given kasi dahil nga hindi pa naman fully develop the products under UUA yung ating legally must save for everybody kung anulat talaga yung authorized yung gagawin natin at yung covered ng indemnification fund natin na nakalagay ngayon na nagingawa ng patas so when we go beyond that it will be very difficult for us to kumakaroon ng problema so kailangan ko laga very stake but we do what we do is we share it with the Department of Health kong ano Doktor kasi pinapadalan ang initial yan mga IATF members yung DOH papadalad ko lang copy papatas hindi atas magpost kami sa FDA website but I will find a way nga para sa LGUs na ating din nang masapabilis yung information Ya Ted is Ted Ted, are you here? He was here a while ago Doktor Suzy Oh, si Ted busing me ikusabans na yan There we go, there we go Ted, you're in the field no? Are you in Baguio or somewhere? Ya Suzy you're asking a question Ya, nasang ka ba? Are you you're in the field? I'm in Baguio City no? I'm in Baguio City there is a launch of the vaccination for adolescents so I mean this mega vaccination center in SM in Baguio the former Pines Hotel they do about 2,000 vaccinations a day it's like two floors of the basement parking is being used the line is all the way down to the to the basement to two basement levels and they have several vaccinators I think about 15 15 tables of vaccinations doing all at the same time so I'm just waiting for Secretary Galvez and Mayor Magalo to launch this I mean launch it officially Sige so earlier Chris Chah had a question for Eric I was going to ask you also do you have any parang points that you want to take up in relation to the FDA? Well of course we have to follow what the FDA recommendations are the bigger problem in administration had been the brand preference because initially most of our vaccines were Sinovac and then when people are registered and they find out that what is going to be administered for that day is Sinovac we have 500 they end up going home they end up only vaccinating 200 so that has been the situation and more recently we've even had a bigger problem where in local chief executives are refusing their delivery of AstraZeneca because we had a donation from COVAX which is expiring on the end of November but November 5 nirerefuse nila dahil expiring down ano nga itatago ba nila? So this is another problem wherein that's what we want them to use like for example here Pfizer is being given to the 12 to 17 but they have AstraZeneca for any parent or guardian that wants to be vaccinated na rin dito siyemahan na nila pero ang ibigay saka nila ang AstraZeneca because we have plenty of AstraZeneca as well so we are reserving the Pfizer and Moderna so of course our 12.7 million 12 to 17 years old Okay, sige let me see Eric, did you want to respond to that or Chris siya? Agree akon doon yun yun yun sa vaccine tandaan din pusa na natin pagpipiehi tayo hindi kasi landang bakuna puwede para sa lahat like for now a dolly set sa lang ang Pfizer and Moderna na lang and if you want to vaccinate them then we have to reserve these vaccines for them mas kami talaga ito so ang adults should I think opt for the other vaccines at our available Kasi parang nakakanya-kanya parang wala nang pakelam sa iban tao ba sa ako gusto ko itong brand na ito parang nga rung ganung klasin pag-isit na So see, I think for the community yes sometimes there is that brand preference but remember that even before this came in the LGUs already procured their own stocks So sa akin tingin ko part of it is really educating the community as long as like for Nabotas we are now going into focus group discussion we also have tie ups with resilience of UNICEF so yung surveys namin nakukungha namin to na pipick up namin kumibrand preference and alam mo I don't know whether that's just unique for Nabotas but hindi our experience matas pa si Love for Sinova maybe because our population is mobile gusto nila matapos agad yung vaccination the Pfizer talagang binibigay sa adolescent senior citizen nirerepect nila saanman to allocate it So I think if I may go on a different topic tingin ko dapat din pagtuunan ng panahon ang pag-digitalize ng records kasi doon nakabase yung at makakatunong tokydoctora lapitan makita talagang hindi itago na ito yung accept na vaccine ito yung binibigay na booster ko meron man para maaral yung safety sa halip na may mga nakikita din kasi kami na hindi maayos yung pag-bibigay ng dato so we're really ramping up also on our digital technology to ensure that everything else is documented yun lang po Ya, yun know ako na abalita ako people who have a hand sign of app and then they go to a place and they're asked have you had a vaccine and they'll say no para makuwan nila yung moderna So talagang meron talagang what should I say it's not even confusion there's really a preference that's happening which I think I don't know how to address that Reemon ano bang initi mo dyan? So well a lot of them really is how to how to mitigate po those who are right now kasi unauthorized seeking of additional doses well it's multifactorial it really depends on having all of the data be centralized but also have a way to sort of verify kung talagang yung paong yun short of harmonizing all of our data a way to validate if that person already has received the primary series or not but in parallel Doctor Susie also there's also the issue of and I've also seen it in the Q&A there are those who have mga contacts nila let's say mga contacts po nila in the private sector and those contacts in the private sector are essentially parang nilala quote-unquote yung kanilang mga procured na-bakuna just because mag-expire na yung ka nalang mga pin-rocure so there's really even though we are pushing for equity there are those we also have to face the reality of expiring vaccines brand preference and also a relatively high percentage of the population in certain regions that are hesitant to get the vaccine all together so it's a confluence of factors so even if as mentioned by Doctor Apadolina 44% of the entire population ang nabakuna ang palang po with na at least na naka-received ng one dose mahirap po talaga na to make sure that all of those are achieved I also in one of the meetings we heard from in terms of analytics po just because we have a very low percentage of elderly who are vaccinated yung po talaga yung kailangan nating pagtunan because based on the analysis if the vaccinated elderly if we increase that that usually is five times more effective than giving the booster shots for those who are who are getting received. Raman, pero yung point ng information systems kasi of course Eric has picked up on this na dito sa US tatulang naman yung bakuna pero actually when you think about it now if we think about mela's analysis na titignan mo this yung homologus yung heterologus yung ito pwede yung bind dito actually pwede mong algorithm yan e meaning in a computer setup in a computerizer digital setup you can just key in what you had right because it was recorded so for example here in the US there are only two pieces of information that they get your name and your birth day and what vaccine you had so hindi ka pwede yung bandaya sabihin na wala pa kong bakuna lalabas at lalabas siya so para ako hiniisip ko well over the long haul sabihin man natin na ngayon mahirap siyang gawin over the long haul we'll have to do this because I think this is related to I was saying earlier the UK is having another surge Singapore is having another surge we have to put in place the systems para ano parang mali na parang ko niya rin na bakunahan ka na ng Sinovac nakarecord na yun so ang kailangan mo third dose di ba hindi closer na modern na mga ganoon pero two information sets two data points lang name and birth day kasi ano yung possibility na may Susan Mercado na birthday ko maliit maliit yung possibility dad so yung na put in too many things like your address whatever it's just your name in your birthday and what vaccine you got and when very simple although for other countries Dr. Susie the reason it's effective is because they have already implemented a natural ID system which we are still a little bit in its infancy so if we had that I mean we could reduce the number of required data elements for that to nilabless confusion kasi titignan mo lang e para kung baka para AATM mo lang yun e ano bang pwede mo kunen and then the computer figures sit out for you anyway so Eric did you have something to add to this discussion? yun nga talagang we need this even our pharma of vigilance is getting a lot more complicated siguro pag nag-boosters na ibang-ibang vaccine na natanggap ng isang tao so it's really not that easy and it's very it's a very complicated thing kaya yun nga e talag yung hinay-hinay lang sinasabi nga nire mga ninaid there are so many things to consider the supply of vaccines unfortunately baka ting kasi sa EUA for example safety and efficacy lang e ang pwede namin ting na hindi ko rang pwede ting na dahil may mag-expire e expand ko na yung EUA bagay ka rin sa bata kaya hindi sa yun e hindi yun sa yun that's not your colleague so sometimes complicated but you know when you look at the nitty gritty and you are very clear kaya times on making decisions lapapadali din naman kaya alam mo rin you just have to follow the processes yeah Mela what do you want to add to this si Mela tahimik lang yan pero lahat ng research minabasa well it's really it's complicated even at the science level I gave you parang the really overview of the data pero kung talagang bubo si namin pa yun na dapat ngawin namin like different studies iba-ibayong dosing interval from the primary to the boost merong short merong long so hindi din automat bababili hindi dapat automatic sabihin na o basta Pfizer followed by Moderna ganito yung results kasi kaya pwede pag short interval iba-palayong results sa long interval iba-palayong results unfortunately we only have 13 studies to play around with kaya nga sabi ko will new studies give a different set of conclusion so yun din yung medyo mahirap and then I also see some questions here what I gave you just to clarify is boosting para marami pang ibang studies I think we have a different looking at what we call as talagang mixmatch meaning yung first dose mo iba sa second dose mo yun I think that's a bigger review kasi pati yung hindi lang yung combination na Astra Pfizer pero iba rin yung Pfizer Astra so medyo mahirap din sa brains pero kung pano namin siya aayuse na ito ba ito yung best although there is a research methodology namin network metaanalysis so ipap-project po namin nyan so that we can really see at least based on what we have ano ba talagay yung best combination of primary tapos best combination din na booster pero mahirap po talaga so ang anulang is there is a reason and a process on why we give recommendations and why we ask there is a there's a logic on the recommendation so pinag-isipan po ng maigiyan so at kung hindi pa kami nakakapag-decision ay dahil pinag-aaralan pa po ng maigiyan so sa binga namin please give us a little bit more time kung ang WHO na marami silang experts they work they can really work 24-7 kasi while Latin America group is working sleeping the Asian group is working eh, kami sa Pilipina siyepet at utulog din ang ang kami pagkaslip time or duminsan hindi na rin so but yeah we will study the data if it's there and try to see what we can give you and inform people who will decide and people who will implement they do ask for the data so rest assured we act and decide based on the science Thanks Mil at tata mo si Eric kung siyabi mo di na utulog para na tamaan siya ok Raymond what are the what are the questions coming from the audience siging nating tanong nga we have well I'll just speak out some of them have already been asked but I'll this one pala will be asked live ok so this one is coming in from Irene Garganta and I'll just throw this to to DJ Eric kasi this has to do with the public well public announcements let's call it in terms of the H-Tac recommendation so here our audience member cites an article from CNN Philippines in terms of as it states here the health department recently approved the recommendation of H-Tac to give booster shots for healthcare workers and senior citizens six months after they complete the primary dose and while immunocompromised patients can get additional shots at least 28 days after they complete their vaccination so any comments on this DJ Eric and is this something will happen how soon will this happen is it happening already ayun po go ahead sir so yung recommendations ng H-Tac is exactly what na yung combinations na nakalagay yun yung inevaluate ng vaccine experts natin ayun kung papayagan natin if you look at dapat pasahindi natin yung H-Tac recommendation I think it's posted somewhere on the website of H-Tac nakalagay din because we have to remember that these are interim recommendations that as more data counts in sabihin na himela araw-araw pag-using na may bagong data pack magbabago pa po talaga yan at yung bago tayong information and in fact they admit that it's based really on right now very low quality low quality evidence I mean, ulam pa talaga yung evidence siya pero gumagawa lang tayong recommendations na interim para makapag-start na tayong decision making so these are being evaluated now I believe within the month there is going to be a decision on it pero yun niya po puwede pa talagang magbabago yan as we get more information thank you DJ Eric so I'm also I also receive information na discussions were supposed to be asked live pero hindi po we have one member of the audience Dr. Suzy from the media Glendale Nazario of Manila Bulletin and he is asking there is a vaccine mix and match study and now there is a booster mix and match study I think yung pinatong niya yung primary series na mix and match and then this booster mix and match eventually po ba is it possible if someone will get three distinct vaccines like first dose vaccine A second dose is vaccine B and then yung booster niya is vaccine C and I think they are asking how soon that may happen or likely to happen in the Philippines po very unlikely naman yung tatlo na different kasi ang rule pa rin naman kung ano yung primary series mo tatapusin mo yung dalawa of the primary series and then possibly get a heterologoster ano na third dose so yung nang more likely yung tatlo na iba-iba ano na yan unlikely na yan meaning na ka first dose kasi tapos nagkarong ka ng some severe reaction to that that's why hindi nang naman ibigay kaya iba ibigay sa yung second dose kasi iba pa yung ibigay sa yun na booster pero napaka unlikely na yun I would think naman siguro maximum na yung two doses of the same vaccine and then possibly a third dose na ita nang dose actually actually Raymond iba I think we were talking about this the other day that in childhood vaccinations for example DPT tatlo yun e iba yung hia patay tatlo din yun e so ako I was a little bit surprised that there only two shots for COVID-19 but actually so we have to ano parang I think what I want to say is that we have to go with the flow in terms of the science kasi parang sa sabihin ang iba e sabihin yung dati dalawa ngayon gagawin yun ng tatlo hindi kasi dumalawak yung kaalaman natin so wala talaga usapang sarado rito katulad niya na sabihin e nila baka pag-usut pag-isig natin bukas ng umaga may iba na naman bagong mangyari so we just have to go with the flow I think people are getting anxious kasi pa iba but when I think about it most of these vaccinations are in three three doses and most boosters take a long time before you do the booster tiba ganan din yung principle na sinusunod natin dito siga Raymond go ahead Thank you Dr. Suzie the other question that was supposed to be asked live comes in again from Irene Garganta and I think her question is more so about the terminologies po so is there such a thing as re-vaccination so two full two full doses of another brand yung po ba ay mangyari lalo-lalo na sa mga nakatanggap ng Sinovac and vaccinated more than six to eight months ago we give it to DJ Eric again sir Anang si Dr. Padulina ang mas nakakaalam niya? Sige, sige we'll call her nalang sige sir Dr. Prisya yung re-vaccination definitely nabaggit naman natin na talagang kailangan klaro yung messaging natin sa sa tao but we still rely on the evidence the science that is given to us so kung halimbawa ang meron pa kaminari rinig kasi baka pwede ko mag-testing muna kung may antibodies na ako pag-ok magkuhakulit ng another dose so I think all of this tama si Dr. Mila it's a leaving document it's a leaving recommendation kaya pang nag-issuing kami ng situational report as of today ito yung balita ito yung accepted internationally locally wala tayong data pa o inaaral pa because we're very careful dahil ang dung pa rin naman yung takot sa vaccine at ayaw natin na makasuyo yung community na sabi nyo tapos magkakaproblema kami that is why we are really threading this very carefully and relying on concrete data and advisories coming from the experts yun lang po Raymond. Thank you, Dr. Christia. Go ahead Dr. Suzy. Meron kasing comments si Dr. Clutile de House Professor natin doon ako sabi niya you cannot compare to primary shots for infants since the rational is different due to blocking antibodies in the mother kaya 3 doses before 6 months. So I got that parang I think I was just saying the evidence is changing so that was my context for that. So thank you for that ma'am. Any other questions we have, Raymond before we... A few more questions po Dr. Suzy and this one has to relate well, I go back to Dr. Apadolina. The brand of vaccines available at various sites in the LGU are not allowed to be announced. So kapag booster siya po ba are the LGUs now allowed to announce the brand of vaccines? So what are your thoughts about that, ma'am Christia? Sabi kasi Suzy ba iba par LGU even at the start the votas has been different they register online on the date, time and vaccine they want. So sa amin it's a choice we announce we provide the schedule every Saturday for the whole week that this site will cascade this kind of vaccine and they choose. So I can only speak about the votas but I know na hindi who nag-announce lahat nagkakagulatang pagdating sa vaccination site. Good to know. This one for Dr. Lapitan the question is are there any studies po or what does the evidence say in terms of the effectiveness of these vaccines I mean the boosters sa mga variants po The general observation is especially the heterologous boosters are more effective compared to homologous at least for the variants that have been studied alpha, beta and delta less yung reduction of the titers with the heterologous compared to the homologous but as I said not all the combinations have been studied but that was the general pattern of the results. That's actually one of the three reasons of why they thought of heterologous vaccination and heterologous boosting is the variants the variants is one of them of course the availability of the vaccines is the second and then the primary really is the adverse reaction to the first dose vaccine then that's when they thought is it safe to give another so mixed match show. So parang Dr. Ramela even if they're more reactogenic kasi heterologous mas okay mas protected against the variants is that what we're saying? Theoretically that seems to be the result because the antibodies higher than T-cell reactogenicity mostly when you look at them the results in detail mas mas matas lang yung pain kasi siguro iban na yung vaccines so iban na yung paki-ramdami at syaka matagal na since the first vaccination so parang mas madami nag-report ng pain mas marami although meron ding mas madami ang reporting ng flu-like symptoms so menyong mga short term mas marami in the heterologous compared to the homologous pero as I said we don't know the long term safety yet Okay, thank you Dr. Ramela I will ask I'm a sort of controversial question just because it's repeatedly asked here in the Q&A that's about a private sector procurement DJ Eric pinapayagan po ba silang mag-benta na kaya lang mga naprocure na stocks gamitin na pang booster kung baga DJ Eric Yung short answer is no Kung bakuna na pwede ng event na sa Pilipinas yun yung first line every time my issue on emergency authorization nakalagay this is not a marketing authorization that's the first thing you cannot sell it you can only sell it to government or partners of government so pwede naki pang partner yung private sector alimba wa sa gobyang para sa employees nila para sa employees nila kasi ito yung lagi ang tanala nag-dagal ko na Raymond nag-say na e binayarang ko naman isaksaksas binayarang ko naman ang pera ko tandaan po natin nung binayaran nyo yun inisip nyo yun yung bakuna na tatanggapin nyo kailando sa kahihintay nila e nagpabakuna nila pumila sila k Dr. Christian nagpabakuna nila nang libre kinuha nila sa ibang Pilipino yung bakuna na yun kung meron po kaya yung binayaran naman na bakuna e kung ako naman na sa iposo ninyo itulit nyo na doon sa yung di panapakuna kahit meron pang 45% 55% na Pilipino na kahit isang bakuna wala pa so you cannot sell it you cannot buy it na isip natin tumulong sa gobierno natin kaya tayong bumiliti ng bakuna para sa tawang empleado natin ngayon po na hindi na natin magigamit sa empleado dahil nagpabakuna na sila sa gobierno hindi hibigay po natin doon sa kailangan bakuna hindi hindi pa po pwede yung gamitin asistitwa sa commodity and so ok, thank you sorry po following through yung binanggit po ni Dr. Eric we just like to inform you that we have three private entities po na nag-donate ng vaccine na sa sudan po ng nabotas dahil sumobra na po ok ok, thank you very much alright, we are at a good time to start winding wrapping up and we're going to give our speakers a minute or two to compose their parting words and we're going to now do our evaluation Raymond ok, TVUP may we have it on the screen thank you ok, maraming ramin ramin salamat po this usually how we do it towards the end of the Q&A we have five questions which form our evaluation questions we are seeing well slow trickling po of those who are part of the zoom able to respond sana po ay mas marami po po ang mag-respond we have a little less than 1,300 attendees in the zoom so hopefully they'll be able to most will be able to join wala na po kaming nilalabas na iba po ang evaluation po, ito lang po iyon so sana po ay salip po kayo dito po sa questions na ito the five questions are as follows and how you answer it is based on a Lycord scale the panelists demonstrated of the topic number two the panelists were well prepared and organized number three the panelists spoke clearly and audibly number four the panelists used appropriate language with technical medical jargos adequately explained and number five the panelists contributed to new perspectives and knowledge on managing various key COVID-19 health issues we will not be closing the evaluation po as we move on to the well final word or final messages from our panelists ok, thank you very much let's go to our parting word so for our panel our audience are mainly frontliners so what is the take home message for them so we'll start with Dr. Padulina let me say that kontin tista lang po sa frontliners definitely what if boosters would be given it should be safe equity should be there and I would appreciate as a provider the flexibility that will be provided if allowed in terms of booster I will rely on our scientists to provide the best evidence because definitely we deserve as Filipinos the best so kung niyeng tama yun yung ibigay so with that maraming-maraming salamat po thank you very much it's Dr. Christian Padulina nabotas Dr. Mela Dr. Mela Glenn well best assured we are working very hard to update on what is the latest about vaccination COVID vaccination so just be careful of the information that you receive make sure that it is correct it is true it is validated and there are reliable sources of information and also trust your government officials that we are really studying what will be the best for us as a nation to get out of this pandemic thank you okay thank you very much Mela and now Dr. Eric Domingo Refty I think we all want to protect our healthcare workers and our senior citizens but the best way to protect is really to vaccinate everybody so concentrate mo na tayo do na this time and stop this virus from circulating pag ganoon protectado tayo lahat we do recognize that there's going to be a need to protect our healthcare workers and the most highly vulnerable pero inya talaga it will have to be based on really strong scientific evidence safety mo na tayo and makita mo na natin na may added benefit and we will do it as quickly as we can and once matapos naman po yat makadysition we will share the information with everybody so that everybody will be guided okay thank you very much is Dr. Eric Domingo the director general of the Food and Drug Administration I don't know if Ted is still here Ted, are you here? Dr. Ted baka nagsimula na yung event nila Dr. Soros nila sa bagyo okay so okay thank you so much for our speakers for your time we know you're very busy and I know our audience is really appreciating you you can see in the chat box yung pa sasalamat nang ating mga tagapakimil okay we will now go to our closing remarks and we have of course Chancellor Manchit Padilla or UP Manila Manchit Pagandang hapon po sa inyong lahat webinar 77 was opened by Dr. Ted Herbosa and he started by saying that because of the success of the public health measures we celebrate the following milestones well first we have we have given 106 million doses by the end of October 2021 second we have the highest number of vaccine deliveries of 31 million in the single month last October number three the highest number of vaccines 13 million just for the month of October and of course you know the inclusion of children in the vaccine schedule and now we are discussing a third dose for health workers and those with comorbidities our first speaker is a regular FDA director general Eric Domingo and here are the highlights of his talk all vaccines in the Philippines are still under emergency use authorization they were given EUA because it has been shown that the benefits outweigh the risk there are eight vaccines with EUA and of the eight only two vaccines were granted EUA for the children and that will be Pfizer and Moderna now in terms of the number of doses six have six of the vaccines have two doses and two with a single dose DGR informed us that every time there is a product variation they have to apply at FDA for an amendment so there is a process so we don't have to worry because that is exactly what FDA is doing for us protecting us by conducting the process for the approval of the amendment DGR explained the difference and this is the interesting part because he explained the difference of an additional dose in a booster dose so confusing for everybody in this webinar an additional dose is given to individuals with insufficient response to the primary series and that will be for the elderly and the immunocompromised and the second point is that an additional homologous vaccine is given at least 28 days after completion of the initial series now on the other hand a booster dose is given at least six months after the completion of the primary series and usually the booster is given because of the three messages we were informed we were informed that by DGR that FDA conducts post authorization monitoring but I think this is so crucial for us it's not a question of just FDA releasing an approval but even after the approval they continue to to monitor the outcome of these vaccines now he continues by sharing the experiences in other countries but let me just share with you what the DOHL experts group has recommended well first the booster doses or third doses may actually be procured at this point but we will await the recommendation of the WHO now second at the issues of equity and flexibility will be considered in the decision making DGR and the this talk with an assurance that the application for boosters are now under now FDA expects WHO recommendation to actually come out in about two weeks and that the DOH is already preparing for the guidelines for the roll out so I think we're in good hands we've got DOH and the FDA taking care of the decisions as far as the guidelines and the releases for all of us our second speaker is Dr. Mela Lapitan and she presented the latest test from the Philippine COVID living clinical practice guidelines I just want to introduce the group of Dr. Mela she belongs to a group of epidemiologists who are doing real time review of the studies conducted all over the world so thank you Dr. Mela and the rest of the members of the Institute of Clinical Epidemiology at the National Institutes of Health UP Manila Totopo, hindi na tutulog because every time there is something new they have to evaluate and just as they've finished reviewing the data there's a new set of data again so Dr. Mela started by saying that there are only 13 studies on heterologous booster COVID-19 vaccination only 13 three RCTs four comparative cohorts three single cohorts three case studies and zero on clinical effectiveness and the data is only on 28 days duration of safety following a post booster tighter measurement now indeed there are no long term studies because everything is just being studied right now so we don't have those studies at the moment so thus at the conclusion is that there is really low certainty of evidence but what is clear according to Dr. Mela is that boosting and there is a higher immune response now the interesting part is that Dr. Mela showed the results of the studies of the combinations of the different vaccines and since all of us in this webinar received different vaccines for our primary series I encourage you to watch the replay to review the results that are relevant to you now the data that was presented by Dr. Mela showed the number of clinical studies umeral and cellular response and the safety so I think this is something to go back to look for that combination and see how it will apply to you now as a vaccine but indeed the general observations are according to Dr. Mela are the following heterologous boosters are highly immunogenic heterologous boosters are more immunogenic than homologous vaccines with some exceptions and heterologous vaccines are generally safe so at the end there are so many unanswered questions given to us by Dr. Mela what is the best combination when is the best time how long do the effect last is an additional dose safe in the long term and for our researchers the questions we have these questions for the researchers what level of immunologic response translates to clinical protection does this correlate to clinical protection the same for all vaccines and the most important part is that new and better status reveal better results and better conclusions now our team of epidemiologists have a lot of work to work on she mentioned 96 registered trials on COVID-19 booster vaccination and I understand when Dr. Mela was saying wala na talagang tulogan because as they start to finish one job they start reviewing the next set of data thank you again to Dr. Mela and the team of epidemiologists our reactor is a regular Navota city health officer Dr. Fischa Padadina she is coming to this forum with three hats as a city health officer an obstetrician and as an end user and listening to her sharing I think she represents the sentiment of most local government units in the ground with the announcement of an additional dose and booster dose they were flooded with questions she had to release a communication statement to translate all of these issues all of these terms in layman's terms as she said reality check it's very important because the community gets so confused with so many conflicting statements being released in the television in the radio and even in newspapers her office also releases situational reports because as she said she wants to highlight what is local and then she also highlights the international studies at this particular day so that somehow she shared some light into the confusion within her community in Navotas now in Navotas she has to consider the uniqueness of her community she said there are a lot of OFWs the issues are different they want to live soon and they want a certain brand because probably they were vaccinated with that brand already overseas but at the end as a city health officer she has to consider equity, availability and flexibility this time as an obstetrician she expresses concern for the pregnant and the lactating Dr. Christian Ends by saying that she and probably all of us continue to depend on science for the recommendation now let me end with a WHO statement shared by Dr. Mela and open quote each dose of vaccine will save more lives if provided to the unvaccinated versus being used as a booster in the general population close quote so have a nice weekend magandan hapon ko sa inyong lahat and back to you Susie and Raymond thank you very much it's Dr. Manchit I'm still muted as Dr. Manchit Padilya our Chancellor from UP Manila I don't know how she does it how she summarizes that but she really captured everything thanks so much Manchit for that excellent summary okay next week na ko we have a nice topic next week and speakers that you want to like so one of the things that we would like to talk about maybe we're just looking for the time to do it I think this is a good time to do it is to talk about how are we arranging the physical space of our hospitals hospitals health centers district hospitals et cetera so the Philippine General Hospital is going to present it's one word concept for COVID-19 and we will have also the so we'll have Dr. Gappi Gaspi talking about how PGH is arranging so that na kasi na simula di ba parang like sa sa suffer yung ibang clinical services natin parang puro COVID especially for the COVID referral hospitals but now how do we do it and PGH has its plan they're going to share that so Dr. Gappi Gaspi is going to present that we're going to have the medical director of St. Luke's Global Dr. Dennis Serrano and two other speakers but we will also have architect Louis Daya Garcia who is an expert in design so don't miss it kasi na tayo pinagisipan natin panunga pa natin na tayo sinong mga health center natin, mga hospital natin so that it's safe kasi mukang pabalik-balik pa rin itong COVID so we will talk about design we have a title but I think we're going to have a better title but it will be about how do you arrange the physical space so please invite your colleagues in the hospitals and in the health centers to join us next week when we talk about this Raymond over to you Thank you so much Dr. Susie and thank you for another excellent recap of our Chancellor Chancellor Padilla of the University of Philippines Manila so before we conclude our program for today we all know that you had a very good time in terms of really absorbing a lot of the information that was very very clearly conveyed by our panelists we'd like to first acknowledge po the very hardworking team behind the stop COVID that's web in our series without each and every one of you our learning series will not be possible you really are the backbone of our online community and we hope more and more people will join our credible online community and then finally also those who are asking all of our webinars 76 webinars and now after this webinar webinar number 77 will be archived for viewing at the YouTube channel on TVUP so if you go to www.youtube.com and then type in TVUP you'd be able to go to the channel of TVUP and then see all of the listed stop COVID deaths webinars para sa ating online community maraming maraming salamat po ulit sa inyong pong lahat this formally closes our webinar for this week we hope to see each other next week again during our regular Friday lunch date same time same channel Friday from 12 noon to 2pm it's a date together we can stop COVID deaths so keep safe keep healthy and see you online see you again do I have strength to carry on my God our Lord mistakes go on and leave you here to keep me strong I'm here to hold the line I'll keep my hope until my name to read just hold on to the word this time we'll come to pass because this salvation makes it last you carry you to see the break the others pain from my fears the others laughs before my tears but right behind the mask I look into myself and ask do I have strength to carry on my God our Lord mistakes go on to keep me strong I'm here to hold the line I'll keep my hope until my name to read just hold on to the word this time we'll come to pass because this salvation makes it last you carry you to see the break I look into myself and ask do I have strength to carry on you here to keep me strong I'm here to hold the line I'll keep my hope until my name to read just hold on to the word this time we'll come to pass because this salvation makes it last you carry you to see the break