 Magandang hapon po, good morning, good afternoon, good evening everyone asalman po kayo sa parte ng mundo. Welcome to the 71st installment of the Stop COVID Debt Webinar Series and thank you for being part of our credible online community. To all of those who have just discovered us for today, welcome po at we are sure that you will enjoy being part of our community. So for today, we will be talking about booster shots. Aro-aro po na sa ating mga balita, ito po ay napag-uusapan, ano po bang alam natin to call sa mga COVID-19 booster shots? Should we be receiving additional doses of COVID-19 vaccines? Ganu po ba katagal ang mga current vaccines po natin na na-protectionan po tayo laban sa severe disease and hospitalization? Are all the current vaccines providing adequate protection against the Delta variant na very, very dreaded po? So teka muna, aalamin po natin for today the science behind the COVID-19 vaccine boosters. So if you want to cut through all of the noise, yung po mga disinformation, misinformation and really get the answers from credible sources, then this is the place to be. I'm Dr. Raymond Francis Sarmiento, Director of National Telehealth Center, National Institutes of Health University of Philippines Manila. Always a pleasure to be with all of you during our regular Friday lunch date and as always get to enjoy our Fridays kasi po I share hosting duties with my partner and my beloved mentor po, our adjunct research faculty at the National Telehealth Center International Renowned Public Health Communications Expert, Dr. Susie Pineda Mercado. Dr. Susie? Hi, hi Raymond, good afternoon. Ganda na mo na introduction. Pag gandangapon po sa inon lahat sa mga nagikinay from all over the country. Welcome and nice to see everyone who is usually here. Raymond, pagkama aga po na haka pag chat ko sa mga maagang pumasokin ay tatakay yung iba, but kami hindi binabati kasi pag nags-start na mahirap ng mag-chat, pero magandang hapon po sa inon lahat sa inon kayo na roon. We hope you're okay, we hope you're fine, we know, okay, we know that many of you are getting infected, many of your family members are getting infections. Saramat na lang sa Jaws, ang karamihan ay mild, asymptomatic. Dun sa ma na nagkakaroon ng mga serious condition, you know, our hearts are with you, we know that it's very difficult and difficult to be a health worker in these times, pero tuloy lang tayo, tuloy lang, tuloy, tuloy lang, matatapostin to. And our topic today is very interesting, we're going to talk about booster, ano ba yung booster shot na yan? Iba, ano ba yung ibig sabihin yan? Right now, I think we will focus on the science, ano ba yung, ano ba, ano principyo ang, bakit natin kailangan magbigay ng booster, no? And we have a very fascinating group of speakers. Again, only the best for you guys, thank you for joining us kung hindi po sa inyo, hindi po namin maipapagpatuloy ito, na ginaganahan talaga kami, pag nakikita namin, oh yung mabalik sila nandyan lang sila. So also those who have watch parties, if you're in a watch party, let us know on the chat or send us a picture on Facebook. Okay, so to start our discussion, and we're going to talk about ano ba yung booster shot, we have a very special animation from TVUP. So TVUP take it away. Ang protective immunity ay nabubuo pagkatapos ng infection o sa unang turok ng bakuna, ngunit bakit kailangan natin ng dag-dag na turok ng bakuna? Magkakai ba ang reaction ng ating immune system sa bawat infection? May ilan na mahina at nawawala nalang paglipas ng panawan, ganun din sa mga bakuna. Kaya kailangan ng mga dag-dag na turok nito. Kinakailangan natin ng mga dag-dag na turok ng bakuna para mapalakas ang protection na nakukukuha natin dito. At para sa mga bakuna na hindi nakakapagbigay ng panghabang buhay na protection, kinakailangan natin ng booster vaccine. Malagang magpabakuna taon-taon upang labanan ang mga virus na mabilis na nag-miumiotate o nagbabago. Kinakailangan ng ating katawan ng panahon upang lumika ng pinakamahusay na immune memory. Kung kaya't may pagitan sa unang turok ng bakuna at sa mga susunod nito. Kadalasan, nakakaroon ng mas magandang reaction kapag mas mahaba ang pagitan ng bauturok ng bakuna. Kinahayaan nito ang ating immune system na bumuon ng malakas na immune memory para ang booster vaccine ay makakaroon ng pinakaangkop na boosting effect. Thank you so much, TVUP, ay mga nag-gandano. Congratulation, Nagalog. Congratulations to TVUP. We have really this brilliant creative artist in TVUP who put this together. Of course, our director, Chancellor G.G. Alfon. So thank you for... Voice over, next. I'm going to reveal in pa sa likod, Raymond. Ano parang very, what should I say? It's a very calming video. But I think animation is really a very good medium. Specially for understanding very complicated processes. So congratulations and thank you. TVUP, hoping there will be more in the future. Over to you, Raymond. Yes, thank you, Dr. Suzie. And thank you also for that excellent video. We just showed that... But well, an English version of that video last Monday. So thank you for really working very, very hard on this TVUP. We are now numbering at a little over 1,100 participants in the Zoom webinar. So for those who are joining us sa YouTube channel ng TVUP as well as the Facebook accounts ng stop COVID deaths, University of the Philippines, as well as TVUP, please let us know if you are in the watch parties po so we could acknowledge each and every one of you. Please remember that our Zoom webinar can accommodate up to 3,000 participants. And hopefully you'll be able to join us in Zoom so you could fully experience the interactive program. So for those who may not be able to join or baka mas madalipo sa kanila ng mag-join through other platforms, as mentioned, we are sharing especially the experience through our Mentimeter. So yung pong ating na sa Zoom, sa Zoom poll, sa mga outside of the Zoom, please go to www.menti.com and enter the code 78281242. That's 78281242 so you'll be able to join in our fun mini-quiz. And for those who are asking, our certificates of attendance will be given to those who have watched at least 50% of the webinar duration. Ang ating mga very, very hard working team behind it po, will be answering all of your queries, please. Direct all your queries to stopcovidets.up.edu.ph. As mentioned, only those who have spent at least 50% of the time, so webinar will be given certificates of attendance po. And that's something that we have been very, very consistent as well as to make sure na inyong mga names na na sa registration po ay un po talaga ang mag-re-reflect sa inyong mga certificates. Over to you, Dr. Suzy. Okay, thank you very much, Raymond. So we're really looking forward to a very exciting webinar today and I assure you, we have really top-notch speakers for this webinar. So, Raymond, are we going to, pag-launch nabatayon ang nanglentimeter, mukhang ikaw ang introduction, di ba? Okay, okay, just to give a very, very brief opening remarks po na for our webinar. We have been talking about COVID-19 boosters for the past, I think for the past month. We are waiting for experts from the vaccine expert panel, from the Health Technology Assessment Council, our experts from the National Adverse Event Following Immunization Committee, as well as our Intrim National Immunization Technical Advisory Group, and all other experts to chime in and give their position with regards to the giving of the COVID-19 boosters po. We are looking at really all of the evidence that's available to be a, ano po ba yung science behind giving a series of vaccinations, difference between a primary series and a booster series. How do all of these protect people from viral infections, including COVID-19? For today's webinar, we'll also want to discuss the evidence supporting all of the additional doses. Mayan po ba talaga evident siya? And does the evidence support the claim na dapat po ba ay magkaruna tayo ng boosters shots? You will note, especially for those who are reading the news, Israel has been moving forward with their boosters shots. There are those, at least in the United States, approval for the elderly and for the immunocompromise. So yun po yung mga ibat-ibang elemento ano po ba yung mga groups, priority groups of people who will be eligible and will be recommended to receive a booster shot. We also will hopefully touch on the World Health Organization's concerns with regards to equity of the vaccines. Bakit po ba importante na masigurado na lahat po ng mga tao ay maka-receive ng at least one vaccine? You will note na the WHO has been harping on the fact that a lot of the vaccines, majority of the vaccines have been distributed among the developed countries and a very, very small ball portion has been received by the developing countries. So yun po ang ating pag-uusapan for today's webinar. Okay, over to you, Dr. Suzie. Hey, thank you very much, Raymond. Ganan ang introduction mo. Parang sabiwan, no? So many issues around booster shots. At the moment, I think we are really focused on making sure that everybody at least gets one shot, although those who are eligible, so nandong pa tayo. Pero magandang nang iniintindi natin lalo na ating audience are mainly frontliners. Bakit na tatanong kayo or bakit ng iisip din kayo, kailangan nyo ba? Okay, so ito ay, pag-aralan mo na natin kung ano ba yung booster shot na yan kung papano siyang nangangkatulong natulit for COVID-19, but other viral infections. So we are going to start first with our fun quiz. So we always start with, kawanteng ano lang, audience participation, Raymond, di ba? So, Raymond, let's go to our fun quiz mo na before we introduce our panel. Okay, thank you so much. We are seeing, at least for those who are in the Zoom, the opinion poll. And then on the screen, there we go. Uy, may bago na naman tayong pakulo. Very, very cute pictures sa ating Mentimeter. Okay, doon po sa ano ha? Doon po sa ating mga, nasa Facebook ulit or YouTube, please note that if you could join us sa www.menti.com and enter the code 7-8-2-8-1-2-4-2, you'd be able to join our fun mini quiz. We only have two questions as always. Very first question natin. A booster is, so ano po ba ang booster? Apili lang po kayo ng isa. Option A, additional dose. It's an additional dose given after the primary series. Option B, given immediately after the second dose, if the person has comorbidities. Option C, given to the elderly population. Option D, lahat ng nabanggit. So, yun po. We are seeing, ang galing no para po ano, para siyang, ano ba ito? Kareras. Parang you're peering down under a microscope. So, siya na, ang galing. Ang galing kaya o ang kit na, o siya. It's very, very dynamic. Thank you, TV UP for this one. And then for our second question, the second question reads, the evidence of effectiveness of booster shots for COVID-19 vaccines is letter A, not available. Letter B, consistently increasing the antibodies. Letter C, inconsistent. And letter D, confusing. So, we are talking about the evidence of effectiveness. Ano po ba yung mga sinasabi ng evidencia tungkol po sa booster vaccine? So, we will not be closing our opinion poll. We'd like to grit po muna ang ating mga registrants. All the way from Madela District Hospital in Madela Kirino, from Marivellas Mental Wellness and General Hospital in Bataan, from Industrial Technology and Development Institute, from DOST in Tagig, Lambuna Rural Health Unit in Iloilo, the Provincial Government of Negros, Occidental in Bakolod, and internationally, the Parkway Hospital in Singapore, Chonin Hospital in Taipei, Taiwan, Ministry of Health in Oman, Lunichi Ali University of Bleeda II in Algeria, Penang Malaysia, Ho Chi Minh, Vietnam, Dubai, UAE, Riyadh, Saudi Arabia, San Jose, California, the University of Fiji, Laotoka. And finally, ang ating pinakabago, Inis Fail, I hope I'm pronouncing it correctly, Queensland, Australia. So maraming, maraming salamat po. We are now numbering nearly 1,300, so hopefully a whole lot more of your friends and families and colleagues will be able to join. Again, we will not be closing the opinion poll as we move on to our webinar proper. Over to you, Dr. Suzy. Okay, thank you very much, Raymond. And thank you, TVUP. I really enjoy those growing microbes. Portamento meter, very cute. Okay, so we are going to our main speakers. So today we have a number of speakers. And the first is someone you have met before, but we always like to invite her because she is the lead of the vaccine expert panel. I mean, it doesn't get any better than that to have this expert with us. She's former Dean of the UP College of Public Health and she's always game to join us and give us very, what should I say, very clear explanations of the science behind vaccines. So let's go to Dr. Nina Gloriani. Dr. Nina, welcome to the webinar again. Yes, thank you very much, Dr. Suzy. And a very beautiful afternoon to everyone sa mga followers ng TVUP. Happy to be here again, no? Very happy. Maraming salamat po. Thank you for joining us. Sige po, go ahead. Go ahead with your presentation. Okay. You have seen the beautiful animation that should set the tone for my presentation. Ay, bakt na wala? Ma'am, lipa po kayo sa ano. Oh my God. Just click on something, Dr. Nina. Yon po. And then... Go to presentation. Sige po, sige po. Sige, go to slideshow. Ma'am, okay. Yon, okay. I've been required to have my disclosure. So I have no financial disclosure or conflicts of interest to disclose with regard to the subject matter of this presentation and all others here. Okay. True love lasts forever. Po to ba yon? May forever nga ba? Well, for some, yes. But immunity to COVID-19 vaccines will not last forever. Sorry. Anyway, but let me define first at least these two terms, the primary series of vaccines versus the booster. By primary series of vaccines, we remain the dose and number of doses determined usually during clinical trials. Ito po yung data that will show na ito yung optimal. So the series of vaccine doses peding one lang or two to four doses, mahabano yung four, to reach full effectiveness of these vaccines. So if you remember or if you know, may children, kayo, gran children, ang OPV for polyo requires three doses, MMR two doses, yung flu vaccine, one dose yearly, but for the COVID vaccines that we have available right now, isay lang po yung merong one dose na binebiga and all others will require two doses. So now we move to defining what is a booster dose, at least for this presentation, we refer to a third dose or additional dose to the primary series. So nabigyan na nung mando, na klok, dalawa, then we add another one. So for some vaccines, a booster dose is needed months or years after the primary dose to refresh the immune system's memory and maintain protection. So ito mga naka examples po dito, merong po talaga mga booster doses yan, but for COVID-19, do we need boosters? Masasagot po natin yan mamaya. So just to give you an idea ito po yung core routine vaccines, mahikita nyo, may mga cheta yan, ilang doses ba yan and then after so many months or many years, you have boosters. So pa kasi partial protection or maybe even no protection yet after one dose, which we just call priming dose, okay, two to three dose primary series and then you get higher or full protection after completion of what we call the primary series but which will vary for different vaccine antigens. Okay. So let us understand why some will require boosters, others will not. So there is individual variation in immune response to vaccination. So I have listed here a number of these factors. So ang unong-unong siguro is intrinsic host factor, showcase. Sino ba ang mas madalig maka generate ng immune response? The younger, the middle age or the older sex, my genetics of the immune response, then those who have comorbidities or are immunocompromised may have lower immune responses and then we do have our behavioral as well as nutritional factors. Now this is only for children or may mga factors din to consider. Among the extrinsic factors, we also have to consider for example, pre-existing immunity. In the case of COVID, we have to look at natural immunity ng na COVID and then do we give vaccine pa ba or what do we do? And then for these are for the host factors, these are for vaccine and administration factors. So we have to look at different vaccine types, the product, the vaccine itself, pumero silang adjuvant or what the dose, yung concentration of antigen in that formulation. And then the number of doses in the primary series and especially the interval between doses. And you will see later, two weeks ba ang interval between the first and second doses. May three weeks, may four weeks, may eight to twelve weeks, may ilong pang ibang vaccine, it's not for COVID. Five to six months or longer. So these factors will make your immune responses vary. So iba-iba. So we're looking at different equality and types of antibody responses. For instance, so may na tayong pinotaw na IGM, IGA, IGG, may na tayong neutralizing versus na-neutralizing antibodies. We also look at cell-mediated immunity. May na tayong T-helper. May na tayong killer or cytotoxic T-cells. Not just na quality, but we had to look at na quantity. Ganu ka dami yung elicit na immune response na nyo. For antibodies, we're always looking at tighter. So ito yung magnitude. Mas mataas na tighter, of course, better. And that translates to a longer duration of immunity which could be weeks, months or years. Now, this is something I will explain again some more later, but over time, n with two or three or four boosters or dosas, there will be an increase. This is an immunologic phenomenon or immunologic, based on immunologic principles. There will be increase in potency, avidity to yung total binding ng antibody sa lahat ng mga antigenic epitopes ng isang virus, for instance, yung affinity maturation. Nag-mama-matured din yung strength ng binding niya habang tumatagan yung interval from the time you get the vaccine and increasing the braille of the immune response, meaning nagiging broadly reactive yung antibodies. Okay. Siguro, I'll just explain in more detail what does dosage requirement mean. So yung number of doses kasi medyo iba nga, so for primary immunization, example ko dito is for COVID. So for one dose, meron tayo yung yansen. This one dose may provide enough immunity and afford up to 70% protection. So you see this graph here, pag one dose, this is what sort of antibody response you will get. But for other COVID vaccines, they will require two doses like Pfizer, Moderna, Sputnik, Sinovac, Sinova ba? Okay. Nakamay nakalimutan ako. So pag mag-second dose ka, that will shoot up. I will explain again dahil meron tayo yung memory response, satisfactorily secondary response. So one dose versus two doses. The spacing between doses, as I already explained earlier, will also be important. So different vaccines use different schedules. Yung three weeks ang Pfizer and Sputnik, I think have yung interval of three weeks between the first and second doses, ang four weeks apart, ay ang Sinovac, Moderna, for vaccine, I think, and then as a Seneca, ang data on the longest interval, four weeks to 12 weeks. So actually as a Seneca, date data on the higher levels of antibodies when the interval between the first and second doses was longer, up to 12 weeks. So actually mayo pa silang ibang data na longer dan 12 weeks na mas mataas pa ang antibody response. So thus, the need for booster doses after primary series will depend on the duration of immunity which could win in months or in short, or in years. If shortly immunity, we may need to be boosters. So ito yung paktinotoro po sa mga estudianto. I think a lot of your healthcare workers here. You enter immunology class. So ito yung primary versus secondary immune response. Ito yung first exposure, first dose sa inyo. So we call that the primary response which is short lasting, mabilisyang bababa. It is smaller in magnitude, mas mababa, yung level of antibodies. But that is the time when the switch from what we call IGN to IGG would occur. So maguumpis na nga yung tinatalo ng nating memory response. So now when we give the second dose, yan yung secondary response. So mayro tayong na nagingerate na memory cells from the first dose. So the memory cells developed from primary response are activated very quickly. So makikita nyo dito in na siguro a few days, five to seven days. Papa nikagad yung mga antibodies nga. Mabilis ang response na yan. So faster response, also more pronounced, kaya tiktita nyo. Mas mataas. Taas. Taas ng kaatiter. Higher magnitude or tighter of antibodies. At mas mataas, longer ang duration ng immunity. And repeated exposure, you may have a second, a third, a fourth, leads to faster, stronger response, more effective at limiting the infection. Yan mga antibodies na yan. Sambaga leg. They come from the B cells which become plasma cells. So this is a little technical. But what I want you to appreciate here is ito mga antibodies na toh, galinga sa B cells. So the level of antibodies you get will depend on how many B cells divide into so many plasma cells later para to produce those antibodies. So mayan tayong tinatawag na clonal expansion. Ito yung clone ng nga re- against one anti-gen of the COVID, of the spike for instance. Magco-clonally expand yan so da dami. If sabi na clonal expansion, yung isang, yung isang B cell magiging galawa, yung galawa magiging Apa 12, it is exponential. Then as you go along, so ba ulaan dito yung recognition. Marerecognize mo na ng B cell yung anti-gen reticillus spike. Then ma-activate siya to clonally proliferate. Da dami. Kaya din nanyo, padami ng padami yan, expand ng expand. And what we have seen is that more B cells clonally expand with time and with longer interval between doses. So more Plasma cells will be there with dividing and therefore the Plasma cells are the ones producing the antibodies. And as you go along, hanggang tumatagal yung time na yun, meron pinatawag na affinity maturation. So para di sa tao habang nag-mama-mature tatagalan yung affinity of binding of the antibody to the viral anti-gen. And then many generate na memory. So yung si sabi ko, more antibodies produced with stronger affinity. Therefore, there is wisdom in waiting for the right time to boost. Hindi po pwede agad agad. Yeah. This is another maybe safety or this is light, but what I want also you to understand is ito po mga vaccines natin or usually ang meron tayo either the whole virus, inactivated vaccine or the spike. But within the spike alone, marami poong pinatawag na B-cell antigenic epitopes. So hindi lang po isa yan, marami ang atang haral yan kaya nga po nagkaharod ng immune evasions or variants kasi na iibah yung mga antigens na yun dahil do sa mga mutations nila. But without the mutations mo now, there are so many such B-cell epitopes. So marami. And that means ito no, there are so many depicted here by different colors of antigens. And for each antigenic epitope, there will be an antibody that will be generated against that. So this is a very good article that was recently published as a print, pero to want to ako kasi actually there are many such publications on other vaccines. What this is showing here is ito yung wang et al just released September 5, the profiles of antibodies from those who received three doses, those who received two doses, and those who had your antibodies after they recovered from COVID ito yung convalescent sira. So these antibodies were dissected very, very comprehensively. So what did that show? Doon sa after the third dose, nito na papakita yung mga two doses, doon sa third, yun naka-received ng third dose. They produce a highly sifted humoral immune response. So meron po na e-evolved antibodies, yung ka sabi kong ay, ba'y ba yung mga antibodies na yun? That showed better neutralization, drug, so maas marame, especially also seen against the variance of concern. They also of course showed quick memory response and yung higher tighter dahil boosting long lasting immune response in warding of COVID-19. So actually they were able to analyze, napakarami po nito, hindi ito madalin i-analyze. 171 complex structures of SARS-CoV-2 neutralizing antibodies which identified ito, kung maro ito, ibayon sila. Identified structure activity correlates so yung nakakabiat ng mga antigen at antibody pinag-aralang po mabuti ang that revealed very potent, variant of concern, resistant and broad spectrum antigenic patches. So ito po i-medyo technical pero ito po atitotorong natin sa immunology sa graduate school. Talagapong yung mga antibodies ay na iba-iba over time. There is a lot of memory B-cell clonal turnover. So yung siguro yung antibody composition changes in the B-cell repertoire which is driven by prolonged repeated antigenic stimulation such as what we will find after a serb dose or an additional dose. So given that to boost or not to boost that is the big question. Kanda ngayon, abalikan natin ito na dito na kayo some of you may have received one dose some of you may have received two doses so ito yung response better sinabi ko na that the interval the longer the interval between the two doses better but tignanin nyo kung yung second dose nyo pababana or umas mababa pa then you have to consider a booster then there you have some considerations for boosters so waning immunity baka we are loping at race groups sila yung talagang mas malimit ma aga magway ng immunity the elderly the immunocompromised but not just the waning immunity but those are very high exposure risk yung mga talagang to meeting yung mga COVID patients or yung mga frontliners kailangan magkita lahat yun then we have to look at the epidemiology of breakthrough cases over time and the disease severity so kung may mga variants then performance we also have to look at the data nung mga vaccines for COVID kung may data sila on how the third dose will perform or have performed so yung looking at the safety and immunogenicity of the not just the immunogenicity do mami ba yung antibody but is a third dose safe titignan din po natin nga and then pwede bang magmix and match and you mix and match yung first two doses are one platform and then the booster the third would be another platform and then there are also recent studies on dose sparing or lower doses given as boosters for instance na yung isang vaccine na nang kilang kalahati lang nung dose na binebege sa primary series ang binebege sa booster and that was also very good so question is what is the optimal timing for boosters is it six months eight months twelve months it will depend so sorry na medyo anti-climatic and acting last slide but despite saying all that we have to remember that the WHO officials say that the scientific justification for boosters remains unclear ang dami po napak tinok-onsider so director general Tedros acknowledge that third doses might be necessary for at-risk groups but he said we do not want to see widespread use of boosters for healthy people and who are fully vaccinated the WHO target is for all countries to vaccinate at-risk 40% of their people by year's end and in fact the WHO called for a global moratorium on booster doses at least sana initially until the end of September lapit na po na on pero ang baba-baba parin ang global immunization coverage so this was later moved to end of 2021 to prioritize vaccinating the most at-risk people around the world who are yet to receive their first dose and just to give you an idea of the countries who are planning on giving boosters or are already giving boosters we have listed Israel nasabkaya dosila al donari nito usupan ila mag-fort dose U.S. U.K. Czech Republic Germany France Thailand Indonesia China Cambodia so with that thank you very much for your attention thank you very much that's former dean of the U.P. College of Public Health Dr. Nina Gloriani was also the lead of the vaccine expert panel and a very clear explanation na isip po nga mam-mine parang yung memory parang ano yung like our ordinary memory habang inoulit diba pagbata pa kaya sa sabihin ng nanayin nyo o dapat yan nito dapat yan yan tapos hindi niya parin gagawin kailang paalala sa inyo so habang pinapaalala ang kakaroon ng memory yung nagkakaroon tayo ng memory ganun din yung mga sales ng tin sa katawan so it's a very simple concept but it's an important one because at the end of the day it's not about what vaccine you're using but about is your body remembering na alala ba nang mga sales no so thank you so much for that wonderful presentation Dr. Nina Gloriani okay Raymond over to you thank you Dr. Susie and thank you Dr. Gloriani for really making making sure that everyone understands the science behind the booster shots in comparison to the primary series po our next speaker will be talking about the available evidence with regards to COVID-19 booster shots she is a professor at the Institute of Clinical Epidemiology of the National Institutes of Health University of Philippines Manila please welcome to the webinar again Dr. Marie Carmela Lapitan mamela hello good afternoon good day to everyone good night event to all the others thank you for giving me this opportunity to share our work at the Institute of Clinical Epidemiology from the National Institutes of Health of Philippines Manila okay so let me just start sharing my slides okay so professor professor Gloriani has eloquently explained how vaccines and boosters work for in protecting us from disease but for the COVID-19 infection the trials on the COVID-19 vaccines have demonstrated that they work in preventing disease and as we see in the real world as we continue to roll out our even here our vaccination program we've seen that it really does protect us from the disease but as for the case of the COVID-19 vaccine booster beyond what theoretically should happen is there really proof that it will give us additional protection without giving us an additional risk so let's see if in the next few minutes we can have a little bit more light on the COVID-19 booster vaccine boosters and looking at what is the current available evidence well i will really be presenting the work our work of a group of researchers of the Philippine COVID-19 living CPG tasks force of the institute of clinical epidemiology of the UPNIH on the evidence that we have gathered on COVID-19 boosters and other important pieces of evidence that we share with our decision makers on how and when and you know is it really at the right time and should we implement a booster program here in our country anytime soon so let's first discuss i'll present to you the results of the rapid review that we've done on the evidence on COVID-19 vaccine boosters so we looked at we did a focus in directed search of these different electronic registries of COVID-19 studies and information to answer two basic questions are COVID-19 vaccine boosters effective and are they safe so as of September 17 and actually I did a quick search the other day this is still the numbers no we found 21 reports really that discussed or looked at the performance of COVID-19 vaccine boosters 11 of them involved gave information regarding the booster performance on the general population and 10 showed the information regarding its performance on the immunocompromised so let's look at studies regarding that involve the general population the studies reporting on the immunologic outcomes after COVID-19 booster vaccination actually showed very consistent results all of them all these booster vaccines did show a significant increases in the antibody titers when you compare them with the titers after the second dose some even rising to about 100 fold rise in the titers so this was what professor Groyanias said that the booster will actually should increase the levels of your antibodies again but more importantly rather than just looking at antibodies do they really prevent infection or give you additional protection there are only two studies and unfortunately there were just observational studies that provided actual clinical outcomes after a booster and this was these two studies both used the BNT162B2 or the Pfizer vaccine the first study was a test negative case control study and the second was a comparative cohort both studies were done in Israel so the first study showed that the marginal protection against testing positive for SARS-CoV-2 increased to about 84% after 14 days after the booster compared to without receiving a booster and then the comparative study comparative cohort on the other hand showed that receiving a booster provided an 11.4 fold increase in protection against COVID-19 infection and an even higher 15.5 fold increase in protection against severe disease now let's look at the impact of boosters on the immunocompromised population again the same immunogenetic or immunogenic effect was seen after COVID-19 booster vaccination among the immunocompromised now the anti-body titers and the zero positivity rates consistently increased after these immunocompromised patients received the booster shot now what about actual clinical outcomes in terms of the actual ability of the boosters to prevent infection three single cohort studies on transplant patients reported only one COVID infection across these three studies after the boost however these studies did not really tell us what was the post vaccination infection rates before they had the booster but more important outcomes or performance outcome was seen in this one report among patients who were on dialysis it gives us a clearer picture on the effect of the booster when this study showed no breakthrough infections among within the months of though after receiving the booster compared to the four symptomatic cases that they've seen within the first three weeks of receiving the primary vaccination so to answer now the question are COVID vaccine boosters safe the studies reporting safety outcome show that at least within 28 days of receiving the boost although you can have well of course expectedly there's a higher rate of local and systemic reactions when you compared the boosted population compared to those so just receive placebo but most of these reactions were found to be mild and transient but then but when you compare the rates adverse reaction rates during the time of the second dose in the booster some studies even actually showed lower adverse event rates after the booster although generally they were most of the studies reported similar adverse event rates now in terms of the more important severe and serious adverse events the studies that reported these showed very low rates or even no adverse serious adverse event rates and majority of them it's not all were unrelated to the booster and for the immunocompromise there was no instance of acute rejection in the transplant patients who received the booster now looking at homologous versus heterologous boosters so what if you get boosted with another type of vaccine compared to your primary vaccination the three studies that looked at this show that heterologous booster vaccination was actually associated with the higher locals and systemic reaction but still most of them were still just mild and moderate adverse events so when we summarize the available evidence we considered also not just the results but also the quality of the studies that gave these results the types of outcomes they reported whether they were consistent in their results across and whether their results were precise so that we can see now the overall certainty how sure are we that these studies actually answer our questions now we see here the summary of findings of the effectiveness of booster vaccines among the general population the certainty how sure are we of the evidence that these studies gave us we had to downgrade mainly because these are most of the studies are observational studies and those who actually did perform randomized trials most of them just showed immunogenic outcomes and not real clinical outcomes so but the same was true with safety outcomes naman the reason for us downgrading the certainty of the evidence is because most nearly all actually all of the studies except for one had only very short follow up of about 28 days now the similar finding summary of findings we see among the studies that were generated from involving immunocompromised patients again most of them were observational studies and of course these are just indirect measures of effectiveness because again most of them just showed antibody titers and very few and very low quality studies did show did tell us the actual clinical outcomes of the booster vaccine among the immunocompromised patients so so the wrap review that we've done so far at least the ones that we've done for as of today showed that COVID-19 vaccine boosters are effective in preventing COVID-19 infections but these are based on very low to low certainty evidence and they are safe again based on moderate evidence but safety and efficacy of the boosters is just one part of the puzzle the HO and most regulatory authorities actually look at other pieces of evidence to inform the decision of whether to roll out COVID-19 booster vaccination programs no the double the WHO to answer this no conducted a systematic review of real world evidence on vaccine effectiveness to provide some answers to these additional decision points to consider the first was the real world evidence of primary vaccination how is the primary vaccination working the systematic review including more than 50 reports showed that majority actual majority of our vaccines now demonstrate that a very high effectiveness rate of at least 85% against any infection and at least 90% against severe disease now a lot of the worry on vaccine effectiveness was in the light of this delta variant and this may be allayed no this worry may be allayed by looking at these results on the review that they the studies that look into our current vaccine effectiveness on the different variants showed that almost the effectiveness seems to be almost preserved even with a delta variant no although it's lower compared to the alpha and wild strain the current vaccine still showed some effectiveness at the rate of at least 85% against any infection and at least 90% against severe disease with the delta variant now all current platforms of vaccine provide at least 85% effectiveness rates against severe disease and lastly probably the most relevant in terms of boosting whether to start a boosting program or not is that when when the effectiveness was assessed at a later time or a longer interval from the time of the primary vaccination again the systematic reviews showed that vaccine effectiveness rates remain at least 80% against infection and at least a very high 90% against severe disease so based on all these considerations in its August 10 statement the WHO said that the evidence remains limited and in conclusive on any widespread need for booster doses following primary vaccination they emphasize this in the context primarily of global supply constraints and inequities in vaccine distribution even within countries so our review also tried to identify these limitations in the evidence that WHO refers to now while we have information that antibody titers boost really actually rise and there is some information on its clinical effectiveness there is still really no established correlates of protection which will tell us at what level of antibody titers really equates to immunity from disease we still don't know that and we still don't know when is the best time to boost to get its maximum effect as Professor Gloriani says there is a factor of time interval when we can really get the maximum effect of the boost and we don't know that time yet now should we get the same vaccine or should we should we be boosted with another with a different vaccine now the long term efficacy and safety boosters are still not known that the studies that I showed you the 21 studies most of them majority of them only had very short follow-ups of one month and beyond the clinical effects of boosting on the public health sphere we don't know the overall impact of rolling out a booster program on achieving that maximum coverage of the primary vaccination so we look forward to getting all these evidence and evidence is really set to come out soon we've looked at the registry of the clinical trials and there are 17 active trials on COVID vaccine COVID-19 booster vaccination and one is expected among the 17 is expected to be completed as early as December 2021 and I'm sure when I look into the registry again tomorrow there will probably be more reports on booster vaccination effects and we are also awaiting that results locally to give us the local evidence and data we are awaiting the results of Dr. Raminan Berbas Group in PGH on the Philippine vaccine effectiveness study and one which focuses on healthcare workers and I believe there are already analyzing the data now there are also I know of many other ongoing local trials on COVID-19 vaccine and some of those these trials actually have a booster arm to them so I think it's a very exciting time as a researcher that because every day there's really new evidence that's coming up so to match this effort we will really make effort to seek all these evidence summarize this and inform our decision makers and our group is really trying to work very hard to be to get these rapid reviews on time and get us out of this pandemic to answer all these different questions that will eventually tell us is it really time to boost and how should we go about this booster vaccination program so thank you and I hope that gave us a little bit of more light thank you so much Dr. Ramela very very important to note po para po sa ating mga audience yung pung summary of findings sa grade table it shows po yung the strength of the evidence if it's certainty in terms of very low low moderate or high makakita niyo po na use of boosters are safe moderate po ang certainty po niya and then with regards to immunogenic studies as well as the clinical outcomes preventing infections medyon on the low side pa po siya please also note the WHO statement on kung pwede na po magpabakuna especially do sa mga healthy ang magpagabu boosters sa mga healthy individual po no given the global context of limited supply so thank you so much Dr. Lapitan excellent presentation we now move on to our next presenter to be introduced by Dr. Suzy hey thank thank you very much Raymond and thank you very much Dr. Lapitan of course Raymond I think one of our what should I say one of the things we've always said in this webinar is that the information and the evidence is changing rapidly and I remember in the early days of the pandemic even on this webinar doctors were doing everything trying everything every medicine kasi hindi na alam hindi tiak so pinag-a-arala so ito I think we have to wait a little bit more there is there is evolving evidence but you know what we knew six months ago or a year ago is very different from what we know now so it's very important to just keep abreast alam natin hindi tayo na dadala ng bali-balita at dito sa webinar na ito sa kaya namin parang tinutulungan namin kayo na to be critical thinkers to be able to say okay ito ang ibig sabihin ito dibawag natin pauunahin yung nararamdaman natin gamitin natin yung yung husay yung husay atalino natin para mag-isip mo na bago tayo mag-conclude na oh, dapat ganito dapat ganito anyway, all right it is my pleasure and my honor to introduce our next our next speaker who I would say has one of the most difficult jobs one of the most difficult jobs during a pandemic where there aren't always new products being introduced into the market and I've known him for sometime and it was a stroke of genius that he was put in the position that he is in kasi ano nalang mangyaris natin kung hindi siya ang ginawang director general ng food and drug administration so it's my honor to welcome Dr. Rolando Enrique Domingo Eric Domingo the director general and undersecretary for the food and drug administration welcome Eric thank you, ma'am Susie that is Susie, nice to see you let me just share tama po yung napakahirap po talaga ng trabako namin sa FDA ngayon and ang manaproducto po bagong bago so let me just refresh everybody pag upo tayong magtatalun at gusto mo magpabuster paalala ko lang po sa inyong muna kung ano ba yung status na mga bakuna na ginagamit natin ito po before tayong nagstart magbakuna pinapakita ko lagi yung slide na ito to remind everybody let it usually take seven years mga lima anim pitong taon bago makadevelopo ng isang bakuna magsisi mula sa discovery phase one phase two phase three trial hanggang marihistro ito pero dahil meron tayong pandemic tayo ay nagbabakuna under emergency use authorization in the middle of phase three so a lot of the vaccines that we are using binigyan po natin ang authorization niyan siguro mga two months three months ang kanilang data na naibigay sa atin no at dahil niya po hindi dahil yung nagdati nagbibigay ng gamot na hindi completely registered tapos lahat ng clinical trials at till phase three kailangan humimipatayo ng isang batas mula po sa ating pangudo we had executive order number 121 which grants the FDA Director General the authority to issue an emergency use authorization ang ibig pang sabihin noon kailangan yung bakuna ay ia-apply either ng private sector kung sino yung developer ng bakuna or ng Department of Health na nag-implement po ng vaccination ng emergency use authorization tapos ang mga pag-aaral sa development ng vaccine na yun kailangan good manufacturing practice at siyempre mga unaman sila na yung complete development ng vaccine so sa ngayon po ito yung criteria na ginagamit natin so it should be reasonable to believe that the vaccine may be effective the potential benefit outweighs the risk so maganda yung safety profile at wala pa naman talagang approved na vaccine at this time wala pa po ano sa U.S. meron na yung Pfizer pero dito sa atin wala pa so all of the vaccines that we're using now show that the benefit outweighs the risk doon po sa data na pinigay nila sa atin which is the primary vaccination data meaning yung kailang either one dose or two dose regimen so pag dinadevelop yung vaccine ito yung kanyang tatapusin niya ang phase three sa kalagit naan ng phase three kapag nakita naman na talagang meron ng enough data to show safety and efficacy binibigyan natin niya ng emergency use authorization kapag naman completo na yung data natapus na yung phase three puwede na siya mag-apply nang certificate of product registration or a marketing authorization which will make it commercially available to the public sa ngayon po Pfizer pa lang ang nakakuha sa USFDA nang certificate of product registration or full approval and that is based on six months clinical trial data sa ibang bansa po katulad sa European Union hindi pa sila nag-apply kinokompleto pa rili yung one year and then after that at chaka pa po sila mag-apply sa mga bansa katulad natin so ito pung full registration possibly baka next year pa po yan kung may mag-apply dito sa atin pero ngayon ang binibigyan po natin pa rin ay EUA and these are the vaccines that we have now under emergency use authorization memorized na po natin yan yung iba iba lang yung brand name niya pero si Pfizer, siya rin si Cominarity si AstraZeneca, siya rin si Vaxibria Sinovax, Putnik, Janssen, Moderna, Sinofarm and yung barat biotech na kumpaksin these are the six authorized vaccines in the Philippines right now so yung walu, I mean the eight so yung pun ng walu na yun ato lang yung gilagamit pa lang natin pito yung barat biotech yung kumpaksin wala pang gilagamit sa Pilipinas pero yung pito either na bilina natin and we are currently using karamiyan po yan nung kumawa ng EUA sa amin ang karilang indication is of course prevention of COVID-19 using either a single dose in the case of Janssen and yung Sputnik lite or two doses, lahat po yung iba and then karamiyan 18 and above yung Pfizer nung una 16 and above at yung Sinovax nung una bidigyan po natin yan 18 to 59 which later expanded to older people tapos ngayon po nagbigay na rin tayo for 12 to 17 for Pfizer and Moderna so hindi po once kumawa ng EUA ay ano na yun na yun na yun nakatagana sa batoyon nakakaroon ng bagong information bagong data and then they can ask for amendment to their EUA so hindi din po pwede na basta basta nalang gagamitin ng bakuna sa isang bagong indication na hindi po kinukuka ng approval from the FDA kailangan aaralin mo na ng experts natin yan to make sure na yung bagong expanded indication is really supported by information and by enough data for example, nagkaroon ng change ng age yung Pong Sinovax nag-increase ng 16 and older yung Pfizer and Moderna nag-start ng 12 and above so after they got their EUA nagpadala sila saabi ng bagong data to show na pwede siyang gamitin sa ganitong edad para bigyan natin ang paintulot na gamitin they also ask for variation from us when they have a new manufacturing line ganun po tayo astrict sa man good manufacturing practice Bawot EUA nakalagay po doon kung sa ang factory ginawa yun kung saan nilagay sa batoyon at kung paano po makakatating dito sa Pilipinas kung magtatayo sila ng bagong factory kailangan pakitan na sa amen ang data na yung factory na yun as good manufacturing practice and can consistently produce good quality vaccines pag nagbago siya ng variation nang ng bote, naging two doses one dose ampule, naging bayan bago rin po yung data yan papakita rin sa amen it's as good as the original vaccine and of course ito talaga yung Pong change in the dosing schedule kung makakalan ng change from one to two doses or two doses maging increase po yan to maggabibigay ng booster kailangan po yan maginging sila ng amendment sa kanilang EUA bago po yan magamit So, pag na-design po ng ating mga experts that it's time for boosters kailangan po dadaan mo na sila sa FDA we have to do our regulatory part that existing EUA shall apply for a product variation kasi magiging bago yung product may makakanon siya ng third dose yung new generation vaccines kung mayro naman pung bago talaga yung bagong EUA po yan and in any case, clinical data must be submitted to support application hindi po po hending basta lamang kasi ginagawa sa ibang bansa o kasi nakita na natin yung mga antibody sa ito mataas kailangan po mapakita natin yung clinical data to show na tanagapong mayroong benefit that outweighs the risk of giving a third dose to a patient now who will apply for a EUA ito yung medyo tricky kasi katulad ng sinabi ng Doctora Mela yung homologous vaccine or kung heterologous booster if it's not going to be the same vaccine for example Sinovac or Pfizer magdadagdag siya na third dose I would expect the company mag-apply siya kasi yagamitin niya yung kanyang bakuna uliip dadagdagad niya na third dose and they would probably have data to support that pero kung heterologous yung booster for example you got AstraZeneca Sinovac ng first two dose tapos ang gobierno gusto magbigay ng Pfizer or Moderna as a third dose then it's very unlikely that the company will apply kasi hindi naman siguro siya mag-apply na ibang bakuna yung gagamitin para pang booster ng bakuna nila or gagamitin booster ang bakuna nila ng vaccine na hindi naman siya na mag-manufacture so in this case siguro yung other possible na-applicant after the private industry would be the government then the Department of Health should be able to collate enough data show us at the FDA that will be enough to convince our experts na okay ang heterologous booster it's safe and the benefit outweighs the risk and then of course since these are still EUA vaccines and the new regimen with a booster if gagawin natin yan would still be something very new then we will have to be very closely monitoring kasi kato parang may kumpisa odi tayo ng vaccination natin kailangan ba tayo natin yan and the EUA holder has very specific pharma of vigilance obligations kasi it's something new and we just have to make sure that every now and then i-review natin kung yung positive pa rin yung benefit and risk balance so yun po ang sa FDA and before I go may I have 30 seconds gusto ko lang paalala sa lahat yung po kasing pagkakaroon ng susceptibility or the probability of us getting COVID-19 hindi lang naman yun nakasalalay dun sa personal na protection ng antibodies ng katawan natin napakarami naman ibang paraan including of course vaccinating and protecting everyone around us so hindi po na wag mo na tayong tumalun agad dun sa ating mga boosters kung yung mga varsin natin ngayon under EUA pa aalalin pa putan ang gusto yun and once masatisfy lahat ng atin po mga requirements then siyaka po tayo lang mga aring mga boosters syat. Thank you. Okay, thank you very much. That's Director General Undersecretary Eric Domingo from the Food and Drug Administration. Eric, thank you so much for that very enlightening presentation. I'm just listening to you and while I'm listening to you parang andami mo talagang iniintindi parang this is not it's not easy. It is not easy. And I think people are impatient. They want answers right away. But that's why we have an agency like the Food and Drug Administration just to make sure na ligdust ang mga gagawin mga patahara na gagawin natin ay ligdust. So na paka husay ng paliwanag ng Dr. Domingo. And Eric, thank you so much for the time that you spent to be with us. We know you're so busy. I understand at two o'clock you have to be at a hearing. But you know our frontliners really benefit from a bit more explanation kasi kung daririnig lang natin sa radyo, nagikit na magkonti tayong nababasang news hindi na uunawa pero dun sa pinaliwanag nyo napakalinao na na marami tayong kailangan daan ng proceso para matiak natin pagbibigay ng booster ay ligdust at karapat napat ang panahon. And I think the most important thing although I don't want to really go into this too long is that you're right. The more people who get vaccinated the more protected everybody is. So napakaganda nung mensahan nyo. I know you may have to leave early but if you can please stay Eric for the panel discussion. Okay, so we're going to move to our next speaker Ray Maggo, over to you. Thank you so much for sharing your insights Director General Domingon. Thank you, Dr. Susi. Our final reactor for today will be siyempre we've heard one from the perspective of a vaccine expert perspective of epidemiologists and then from the FDA. Finally, we will have one from infectious diseases. She is an infectious disease specialist practicing at the division of infectious diseases at the Philippine General Hospital. Please welcome to the webinar Dr. Sonya Salamat. Dr. Salamat. Hello, good afternoon to everyone. Marami po akong natutunan ngayon sa webinar na ito. Yung sasabihin ko po ngayon wala naman po ako masyado idadag-dagna na informasyon sa nasa na nabigay na nina Dr. Loryani, Dr. Lapitan, Dr. Domingo pero andito ako para sa pananaw naman ng clinician. So as a clinician what's a clinician interested in so, siyempre as clinicians we're interested in having fewer people get sick we're also interested in if people do get sick we're hoping that they will not get sick with a severe or a critical illness with COVID-19. Tapo siyempre we're interested in not getting sick ourselves and also if we don't get sick we would that would also be very beneficial because we won't be passing on the infection to our loved ones the people we live with et cetera. So Dr. Lapitan has already presented earlier the benefits of well the evidence about the benefits of receiving a booster or an additional dose of vaccine and I think that was very clear to us the evidence the quality of the evidence right now is low to very low for the efficacy of the booster vaccines and for the safety it was at the quality of evidence was moderate. So pagtining na natin yung as clinicians siguro we should we should be very we have to be aware that again the evidence is really evolving and right now as Dr. Domingo said wag muna tayong tumalon kasi kumakikita naman talaga natin hindi pa talaga maliwan na kailangan-kailangan na natin ng boosters ang ngayon. I get a lot of questions also from colleagues that na sinasabi oh I got my antibody my antibody titers measured so they do this either by by using the黎lai sa format o kaya kahit yung rapid test lang kung negative or positive sila nung sa mga rapid test rapid antibody test kits tapos sa sabihin nila oh bumabana yung antibody wala po ako slides takit ako po sa chat no slides so many people many colleagues many fellow doctors fellow healthcare workers asked my antibody titers are already waning based on my on the test I got or I already have a negative test on the rapid test kit for antibodies should I get a booster now the sooner the better so I think that's the temptation really for us to adopt a purely mechanistic point of view and say that oh ok the moment our antibody titers fall let's go and rush and get a booster pero I think that's where I hope this webinar has provided us clinicians with information that we need unang una di ba si Dr. Gloriani emphasized that there is such a thing as immune memory and therefore our immune response or our protection against COVID-19 does not solely depend on the antibody titers also Dr. Lapitan also said in her presentation I think everyone is also aware of this but it's very easy to forget it when we are scared especially during this time when there is a delta variant surge Dr. Lapitan mentioned that there are no established correlates of protection yet so we don't really know what antibody if you someone says oh my antibody titers fell maybe by half or something like that we don't really know right now what antibody titer levels we are will protect us so it doesn't make sense for us to just to just base our desire or our our decision to get a booster just on the antibody titers kasi ngayon ang isa pakasing nangyayari di ba paraming paramin ang nakapasok na vaccines na hindi siya hindi na siya yung through the LGU through the private companies na siya mukhang yun yung isang nagiging dahilan kaya andami rin nagtatanong kasi nagkaroon ngayon ng access to the vaccines that just arrived and it's not anymore through the prioritization there's another way there's another way that fellow doctors fellow healthcare workers can get vaccines for example through their families who are working in companies who got vaccines for them in their families so even with that even if tingin ko as a clinician even with that access so many people are asking I have access through a patient I have access through a member of my family should I get this booster I think we have to go back we have to go back to what everyone in this webinar has been saying kanina lang kakasabi lang ni Dr. Eric Domingo na we have to remember that it's not just ourselves that will play a role in ending this pandemic but the fact that the more people get vaccinated that's going that will protect more people and that's very important also so we have to remember that it's not just about ourselves as individuals but we have to keep our heads we have to keep thinking about the bigger picture because it's not just the healthcare workers or the frontliners while we do well, yeah of course the frontliners do a lot of the heavy lifting but hindi kasi ganun lang yun talagang kailangan mas maraming tao o mabakonahan because think about it this way that's also going to benefit the frontliners the more people are vaccinated the less people will fall ill the fewer people will fall ill the fewer people will be falling ill with a severe form of the disease so that will protect us also because there will be fewer patients that we will have to see in the hospital with COVID that will also protect us our exposure will also fall and those who get sick and are eventually hospitalized hopefully they are not severely ill and hopefully their viral loads will not be as high that will also protect us and that will also be beneficial to our other patients who are sick with diseases that's not COVID-19 right now they'll also be suffering a lot because of the pandemic hindi sila makapasap na hospital kasi pulo ng COVID patients yung hospital so kung titing na natin kung titing na natin yung bigger picture talaga talagang mukhang hindi unang una hindi pamilywanag nakailangan natin yung booster tapos pangalawa kapantay nga din yung una kailangan ng maraming-maraming pangtaon ng bakuna kaya parang hindi talaga parang hindi talaga tama na tulundag nang atayo papunta doon sa booster ang andami pang hindi na bakunahan ok, siguro yun ang take home point dito sa webinar nato na kahit natural naman na ayaw natin ng magkasakit pero dapat din naman na tayo kasi rin yung tayo rin kasi as healthcare workers tayo rin yung inaasaan we should act rationally we should act based on the evidence yun lang po, salamat ok, thank you very much that's Dr. Sonia, salamat salamat k'y Dr. Salamat sorry, I couldn't avoid I couldn't resist that you know, Sonia Sonia, I just want to thank and I think our audience doesn't know this Sonia manages COVID patients in PGH she is really a clinician handling our patients in the COVID words and it was really very important to have you here Sonia, I know you're busy you're tired and you've seen a lot but really words of wisdom coming from you, from somebody who is currently managing COVID patients in PGH so maraming salamat Dr. Sonia for joining us we are now going to move into our panel discussion I'd like to call into the to open their webgams Mamina, Mela Eric and Sonia and while you're doing that we're going to have a public service announcement from TVUP take it away sigurado ka na ba si reservations natin? oh naman bakit bis na bis ka? oh, magiging escort mo ako e mukang may date si Lola-tlolo ilagay mo kaya ito ang ganda naman maganda yan ispesial ang lakan natin alo, ready ka na? ready ng ready na mam dad alisi Lola-tlolo oh anak after lunch sana lakad nyo po para sa atin lahat ito magpapapakuna kami dahil mahal namin kayo dahil mahal ko kayo magpapapakuna ako ok, thank you TVUP for that video it's part of our communications public service announcement it's one of the many outputs of the UP research on communicating COVID-19 in post-quarantine Philippines it's headed by our UP vice president for public affairs Dr. Nanny Perna and funded by the DO-SDP CHRD and the Department of Health as part of the AHEAD HSPR project Dr. Suzy ok, so we'll start now with our panel discussion and I think Raymond's going to try to harvest some of the questions coming from the chat box but let me get the ball rolling and just sort of ask everyone to comment on this thing about doing something I really like Eric's message napat mabakonahan yung mas marami kasi pag mas maraming nabakonahan lahat tayo protectado so how can we get this message out I think we're at a point where people are kind of kanya-kanya yung iniisip nila pero anong magandang gawin ng ating mga frontliners pag nagtanong dapat ba magpabuster ako ano dapat ang sagut nila so let's start with Nina first with ma Nina Gloria paano bang sasagutin yung tanong na yun na dapat ba akong magpabuster I think all of us na nasa panel ngayon relate that the same sentiment that we have to vaccinate more of the global because anywhere you are pwede mong dalin talaga itong virus na ito with all this mobility so siguro yun yung dapat mas ingrain sa ating as health care workers that let us vaccinate as many muna as possible ang nagiging issue lang yung what we hear from the the private sector na nao oferan versus ang hirap ay may mga issues that you have to consider pero if you are very clear on which one you should follow then go for the greater good meaning more of the sa ngayon na sa 18-20% lang ating immunization coverage malayo pa po tayo although nagdadatingan na mga bakuna with the delta tinaas na natin ang ating sana herd immunity na threshold hindi na 70% kung pakausapin lang kami dapat 80-90% yun 20% is a long way sa siguro ganun na lang sabihin natin dapat madagdagan pa nilang, thank you Dr. Suse ok, thank you Dr. Nina Gloriani let's hear from Mela Mela, ano bang dapat samihin kasi lumalapit ang mga tao dito sa mga audience natin at sinasabi kailangan namin magbabuster bakit hindi? what do we see? well, same as an honor well, number one really from an epidemiologist point of view the information regarding the boosters a lot of unanswered questions what is the correct booster when should you give it and we want to maximize each and every dose of vaccine so I'd wait when I was asked a question will you get a booster my answer will be I'll give it to someone first who didn't have any vaccination yet because that protects me and him, that other person at the same time when I get the booster that only protects me at least when you give it to someone who doesn't have a vaccine dalo akagad yung prenatectahan mo I think Eric wants to say something Eric, ikaw nang ako, very specific na to kasi nabangit na rinisod niya ni mam Nina kaya nakita ko sa chat box matinatanong kasi yun niyang mga ino offer sa private sector so ako ba ay magbabuster kung may ino offer sa private sector nakubawal po yun hindi po po pwede just to be very very clear and categorical about it ang vaccines under EUA are not commercially available ang maari lang kung bumili nito gobyerno infact nakalagay po yun sa EUA na ini issue ko sa bawat kumpanya sa gobyerno mo lang pwede yung event na yan the government can designate partners to vaccinate so mingsan po yung mga company na private tumutulong sila sa DOH vaccination program at bumibilis sila but they have to follow the implementation program and guidelines of the DOH pa rin po nakalagay po yun sa contrata nila nakalagay yun sa EUA at bago sila pabayagang bumili kailangan mga agree sila sa tripartite agreement na susunod sila sa DOH so pag sinabi po ng DOH na hindi pwede yung booster hindi po kayo pwede yung bumili at magbabuster nang para sarili din yun kahit kayong nagbayad dahil wala pa po pwede yung bilihin na vacuna nakakapagod nga po every now and then may hospital offer ng ganyan or private company upunta pa yung aking enforcement unit doon at ipaalala sa kanila hindi nyo pwede event ay an at hindi kayo pwede magbakuna ng wala pa sa guidelines ng DOH so sa atin po iitandaan na natin yan hindi pa po pwede kahit po nagbayad tayo thank you very much Eric ano kasi hindi pwede nga kanya-kanya tayo makakagulu yung Bung Pilipinas pag ganyan kaya meron tayo in department of health para parang pantay-pantay no we have that everybody will have the same opportunity and that will help everyone so I think Eric is very clear about this babal po yun you're not supposed to have a booster okay let's get some thoughts from Sonia doctor salamat what do you think what would you say or what do you say to your patients ang tinatanong ako ang sinasabi ko talaga muna wala pa talagang maliwan na evidence na talagang okay magpabunster tapos sinasabi ko rin na yung kung ko sa safety baka gusto mo rin hintayin na talagang makita yung evidence na safe siya pero kasi ang napapansin ko kasi mas maganda kung magsisimula mo na dun sa kung effective ba siya kasi ko sabihin mo sa kanila na hindi pa naman natin sigurado kung effective yan talag atapos pangalawa yung society effects hindi pa rin natin sigurado minsan nakikining sila pero minsan hindi din pero yun ang una kung sinasabi na tignan natin yung evidence kasi akarami ang kasino nitanong sakin ang health care workers din sinasabi ko na ay dapat nga tayo yung na uuna na tumitingin mo na dun sa evidence kasi pano naman tayong papaniwalaan kung tayo mismo para sakin kasi parang ano rin yan parang jumping the queue din yung bigla kang magpapabunster kasi nakakuha ka na nung share mo dati tapos kukuha ka na naman uli at so isa pa yun napangatloko yun na sinasabi na o teka lang parang pandaraya na yan nakarami ka na hindi pa hindi pa yan para sayo hindi pa yan para satin para muna yan dun sa hindi na vacunas yan na sinasabi ko thank you very much Sonya anything Eric's point is bawal hindi dapat magpapabunster okay so I think so of course when you're trying to explain so you're also explaining all the other things but right now as far as department of health in the FDA is concerned bawal siya okay so I think we're very very clear on that okay Raymond I think we have some questions from our audience go ahead yes so very very first question lang po no a lot of are the questions we now have 36 questions po sa Q&A box pero hallo hallo po shay ang pinakam dominant po talala question is about mix and match ano po ba yung mix and match na tinatawag pag pagpabakuna po ba kayo ng primary na sign of vac tapos yung third dose ninyo is another vaccine brand is that mix and match already I think that's something that has to be clarified po I don't know who wants to maybe DJ Eric or doctor Nina would like to say para na po malina of two hour audience po DJ Eric si mam Nina yan kasi sa amin po sa FBA walang registered na mix and match vaccine ang bawat vaccine nagpaparenggister lang siya ng complete regimen ng kanyang mga una at yan lang yung data na meron kami kaya hindi po kami talaga maka-advise na mag mix and match ng vaccine say sa Pilipina so na pa po tayong data dyan although magkakaroon ng mix and match is paddy yung sinin inannounce namin kaya lang di po makapagumpisa but we have data on AstraZeneca and Pfizer malinaw po doon na yung pag nabigyan baliktara Astra, Pfizer, Astra mas tumataas yung antibody response pero pag ka din heterologos na vaccination kagayong sinabi ni Dr. Mela kanina yung mas marami dina nagre-report ng side effects although still mal to moderate so yung titig na ninyo kaya hindi lang yan tatas ba antibody ko mabubus nga ba ako kaya also have to consider yung safety kasi alam nyo may binabantay ang did sa mga bakuna hindi lang sa COVID yung pwede kabibigay ng maraming doses yung pwede ma-enhance din yung disease meron po din tayong minomonitoy ng magag-ganon kaya yung safety ay kailangan din po bantaya ngayon yung Sinovac may rin siyang very limited data na nabigyan ng AstraZeneca for a second dose mas mataas nga yung naging immunogenicity nga yung antibody versus Sinovac Sinovac so Sinovac and AstraZeneca but very limited pa rin yung ganong mga pagaara so hindi natin yung sa atin kasi mga Pilipino ang sasali dyan sa mix and match study natin na sana mag-umpisan na so lahat ng bakuna na meron tayo nakalista dyan na Sinovac bibigyan ng AstraZeneca Sinovac bibigyan ng Pfizer Moderna ay wakakon nakahabul ang yansin and then may base put Okay, so antayin natin antayin natin yung mga dalabahasan natin dito po sa webinar ngayon you're hearing it from the head of the vaccine panel for the Philippines so vaccine expert panel so antayin po natin I know people are impatient they want to know more but everything is new and so our experts are excellent they are excellent napakahusay po na naririnig nyo sila na hikita nyo sila hindi po nila papabayaan kainin ng buaya mga Pilipino I mean we have to trust that they're going to do their due diligence they're going to study before anything is made what should I say is made into a policy or a program Raymond, I think we have we have a live question We have one member of the audience Sir Camilo Nogoy please go ahead sir with your question Hi, good afternoon po Tatano ko lang po if there's really a difference between a third primary shot and a booster kasi I think I heard it in a discussion sa USCDC na what they're giving the immunocompromise in the state is not a booster but a third primary shot kasi two doses of the primary shot they were not enough to give a good number of antibodies for the immunocompromise so I'm just wondering if there's really a difference between the two I answer that that's all we have to define ano ba answered shot on a two dose regimen or bago boost ka pa now some of the vaccines we have for routine immunization are based on three doses na re-hepatitis A, hepatitis B, mga OPV na yun na because that was how they were able to find the optimum immune responses they tried of course one dose, two dose and then three doses now in this pandemic medyo ko lang siguro yung time so hindi lahat ng vaccines we were all eager to deploy vaccines dahil meron silang sufficient evidence na safe, immunogenic as my antibody and then effective naman pero may nageemesh na data na it could be that some of these vaccines na two doses lang would actually require three as a primary so actually yung sign of up meron silang parang sinasabi na and if Pfizer is saying that also so iba-ibayan but all of these pataas talaga kasi third dose so it's up to them to actually say kasi pwede naman din that's how they will also sell yung kanilang recommendation say sorry ha but it's not just sometimes the technical we also look at like yung mag mag-se-sell na one dose lang po we have still data napag nang two doses itong bakuna na to talaga mas mataas so why would I give one dose kung nakita kami two doses na data ay I would choose that pero of course kanya-kanya din na nga so pwede nga third dose sya or primary series it's up to us to to see thank you mamina anyone else want to reply Reemanda? I think none but I think there's one one of the the second po na in terms of category na ma-questions with regards to enforcement I think one of the questions here coming from Grace Nunes is may liability po bang doctor at ang nagpatosok o nagpabakuna kapag nagbakunan sya ng bakuna na wala pang EUA and the other one is there are many anecdotes na nagpabakuna na po ng one brand and then going to a private company and then nagpabakuna naman ng other brand what's the FDA doing about it now po? yung sa dispensing ang meron ka bing meron ka bing habol pag nakulin namin na nagbibigay ng bakuna na hindi sumusunod sa guidelines then we can always give sanctions yung tao na nagpabakun dito sa atin kasi yung uminom ng gamut na fake uminom ng fake counterfeit ng counterfeit hindi naman nating sila kinakasuhan o hinahabla yun naman inasa sariling kusana natin at saka siguro naman nasa consensya na natin knowing na pagkumuatay ng extra vaccine nagde-deprived tayo ng isa pang tao nung bakuna na dapat mapunta sa kanya talong natin na 80% sa kababayan natin ay wana pang bakuna so yung pang pag meron naman po silang nilang nakuling ganoon na nag-dispense na through outside of the guidelines they can report to us and yung nakuling po natin yan yeah thank you very much for that Eric no I think again and I've seen it in the chat no somebody put there it's selfish to want a booster or to do it illegally or whatever no sa ito yung ano panawagan lang na sa well I know you are watching on this webinar are not are not doing this you're hearing about it so I think ano talagay pag kami pandemic people are really anxious they really want you know they start thinking about themselves only but our main message is we need more people to be to be vaccinated so that everyone gets everyone gets protected okay Raymond do you have some more questions are we going into evaluation already? well a few more questions Dr. Suzy but I would like to hear from Dr. Gloria and it's about people who have received their first dose but the interval pakatapos po ay parang lumagpas dan recommended lumagpas ng 28 days lumagpas ng ganyan let's say it's month three from the first dose of Sinovac ano po what is normally the guidance for all of these people po just for the benefit of our audience mam all of these vaccines may kanya kanya silang clinical trial studies no data so yung naging basehan ng kanilang interval but from an immunologic perspective if you recall ang hepatitis B vaccine yung kanyang second and third doses primary series tatlo siya mas mahaba yung interval between the second and third dose kasi belawang regimen sa hepatitis B isang zero one two so monthly tatlo yung isang regimen yung third dose ay five months from the second dose or six months from the first dose and what we have seen for hepatitis B yung nabigyan yung zero one six ay mas mataas ang level ng antibody and data ya na matagal na na mayro and mas mataagal ang magiging duration ng antibody response kaya kung punag mamadali yung mga say let us say healthcare workers na sunilang tomasagan yes they will follow the zero one two monthly pero kung hindi kasi ang durability nung immunity will be better for the one with the longer now having said that now remember ang among these vaccines ang meron talagang data na long interval ay ang AstraZeneca kasi bakit actually hindi naman initially nakasulat sa study protocol na yan pero may mga delay na hindi dumating para sa kanilang second dose and low and beyond yung mas mahaba nakatwell weeks from the second first dose mas mataas ang titer talag serendipitis in a way na then mayro pa silang additional study na later pa after the first dose pa saas pa rin ng antibody response no so but we cannot say that for the others pero generally speaking the longer the interval as I mentioned in my presentation mas marame kasi nga yung B sales dumadami plus ma sales mas mataas sa antibody na pero you can only do that so much hindi rin pwede isang taon after hindi rin pwede nga siguro mga three to six months will be fair enough okay parang anotore may nagnanag sayo ang diw mga under di ba parang pananang medyo okay di ba parang merong paghitan kasi pag paulit-ulit parang narinde okay let's go to answering our fun quiz before we ask our speakers to give their closing remarks go ahead okay fun quiz there we go okay actually we have one more question but for the FDA later nalang po after this fun mini quiz the first question this one came from Dr. Gloriani ma'm Nina a booster is option A additional dose given after the primary series option B given immediately after the second dose if the person has comorbidities option C given to the early and option D all of the above what's the correct answer ma'm ma'm Nina first one the first one okay okay that's the one with the most at least for our respondents the so a booster dose is an additional dose given after the primary series answered by at least 62% of our respondents sa zoom and then for the second question comes from Dr. Lapitan the evidence of effectiveness of booster shots for COVID-19 vaccines is number one option A not available option B consistently increasing the antibodies option C inconsistent and option D confusing mamela consistently increasing the antibodies but that is for today it may change tomorrow so let's watch the evidence thank you pa thank you so much for that so for those who are ano po ano would want to test their knowledge again please go ahead with the answering the opinion poll again po okay I think that one of the questions that I'm seeing po at least Q and A is for the FDA again for for DJ Eric sir in other countries specifically develop countries po no the USA has given select vaccines their full CPR when do we anticipate to have that in the country sir yeah so one lang no one palang ang vaccine to be bury precise about it Pfizer pala bang at sa US FDA pala bang dinanung ko na rin sila kung kailan sila maga apply dito sa atin pa ang sagut nila complete pa nila I mean they start I think with EU and then the other countries like us so ako ang nakikita ko siguro first quarter of next year pa possibly may mag-apply ng EUA sa atin and not only Pfizer the other vaccines nang start din ang kanilang mag-agamagang start to kanilang trials like Moderna ito mga naon na siguro by early next year mag-apply sir for the benefit of our audience what does it mean to have a full CPR sir it means na talaga na complete nila yung clinical trial na lahat na end points kaya nakikita nila nakitalagang very clear yung safety at kasi data and then we allow it to be commercially available so may be benta na ito ngayon may be benta na po sa butika sa mga hospital tayo nakakabili na tayo hindi na sa government lamang ang daan ng bakuna hindi magiging accessible na rin siya through the private ok thank you very much Eric that's very clear no so hopefully by next year may be may be we might see a CPR for the vaccines we don't know so abangan nyo po and that's the point of this whole webinar series sabi na natin kanina napakabilis ng pagbabago ng information kailangan sabaya natin sabaya natin ok so i think we are going to go to our we're going to give our panelists a minute or two to think about your closing remarks like your message for our audience who are mainly frontline workers from all over the country you can see from the district hospitals from Dep Ed from provincial hospitals from the private hospitals from the Metro Manila hospitals and from abroad our Filipino healthcare workers who come to this webinar to be updated so we're going to give you a few minutes to think about closing remarks and while we're doing that Raymond's going to field an evaluation Raymond go ahead thank you Dr. Suzy TVUP may we have it on the screen so again wala po tayong inilalabas na separate na evaluation eto na po yung evaluation na ito especially for those who are asking not just in the chat but have been sending direct messages at sa ating mga e-mail we have five questions answered using a Likert scale the five questions read the panelist demonstrated thorough knowledge of the topic number two the panelist well-prepared and organized number three the panelist spoke clearly and audibly number four the panelist used appropriate language with technical medical jargon adequately explained and number five the panelist contributed to new perspectives and knowledge on managing various key COVID-19 health issues so we are seeing more and more of our respondents answering ating evaluation poll lumapas na po ng 700 800 ating respondents so we will not be closing this evaluation poll as we move on to the final messages of our panelists okay thank you so much Raymond and for everyone please continue to fill in the evaluation form that helps us that really helps us understand and if you have suggestions so now things can be made better you always have the chat box here suggestions about topics and so on we always welcome that so let's hear our closing remarks or not the closing remarks I'm sorry our parting words from our panelists so we'll start with Dr. Sonya Salamat of PGH Sonya please go ahead siguro po ang ano lang parting words let's always keep abreast of the evidence let's not jump the gun won't po tayong masyadong excited lagi natin tandaan tingnan mo na natin yung evidence tapos siguro gusto ko rin sabihin din yung kasi nakita ko sa chat sabi nga ni Dr. Issa Alejandria si Ma'am Pismid Press PSMID President sabi nga ni Ma'am gusto ko rin yung na ipaalala ngayon hindi lang naman bakuna ang kailangan natin sa tayo na mga front-liners healthcare workers huwag natin kalimbota lagi tayong dapat namin personal protective measures tapos lahat po nang dapat naginagawa natin sa workplace natin dapat yan lahat dinagawa natin let's not just let's not be short-sighted and just focus on getting a booster for ourselves yun lang po Thank you very much Undersecretary Eric Domingo Eric go ahead Alam ko po lahat tayo niningervious sa kagusong protectionan yung sarili natin pero talaga naman po ang inuna ng pamahalaan ng mga health workers yung mga vulnerable senior citizens na bakunangan kasi sila yung kailangan talagang protectionan Beyond equity beyond everything else kahit po nakita ko sa evaluation akala nyo lahat alam namin, nai-intindihan namin napakalami pa po natin hindi alam kaya po hindi pa tayo nag-booster hindi pa po nag-pibigay ng booster kasi hindi pa po kompleto ang data at pag meron naman po nakita natin na convincing yan yung bibigay naman po agad yan sa inno pero sa ngayon kong tingin tayo po hindi pa po let's just make sure safety and efficacy first Thank you very much that's Dr. Eric Domingo the head of the FDA let's go to Dr. Mela Lapitan of the clinical epidemiology unit National Institutes of Health of UP Manila go ahead Mela Rest assured we are really working very very hard to get all the evidence out there so that we can properly inform everyone especially our decision makers on what to do and how to get us all out of this pandemic so but yeah let's all keep abreast and make sure that we rely on good evidence to decide on our next steps as we fight this pandemic that's all Thank you very much it's Dr. Mela Lapitan okay ma'am Nina Gloriani please go ahead yung matambaba wang sa hule hindi yung nao na yung nao na po kagalong kawalik kan tayo eh na na na I'm just joking ano taking off from what I actually presented mag tayong magmadale kasi mayroon tayong memory mayroon tayo then we just asiguro sa sabihin ko baka yung hindi pa nakakasekendos makasekendos na kayo kasi you will need better protection I cannot promise you it's full protection but it's better protection kung makukuhan yung second dose and remind the others and like what the others said yung minimum public health precautions we cannot stop this this pandemic kapag hindi natin inestap ang virus transmission so vaccines will only work partially or will only protect at to some extent pero kasama lahat po yung so yung na wang magmadale yung final message ko Thank you Thank you very much words of wisdom from the head of the expert vaccine expert panel of the country for our closing remarks so thank you very much to all our panelists who are so busy but you gave us the time of day and I think our audience is very grateful to hear more than two minutes from you but really an explanation maraming salamat po and to do a synthesis we have the Dean of the U.P. College of Medicine Dr. Charlotte Chong who will give us our synthesis and closing remarks thank you Charlotte, go ahead Thank you Susie so again we are about to conclude webinar 71 Anong nga ba ang COVID-19 boosters this session has given us very important learning since afternoon Dr. Nina Gloriani defined boosters as being given after a primary series of vaccines to refresh the immune systems memory after so many months depending on the type of vaccine intrinsic host factors vaccine and administration factors and even factors like existing immunity or pre-existing immunity she said that immune responses really vary according to QQD quality, quantity, duration and with boosters we can increase the potency ability, affinity and the breath so the need for boosters really depends on immunity after a primary response and a secondary response that generates memory cells with repeated exposure longer and stronger more boosters can clonally expand with time and longer between interval doses so wait for the right time to boost a highly sifted immune system response was seen in a study of 171 complex cases of SARS-CoV-2 with visa clonal turnover Dr. Mela Lapitan from the clinical epidemiology unit did rapid reviews of 21 studies on boosters that really showed evidence for about 11% additional protection with respect to an increase in antibody titers she also mentioned three single cohort studies that showed no breakthrough within one month in patients who were dialized for those without boosters so therefore having a booster vaccination at least in that subset of patients gave some advantage so within one month to expect local and systemic effects that are mild lower adverse event rates in several studies were shown hetero go studies are higher but are local and generally mild effects and boosters as she showed are definitely safe there's low quality of evidence regarding effectivity and very low evidence regarding boosters being immunogenic mainly because the studies were short term and mostly observational there are other pieces of evidence such as the real-world experience on vaccine effectiveness with greater than 90% effectiveness against severe disease and more than 85% against all the variants and a Lancet study by Crosset all showed limited evidence on the need for booster because of the global supply constraints and equity of vaccine access this is something that should wait for better evidence so we look forward to the UPPGH vaccine effectiveness trials the 17 ongoing trials and other local COVID-19 vaccine trials the next speaker our director general from FDA Dr. Eric Domingo actually presented us the executive order 121 series 2020 that actually authorized his office the FDA to issue the emergency use authorization the EUA he mentioned that there's a state to expand vaccination to cover 12 years and above and this was true for Moderna and Pfizer but amendments will be needed if we are going to go for third dosing and therefore clinical data we need to be presented to the FDA for a third homologous vaccine or even an heterogous booster to be approved and therefore when such data are available they still have to monitor what you call post authorization monitoring so individual susceptibility will also depend not only on individual immunity but actually vaccinating everyone I think that was a very important point so the director for this afternoon was our very own infectious disease expert Dr. Sonia Salamat who gave their respective of a clinician who actually treated patients with COVID-19 infections at the PGH and she mentioned that again we have to be able to wait for more evidence and wait for authorities to approve rather than go for that booster even if available in some private companies for example so I think the message has been that we have to have everyone vaccinated sama-sama tayong umaun sa hammer ng pandemya magpabakuna na at wag lang pang sarili ang iisipin kundi ang pambansa ang kapakanan ng isipin sa commonidad po ang laban ng COVID so kumare ay magingatayong lahat magpabakuna na yung di pa nalabakunahan magpasekin dosed na yung di pa nagpapasekin dosed at sumulod tayo lahat sa mga minimum public health standards so I'd like to thank of course the opportunity to do the synthesis and closing remarks thank you of course to the organizers TVUP led by the office of vice president Elena Perna TVUP Executive Director Dr. G. G. Alfonso our hosts Dr. Susy Pineda and Dr. Raymond Sarmiento and our distinguished speakers all alumni of the UP College of Medicine our mentor Dr. Nina Gloriani my colleague Dr. Mela Lapitan Dr. Eric Domingo as well as Dr. Sonya Salamat Marami, Marami Salamat Thank you very much that's the Dean of the UP College of Medicine Dr. Charlotte Chong it's always challenging to try to bring everything together but Charlotte you and Manship really are really good at summarizing everything thank you so much for that Dean Charlotte Chong alright so next week nako exciting to exciting na naman naging naman exciting and topic natin di ba but I think many of you are interested in this because many of you have children we are going to talk about COVID-19 vaccines for children in 12 to 17 years old we will have experts from the pediatric sector and we also have an epidemiologist so we will also have a pediatrician from another country who will talk where they are giving vaccines for children 12 to 17 years old so abangan nyo po also I know a lot of depth ed we have so many folks from depth ed from all over the country who tune in sama po kayo isaman nyo po yung mga iban taga depth ed kasaman yung mga teacher yung mga interesado because we will talk about COVID-19 vaccines for children over to you Raymond thank you so much Dr. Suzy really an excellent synthesis and closing remarks from our Dean from the UP College of Medicine we are now showing po the results of our evaluation poll 1122 of our respondents were able to put in their feedback for the most part more than 90% more than 93% and above po ang sumagot po nang strongly agree dito po sa ating evaluation poll very very consistent with our previous webinar so maraming-maraming salamat po sa lahat before we conclude our program let me first acknowledge the very hard working team behind this top COVID-19 webinar series without each and every one of you our learning series will not be possible maraming-maraming salamat po and then for those who are asking ulit na mga nakaktawan po nila na mga webinars you can go to www.youtube.com search for the TV UP channel and you'll be able to see all previous 70 webinars natin including yung archive po niyong webinar na ito after as soon as our webinar is concluded so yun po magkita kita po tayo ulit next week it's a very exciting topic on COVID-19 vaccines and children but for now we formally close our webinar we look forward to your company next week Friday again our regular Friday lunch date from 12 noon to 2pm it's a date together we can stop COVID deaths so keep safe keep healthy and see you online the enemy remains unseen I'll keep your hand in mine but say a prayer one more time I know long for hope but I am here you're not alone I'll stay with you until the coast is clear the other's pain before my fears the other's lies before my tears my pride behind the mask I'll look into myself and ask do I have strength to carry on my God, how long must this go on and if you're here to keep me strong I'm here to hold the line I'll keep my hand until my... just hold on to the best time we'll come to pass cause that salvation makes a last you'll carry you to see the break the other's pain before my fears the other's lies before my tears my pride behind the mask I'll look into myself and ask do I have strength to carry on my God, how long must this go on to keep me strong I'm here to hold the line I'll keep my hand until my head dies my fears the other's lies before my tears my pride behind the mask I'll look into myself and ask to carry on if you're here to keep me strong I'm here to hold the line my God, how long must this go on