 Second installment, stop COVID-19 webinar series. And we are glad that you continue to join us in this learning journey as we try to continue and address your concerns about COVID-19. During our webinar on February 5th, we were asked the question, who should not be vaccinated? Nakuha po tayo na napakaraming response po, ang pangunahin po dito ay imbitahan ang ating alergologist para sa isang exclusive na webinar at kagadahil po kami po ay nakikinig sa inyo, today hopefully we will be able to answer those questions. So with all of the swirling news regarding potential side effects po ng iba-tibang brands po ng COVID-19 vaccines, possible adverse effects, following immunization, maybe allergic reactions, I hope we could get the real score from the medical experts po that we have in the panel this afternoon. Again, I'm Dr. Raymond Frances Sarmiento from the UT Manila National Institutes of Health, director po of the National Telehealth Center and always a pleasure to be with all of you. And as always, again, I am very pleased and happy to share my hosting duty spot for this webinar series, together with my mentor and partner in crime, our adjunct research faculty for the National Telehealth Center and also the special envoy for global health initiatives by the president, Dr. Susie Pineda Mercado. Dr. Susie? Hi Raymond, good morning, good afternoon, good day to everyone. May sa tanan, maopay ang autoguenas dias. We'd like to meet everyone who's watching us now in Zoom, who's inside the webinar and also those who are watching on YouTube and on Facebook live and those who are watching on the playback. So I'd just like to say, Raymond, my goodness, we have participants from Kagayan, Davao Bohol, Kamarina Sur, mga tagap PGH Ward 9 mo batin natin. The Metro Manila Hospital is a medical center lang center ng Philippines Karino Medical Center, among Rodriguez, but we also have participants from Butuan, Isabela, from the Department of Education, nabati po namin sila. We always have a lot of teachers who are watching so you are most welcome and we hope you are learning with us COVID-19. We've got Davao, Lipa, South Quatabato, Bacolod, Pasig, and Dami pang iba. Magandang araw po sa ino lahat and welcome to the webinar. I've got a bit of an announcement before we get started because we would like to invite you to join our official mailing list. Subscribe to our official mailing list and never miss the latest developments. If you subscribe and you become part of our virtual learning community, you will get updates in your inbox on email and you'll know what the topics are going to be and whatever other information we can share with you, we will share it through our official mailing list. So please register, sign up now for our mailing list for stop COVID deaths. Over to you Raymond. Thank you so much, Dr. Susie. So as mentioned by Dr. Susie, medyo bago po ito ang ating mailing list, but there are those who have already signed up and I hope more and more of our, especially our regular attendees will be able to sign up so that you get the latest information para po sa ating stop COVID-19 webinar series. So for those who are joining us naman po for the very first time, ang ating structure ng webinar, we have our main presenter followed by talks from our reactors. Very, very expert panel po that we have for today. We will bring them all together for that panel discussion followed by a Q&A session. In the last few weeks, we have been trying out po live questions coming in from the audience so ang bangan nyo po kung sino po ang ating matatawang sa ating live audience. So for those who are joining us in the Facebook live streaming, YouTube channel of TV UP, may be watching us in the playback, please keep focus po and keep your eyes trained po with regards to all the things in relation to COVID-19 and allergies. But before I turn the floor over again to Dr. Suzy, I would like to take this opportunity to thank the very hardworking team behind the stop COVID-19 deaths po. Yung po talaga ang mubuhay sa ating every week and manaming salamat po for all the members from each of these agencies and groups for making this learning series possible. Dr. Suzy? Yeah, well today this is, I don't believe it Raymond, it's webinar number 42. We've been doing this for 42 weeks or more, more because we took a couple of Fridays off during the December holiday but it's webinar number 42 and by special request. The audience has been asking about whether or not it's safe for them to be vaccinated against COVID-19 if they have allergies. And I think it's just fitting that this webinar is co-hosted by the Philippine Society for Allergies As My Immunology. So binabati po natin lahat ang mga allergologists, immunologists who are joining us live and who are joining us on the playback. Just like to thank you for the terrific work you're doing. There was a position paper that came out from the Philippine Society and we are going to talk about that today. So over to you Raymond, I think people want to know about the certificate. Thank you Dr. Suzy. So on the screens po, you will be able to see and it's displayed po, you itchura ng ating certificate of attendance. So for those who keep on asking po with regards to changes on the attendance certificates that they keep receiving, please note that we are just following whatever you input. So please be very, very careful with regards to the spend of your name and how all of these are reflected po sa inyong registration para po sa inyong certificate. We are also providing copies of the presentation of the speakers along with a copy of the certificates of attendance. So please let us know if you still do not have received a link to the presentations po. So let's start na po Dr. Suzy. Oh, naganimate ka lang Holti Raymond. Well that's part of our life in the virtual world. We've got a very special introductory speaker for today. You know it's 42 weeks and I think in the past few weeks we've been taking stock of how this webinar has been performing. And again, I just wanted to thank you, our audience, na smoso baibay kayo, sinasamahan niyo kaminong because if it's not for you, we would not be here. And we have a very special person who is going to talk about how the webinar has been performing before we talk about the main topic which is allergies and the vaccines. And this person has been not really all the time behind the scenes, sometimes we've seen her but I just want everyone to know that it takes a huge group of, what should I say, a huge group of very committed agencies and people inside the University of the Philippines to make this happen. And it's the leadership of our Vice President for Public Affairs, Dr. Elena Perna, that has been, what should I say, she has been one of the pillars of making sure that we are able to do this, we are able to do it properly and that we get full support for bringing good information to the audience. So, I'd like to welcome Dr. Nenny Perna. Nenny, welcome to your webinar. Yes, hello Susie, hello Raymond. Now I'm in front of the camera. Yeah, now you're in front of the camera and people can see you but we just want to thank you for all the support you have given us for making this possible. So you've got a little presentation for us. Please go ahead and be Nenny. Go ahead. Okay. Thank you very much Susie and Raymond and everybody who is here. I prepared something to give a little background into how we started and where we are. But first of all, good afternoon to everybody and congratulations that we have reached webinar 42. In fact, our first anniversary will be upon us in a few more weeks. As a communication person, I have always believed that public health concerns are communication concerns, which is why I am very happy and proud to be part of this weekly webinar series. But how did we start and what was the rationale for this webinar series? We all know that when COVID-19 began its rampage across the world, there were no experts on the disease, nor were there any well-established treatments for it. The acquisition of these expertise and knowledge came at a great cost of life. Doctors and other medical professionals were among the first to fall as SARS-CoV-2 quickly decimated the ranks of the breast and the brightest in their fields. In the Philippines alone, just after the pandemic reached our shores, close to two dozen medical specialists succumbed to the virus. A devastating blow to a country where health workers were already in short supply, with just one doctor for every 33,000 people. By August 2020, Reuters reported that the beleaguered Philippine College of Physicians was waging a losing battle, posting a high incidence of burnout and low morale among the 80,000 doctors and million nurses in its ranks. And with the government's COVID-19 response, pinned at $213 per capita as of January 2021, one of the weakest rates in the entire ASEAN region, the push to fortify the country's healthcare system remains a slow and uphill struggle. Even today, many stories and much of the valuable knowledge from the frontlines still remain untold. The UP was among the first institutions to see the urgent need to discuss and disseminate new knowledge and to promote the highest possible standards of care for COVID-19. This was the impetus for UP to create stop COVID deaths, this pioneering webinar series which began to quickly disseminate new knowledge and to inform the practice of medicine throughout the Philippines among clinicians, hospital administrators and researchers. What is this webinar series now known for, known as? To date, stop COVID deaths remains the first and only frontline focused medical webinar series in the Philippines. As I said earlier, it pioneered the widespread dissemination and adoption of knowledge on COVID-19 treatment and management in the country. With over 110,000 attendees today from around the world, it is a key element in the Philippines concerted pandemic response. Do you know that if you do a Google search for COVID-19 webinars, the UP's stop COVID deaths, this webinar will rank third in the search. And it's the only frontline focused Philippine endeavor in a sea of international webinars. Furthermore, in the Apple iTunes market alone, not a single one of the 100 top-ranked podcasts in the country is focused on medical responses to the pandemic. And also, while local news outlets frequently focus on COVID-19 related statistics, there is almost no reportage on the care and protection of and by medical practitioners themselves. Building on the expertise and dedication of UP's graduates, faculty, students, friends and the time-honored tradition of Bayanihan, the spirit of cooperation and solidarity that is inherent to the Philippine medical community as it is inherent to all Filipinos. We at UP provided communication resources and a platform to enable medical practitioners to share their expertise on and experiences of COVID-19. Now, so with this stop COVID-19 webinar, we brought together medical experts in the university and, as Susie mentioned, a team of communication practitioners dedicated and focused to respond to the lack of expert information and opinion on COVID-19. So how far have we come as a health communication medium? By the time the webinar reached its 40th episode, we were elated by the success of this webinar series. The results far exceeded our hopes. At TVUP, please show slide one. Our data show that the total number of views and attendance of our webinars exceeds 110,000 with Zoom attendance at over 25,000 and YouTube at almost 90,000. At the start, we had the conservative goal of having registered attendees from just eight of our regions in the country. Our data show that a full 100% of the Philippines geopolitical regions were represented. TVUP, please show the national heat map. We did some animation here and as you will see, we are watched. Our webinars are attended in all regions of the country. The lighter colors show few or less attendees and as the heat map gets redder, this is where we find our attendees. Some of them are very loyal and have attended all 42. Apart from the Philippines, the webinar series has extended its reach beyond our country to 14 countries across the globe. TVUP, please show the world heat map. You see here the data here that we are presenting in the world heat map represent attendees until only, I believe, the 30th webinar. This needs a little bit more updating. 14 countries across the globe and many of them are medical professionals, researchers and frontliners. What other quantitative targets have we achieved? TVUP, please show slide two. In terms of our attendees, we have hit our targets. Our attendees include 62.1% frontliners which include clinicians, 52.6%, hospital management personnel 5.4% and researchers 4.1%. Over 88% of our attendees who answered an exit call expressed intent to apply what they learned from the webinars in their work. And importantly, where we aim to increase confidence and allay fears over the Philippines COVID-19 pandemic response, we are very pleased to say that the webinar series contributed not just to an overall better understanding of the COVID crisis, but also increased confidence and greater morale among medical frontliners. Specifically, for example, in an exit survey conducted immediately after the 36th episode, data show a 12.38% reduction in fear among participants. So in sum, I believe that this weekly enterprise of ours, this learning journey as Dr. Raymond has called it, has been making an important impact. And I'd like to end my remarks, di na siya little mukaw mahabana, by paraphrasing a glowing review of our webinar. Our reviewer said interventions to shem the deterioration of the health crisis into a social and political crisis were necessary from the outset of the pandemic. This webinar series is precisely what was needed then and until now by bridging the gap between knowledge and practice in the management of COVID cases in the Philippines. Thank you to everybody. Thank you very much. And let us continue participating and learning from this webinar. Back to you, Susi and Raymond. Thank you very much. That's Vice President for Public Affairs of the University of the Philippines, Dr. Elena Perna or Neni Perna. Thanks Neni. I mean, it's really great to have communication experts on board and actually looking at the data we have reached all of the provinces. I just again want to thank our audience, but I also want to thank our speakers and the doctors who keep on watching. Some of my professors say, you know, we watched this and I'm like, wow, baka nakakamali kami? But you know what? We are here to bring you the best information we can. And there's a lot of misinformation out there, but I assure you, right? Everything that comes on this webinar, we review it, we talk to experts, we go back and forth before we get to you. And this is because we believe that you deserve the best information so that you can serve our people. So we are thankful, grateful to everybody. And thank you so much, Deepi Neni, for keeping track of how we're doing as a webinar. So speaking of service to our people, I am very proud to present the co-host of this webinar, the Philippine Society of Allergy Astman Immunology, the President and the Vice Chair of the National Adverse Event Following Immunization Committee. So if, you know, we want to know about adverse events, we want to know about reactions, reactogenic, they're going to explain this later, reactogenic and allergic reactions. No one better to explain this than the team that is coming from the Philippine Society of Allergy Astman and Immunology. And we'd like to welcome the President of that society, Dr. Romel Lobo. Dr. Romel, welcome and thank you for accepting to co-host this webinar. Paraming salamat din po. It is an honor to be here. And at the same time, thank you for having us. Dr. Romel, you know, the position paper of the Philippine Society of Allergy Astman Immunology made waves. I think this was a long-awaited, we're always waiting for positions and statements. But I just like to ask you really quickly what prompted the society to come out with this statement at such a perfect time. I believe that in our own little way, it is our social responsibility to help our fellow men early and also our fellow practitioners to answer some of their questions and help them realize that. So they'd be more in command of how they handle their patients. Yes, ma'am. Thank you very much. Dr. Romel, go ahead with your opening statement. Okay. I'm sure in 2019, no one would have dreamed of our situation right now. And in January of 2020, the World Health Organization declared a public health emergency of international concern. And only in March of 2020 did the World Health Organization declared a global pandemic. And with this declaration, mind you, we now practice minimum health standards, and we are one, if you're sick, you need to isolate. And if you don't have anything to do outside of the house, you just stay at home. And if you need, if you're healthy and you need to go out, we usually advocate that you wear your face mask, your face shield, you socially distance, and you wash your hands as often as possible. And then if there's an interaction, or 15 minutes and try to make sure that there's an open ventilation for free flowing air. So to lessen the possibility of you getting infected. Now, with this religious practice, we found out that it only slowed down the infection rate of our coronavirus infections. And we were praying for something, a key that will bring us back to normalcy. Now comes the vaccine that we have prayed for. This is the light at the end of the tunnel. It's just around the corner. We'll be rolling out our vaccination plan in a couple of days or in a couple of weeks. Now, with this in mind, we saw that there are a lot of doctors that do have certain concerns. We also delay, have certain hesitation. And we came up with this position statement. Our position statements are posted in our website, which is your www.pilipinesocietyofallergyasmaenaminology.org. It's freely downloadable for you to have a copy and read. The primary intention was just to help address the growing concerns of our medical practitioners and as well as address the hesitancy of our lay in order for us to envision that if you read this and you be empowered, you will now be inclined to accept vaccination. Remember, vaccination saves lives. Hindi po yung vaccine, but the art of being vaccinated, yun po yung nakakatulong sa atin. So with that, I would not delay it any further. I will turn back the floor to Dr. Susie and Dr. Raymond to call on my partner, Dr. Recto. Thank you very much. That's Dr. Romeo Lobo. He is the President of the Philippine Society of Allergy, Asthma, and Immunology. Manaming salamat po. And Raymond, I think we are going into an opinion poll before we start. Okay. TVUB may ask you to launch po. There we go. Okay. So this part, we usually have our attendees input where they are coming from. So I'll just read off the list po, no? The first question asks what... Webinar. Okay. I think we lost for a moment, Raymond. Okay. Let me be the one to read it. So what place are you viewing the webinar from? So there are choices there. Metro Manila, Northern Southern Lausanne, Central Lausanne, Eastern Visayas, Western Visayas, Central Visayas, Northern Eastern Mindanao, Western Central Mindanao, Southern Mindanao, outside of the Philippines. And I think Raymond is back. Are you back, Raymond? Okay. Malapa. What is your line of work? Medicine, nursing, pharmacy, midwifery, public health, education, policy, legislation, media, others. Okay. Raymond, ready ka na? Okay. Raymond's not yet ready. I think he has connectivity issues. Let's go to your opinion on these statements. A reactogenic reaction is not the same as an allergic reaction through or false. Okay. Next question. Picture of the following are true. Multiple choice. Majority of the COVID-19 adverse reactions are mild. Reactogenic reactions include pain, tenderness and swelling and can be managed in supportive care. Mild allergic reactions such as rashes can be managed with anti-instimence. All of the above. Next question. The risk of severe allergic reactions such as anaphylaxis, it's rare, should be managed promptly if in a friend 0.3, 0.5 ML, should be observed at least 30 minutes post-vaccination at the vaccine center and all of the above. So we're going to keep that up for a while and encourage you to answer. You know, my dad was a teacher and he used to say, basahin mo sabihin mo isulat mo. Okay. So this is just an opportunity to enhance your learning and this is just to what should I say? To help you remember the key messages of this webinar. So let's see if Raymond is back. Raymond, are you back? Okay, wala pa rin si Raymond. Sige. So we will go, we will continue and we are going to and just, okay, here we go. So, all right. We have, as prepared for us, some interviews of people who have allergies and let's listen to that now. PBU, please roll. I actually have several allergies. So meron ako allergy sa seafood. So nagingyari is if I eat at least a bit of mga shellfish kanyan, nangangati yung throat ko or sometimes masobrahan nag-a-clog yung throat ko. Meron madame sa seafood. Sa chicken, saka sa egg, lalo na sa mga malalansa at saka may allergic rhinitis. Meron ako food allergy ever since pata pa ako lalo na yung mga pagkaing malalansa tulad ng manok, isda, bagoong. Meron ako minor allergy although hindi siya medicaly tyrantos. Meron ako allergic rhinitis saka sa skin asthma. Sa skin asthma bumalik lang siya two years ago natitrigger yata siya sa hangin. Specific na hangin na hindi ko pa napapachek at saka allergy rhinitis natitrigger sa dust at saka pollen. Pag dumating na yung bakuna ay aks na tayo, baka bakuna. Gusto ko magpabakuna siyempre para protection ko rin at nang aking pamilya, pero meron din na hong mga agam-agam or mga hindi kasiguraduhan sa pagkakaroan ng bakuna. Kapag may COVID-19 vaccine magpabakuna Plan ako magpabakuna as soon as possible. Personally, hindi pa ako sure, pero leaning ako more to going with magpabakuna ako. Gusto kung malamang talang ang anay nung ng side effect na kailangan i-expect ng isang magpapakuna. Actually, very curious ako if meron ba siyang side effects in the long run. Anay yung extreme effects, possible effects ng vaccine sa tao. May effect ba yung vaccine sa mga allergies nito? Ako, alam ko na may allergy ako sa mga pakaing malalansa. So ang ginagawa ko, bago ko kumain ng pakaing malalansa, iinom ako ng mga anti-allergy na gamot. Pwede bang gawin nyo? Bago ko kunwari magpabakuna, alam ko may allergy ako para makasigurado ako at gusto kung maging safe yung pabakuna ko, iinom mo na ako ng anti-histamin o yung gamot para hindi magkaroon ng allergic reaction. Ano yung pwede yung pagahanda lalo na sa may mga allergies at mga may kailangan? Ano po yung dapat gawin ng isang katulad ko na may allergy na pag nagpabakuna big lang nagkaroon ng reaction yung aking katawan? Ano po ba yung mainam na gawin? Okay, thank you very much TVUP and I think Raymond is finally back. We're going to proceed with our main speaker. And our title is May mga allergy ako, COVID-19 vaccine, safe ba? You know, continue to put in your questions in the Q&A box. And we're going to ask our special guests to try to answer each one of them. But I think from this presentation, you're going to you're going to learn a lot about the safety of the COVID-19 vaccines even for those who have allergies. So it is my honor to introduce to you the immediate past president of the Philippine Society for Allergy Asphine Immunology Professor of Adult and Pediatric Allergy and Immunology at the University of the Philippines Philippine General Hospital. We'd like to welcome Dr. Marisha Stella. Dr. Marisha, welcome to the webinar. Good afternoon, Dr. Susie and to all the viewers. Oh, Marisha, what do you think? Do you think our doctors out there are ready for any kinds of even mild reactions to the vaccine? Well, we really hope that everyone is ready whether you're an allergist or a non-allergist. Our actual our society is actually reaching out through the DOH to the different vaccination centers to try to give some tips or some guidelines on how to take care of reactions should they happen. So I think we should be ready when it comes. We should be ready and we are continuing to train and help people get ready. I think if you're interested in more information, I'm sure the Philippine Society of Allergy, Asthma and Immunology will be willing to reach out to you and help you. They've got chapters and members all over the country. So Marisha, go ahead and make your presentation. Thank you very much Dr. Susie for that introduction and we'd really like to thank the TVUP group for inviting us to present the Philippine Society of Allergy, Asthma and Immunology position statements and their adverse reactions especially in the context of allergic disease. So, as of Feb 21, 2021, the World Health Organization has noted that there are almost 111 million confirmed cases of COVID-19 globally with 2.5 million confirmed deaths affecting almost 223 countries who are affected rather with COVID-19. So, as our president has previously mentioned, this position paper was developed in response to the concerns of many healthcare workers and even the lay regarding adverse reactions to COVID-19 vaccines, especially allergic reactions. So the objectives of my talk is first to discuss how the COVID-19 vaccines work and of course to understand the immune response to COVID-19 infections and second is to discuss the actogenic versus allergic reactions to COVID-19 vaccines and their management. So before we talk about how the COVID-19 vaccines work, we must understand how a person gets infected by COVID-19 and what the immune reaction would be following the infection and understanding this will help us understand how vaccine immune responses are also formed. So you're all familiar how your COVID-19 virus looks like. It has the spike proteins and it contains an RNA sequence or a nucleic acid inside and this spike protein is what attaches to the host cells, whether in the lungs or in the gastrointestinal tract. Once engulfed into the host cell, the RNA is released into the host cell and this RNA is the genetic template by which this virus can form another virus or other proteins and thus your virus will replicate and proliferate. But at the same time, the virus that enters will also cause an inflammatory reaction within the immune cell that will lead to what we call pyroptosis, a very strong and destructive immune reaction. So patients may actually go into two ways after having a COVID-19 infection. 20% will present a very dysregulated immune reaction called the cytokine storm. So these are the patients who have the severe types of COVID. But majority, 80% of patients who are infected will recover from COVID-19 infections and there are several ways by which our immune system can address these COVID-19 infections. There are cells which are part of the first line of defense called the antigen presenting cells or macrophages that will engulf this virus and kill them internally. Furthermore, these immune cells will also activate other immune cells like your T-cells. There are two types. We have your CD4 and your CD8. That will also produce heightened and more long-lasting responses to the COVID-19 infection once there is a re-exposure. Now another important concept to remember is that there are also B-cells that produce antibodies or what we call neutralizing antibodies that will bind and block your corona virus from entering or attaching to the host cells. And so all these immune processes are very important to be developed so that you would not have severe infection. You can recover from infection and hopefully be protected from re-infection in the future. So the immune responses against a certain viruses are what we want to actually simulate in a vaccine. So we have your innate immune responses wherein you have certain products of immune cells like interferon that will neutralize the virus. Then we also have your natural killer cells which directly kill your virus. And this innate immune system is what activates the adaptive immune system. This adaptive immune system involves your lymphocytes like your B-cells that produce antibodies that lead to neutralization. And they also involve your CD8 cells or cytotoxic T-cells that will kill the viruses. So you see there are two important outcomes of immune reactions against the virus. You have the protection against infection in the future when there is re-exposure and of course the eradication of an established infection. So now let's go into how vaccines work. Vaccines should aim to simulate natural immunity. And the vaccine is basically a tiny weekend fragment or actually the whole organism that could be antigenic. And it is enough that our body can build that antibody response but there are other immune reactions that can occur aside from antibody reactions that should provide long-lasting and sustained immune reaction or protection against infections. So now let us go briefly on the different types of vaccines for COVID-19. So knowing these vaccines we would actually help make an educated guess of what vaccine to choose for our own purposes. So here in this slide there are several different COVID-19 vaccines that some of them are available have undergone EUA in our country and some are not yet here. So we actually have here the viral vector, the RNA vaccines, the whole virus vaccines and protein subunit vaccines. They have different outcomes. You have the viral vector and the nucleic acid vaccines. These are developed to produce spike proteins and once you have spike proteins in the host cells or in the host spike proteins will generate an immune response while the other types will trigger a more holistic immune reaction aside from just the spike protein. So going briefly into each of these vaccines we will now discuss first the genetic vaccines or nucleic acid vaccines. These contain either RNA or DNA which are our genetic materials. Actually these are the materials that make materials of the virus and our cells once we inject the nucleic acid into our system our cells will use its own machinery to make an immune reaction against this protein. So most of this like the RNA vaccine is designed to generate a spike protein and once the person has the spike protein in the body then an immune response is generated. So just to be clear rather that these genetic material are not incorporated into our human nucleic acid. So the considerations are that it is a low cost and is fast to develop that's why it's one of the first vaccines to come out they may need to be stored at low temperatures and examples are the Pfizer and Moderna vaccines and both of them are technically still under clinical trials. Now the viral vector vaccines use an unrelated harmless virus that contains now the SARS-CoV-2 genetic material and this virus is just like a delivery man once introduced into the host the vector will discharge the genetic material of the COVID-19 and our cells will now develop an immune response after the protein of the SARS-CoV-2 virus has been formed. So you see it generates a very strong immune response it may need to be stored at specific low temperatures an example so far in human use is the Ebola vaccine which we do not have and these kind of vaccines are what the AstraZeneca Janssen, Kansino and Gamalaya vaccines are platformed against. So we have the protein vaccines next. This now contains small fragments of the SARS-CoV-2 virus the proteins of the SARS-CoV-2 virus that are recognized by our immune cells to produce antibodies also. They have a good previous safety record and are usually administered with an adjuvant so to boost the immune reaction and these are tried and tested vaccines like the hepatitis B vaccine which we've been using for decades and this is what we see in NovaVax and the Sanofigie SK type of vaccines. Now the next group of vaccines are those that involve the whole viruses and one of them is the inactivated vaccines. It contains a killed SARS-CoV-2 virus so if you look at it the killed virus is injected into our system and because it is a complete virus it is not just against the spike protein that you will develop antibodies to but to the different portions rather of the virus. So you may need to administer it there might be an adjuvant in these inactivated vaccines. An example is the influenza vaccine and this is the kind of vaccine that you see in the Sinovac and Sinofarm vaccines. Now the other type of whole vaccine are the attenuated vaccines. These are the weekend vaccines. They are not exactly dead but they are weak enough not to cause infections once injected will also cause an immune response that is holistic. It is a very well-known approach that requires time and extensive testing and the immune response to this is actually like a natural infection so you see the oral polio vaccine which we know is very effective is an example and the codogenic vaccine which is not yet available still in clinical trials is an example. So we will now go into the vaccine adverse events. There are several types of events that may occur after vaccination. You may have a local reaction, a systemic reaction, an allergic reaction which can range from what we call type one to type four reactions and we call disease attributable events. So some interactions between disease and the vaccination. So now we will go to the meat of the discussion and this is to differentiate the allergic versus reactogenic reactions. So the reactogenic reaction are local or systemic reactions that are mild to moderate and are usually gone within one to three days. They are managed with paracetamol, pain relievers, hydration and cold compresses. So how do these reactions occur? After the vaccination, of course, tissue injury will occur in the muscle and the content of the adjuvant or immune stimulant may actually generate a local immune reaction. So this is what we call the local cell recruitment. There would be local production of cytokines, vasodilators, prostaglandins that will lead to local symptoms of swelling, pain and redness. But in some patients, these reactions can see or pass through the blood vessels and going to the system of the person that you would have now your generalized vaccine reactogenic reactions like fever, headache or fatigue. So which patient will develop this type of reactogenic reactions? There are several factors that are influencing this like certain vaccine factors, administrative factors or intrinsic factors in the host. All of these three may actually lead to what the individual experience would be during and after the vaccination. So our society has actually stated that reactions to COVID-19 vaccines really may occur, but not all reactions are allergic. Majority of the reactions are reactogenic and reactogenic reactions are not the same as allergic reactions. So what is an allergy? An allergy is an exaggerated immune response to a usually harmless substance and different types that involve actually involve different mechanisms and symptoms ranging from IG immediately to the late type of reactions. And the type of severe allergic reactions are very rare. So if ever you would get a reaction to the vaccine it would usually be mild such as rashes, itchy skin, nose or sneezing that may be managed with antihistamines. However the concern of many is that they may develop a severe allergic reaction and this is anaphylaxis which is basically a systemic IG immediately reaction and this is actually being noted in the two mRNA vaccines because they were the ones that were first introduced in the western world that the Pfizer mRNA reported 11 cases in a million shots and the Moderna actually also noted 2.5 cases in 1 million shots. So you see the rarity of this situation happening. It usually happens within the first 30 minutes after injection. That's why we really advise patients to wait for 30 minutes after but in a very few it may happen after 1 to 4 hours. That's why we have to educate our patients who will undergo vaccination and these are managed with a drug of 12 called epinephrine. So recently the World Allergy Organization Anaphylaxis Committee has evaluated the different vaccines that we have in the market and looking at the risk for developing anaphylaxis. So looking at the CoronaVac and the Sinopharm vaccines so these are your whole vaccines so far based under clinical trials no anaphylactic events have been reported and I have to point out that looking at the excipients these are certain adjuvants or preservatives found in vaccine these two whole vaccines do not contain the known antigenic fragments that cause allergic reactions. Now the mRNA vaccines have so far based on their clinical trials no reported anaphylactic events. However when they used it in real life there were some patients who developed it and they are at an incidence of 1 in 100,000 with routine use. Take note that these vaccines contain a polyethylene glycol that is an important coating for the RNA so it doesn't get degraded after vaccination and this particular excipient has been known to cause allergies in patients who are allergic to laxatives certain chemotherapeutic drugs or even certain cosmetics. Now the vector vaccine like that of Astra and the Sputnik vaccines so these are the ones that possibly will be entering our country contain polysorbate 80. Polysorbate 80 is a preservative found in many other vaccines it has actually been known to cause some allergic reactions in some individuals even some vaccines like I think the MMR contains it but as you see it is not very common to react that's why there are so far no anaphylactic events reported with this type of vaccines the COVID-19 vaccines but it has been found that polysorbate sometimes may cross-react with polyethylene glycol allergic patients. So our organization has oftentimes been asked who can really receive the COVID-19 vaccine and we'd like to reiterate that patients with many types of allergies like even food allergy, inhalant allergies, insect venom allergies those with atopic dermatitis or eczema, asthma, rhinitis or ticaria or a hysteria flashes to oral medicines may take the vaccine so there's no contra-indication for allergic patients however those with depressed immune systems like those with autoimmunity or immunodeficiency the information is still lacking and the concern is maybe the immune response to the vaccine may be reduced so we still have to wait for trials that are evaluating whether we can give this to those with immune suppression or immune deficiency. What about the indication of who should not receive the COVID-19 vaccine and this is very clear there's only basically two contra-indications a patient with immediate allergic reaction whether mild to severe such as anaphylaxis to the first those of the COVID-19 vaccine or a history of allergic reaction to any component of the COVID-19 vaccine such as polyethylene glycol or polysorbate so when we talk about immediate that means within four hours of receiving the vaccine and if you are in this category you can be referred to an allergist immunologist for further evaluation and we can possibly give you some recommendations on what type of vaccine you may receive. Now in our document we also provided an allergy risk assessment for COVID-19 vaccinations so this again is available in our website www.pesai.org and you see those with low risk may be these are those that can really receive the vaccine without further work up those with no history of allergic disease I'm sorry why my slides keep on moving and those with allergic reactions to food inhalants et cetera and those with well-controlled asthma and allergic rhinitis on their maintenance medications now moderate risk are those possibly with immune deficiency and autoimmunity they may receive the vaccine with proper advice but so far the data is limited on whether they can really take it safely and efficaciously those with uncontrolled asthma or mast cell disorders because they're very sensitive they may receive the COVID-19 in a hospital settings to anticipate reactions and those basically who have had a reaction before immediately to any other vaccine or injected therapy may have to be referred for evaluation to the allergist but again we are emphasizing who are those who need further evaluation by an allergist or immunologist whether they can receive the vaccine or not patients who have had an immediate allergic reaction to other vaccines and injectable medicines and if vaccinated they should be observed for at least 30 minutes you've also seen let me go back to the high risk that those that have a reaction to the COVID-19 vaccine in the past and those that have reactions to polyethylene glycol or polysorbate should not receive the same vaccine the second time so one of my last slides is presenting to you this algorithm which you may use in your health area health centers in your hospitals this is provided again in our website if you have a vaccination we have here some guidelines on how to recognize whether to just treat it with antihistamines or steroids or there's anaphylaxis and what to do so this is our help for our colleagues in the hospitals and vaccination centers to help recognize and manage anaphylaxis or allergic reactions after COVID-19 vaccination so in summary reactions to COVID-19 vaccines may happen but majority are low color systemic side effects that will disappear within one to three days mild allergic reactions are managed with antihistamine anaphylaxis is rare and is managed with epinephrine patients with allergy to food inhalant allergens insects and those with stable bronchial asthma or allergic rhinitis can receive COVID-19 vaccine patients who should not be vaccinated are those who have had an allergic reaction to the first those of the COVID-19 vaccine and their components such as polyethylene glycol or polysorbate patients who have had an allergic reaction to other vaccines and injectable medicine should be referred to analogies for further evaluation patient should be monitored for at least five minutes after vaccination just to anticipate reactions and based on current data the benefits of receiving the COVID-19 vaccine far outweighs the risk of an allergic reaction so highlighting this if the mRNA vaccine had five reactions in a million people there's a hundred time more risk that one will die from COVID-19 than to have that serious allergic reaction to the vaccine so this is my last slide if you have any concerns would like to reach out to us please contact us at www.pyside.org so thank you very much for your kind attention thank you very much that was Dr. Marisha Stella T. Recto of immediate past present of Philippine society of allergy asthma and immunology and professor at the University of the Philippines Philippine General Hospital and I hope that has enlightened you and reassured you about even if you have allergies it's okay to take the vaccine but we have more reactors you've got other people on the panel and let me turn over to Raymond who is finally back Raymond sorry device problems for Dr. Susie anyway that was really an interesting presentation by the immediate past president of PISAI Dr. Marisha Recto and for the reaction may we call on really a very strong clinician and practitioner from the family medicine field she is associate professor at the Department of Family Community Medicine at UPPGH let's welcome Dr. Lailani at Ustall Nicodemus to Maraming salamat Raymond and Dr. Susie ako'y natutawa talaga at kami din kasama sa ganitong talaka yan and I really appreciated Dr. Marisha's presentation because it really cleared a lot of misinformation that we have as a frontline physician marami kaming mga paciente nakatanong yan din as I was reading in the Q&A the same sentiments that our patients are having in primary care asking us and while listening to Dr. Recto my lens in probably giving my reaction is on ano ba dapat ang sasabihin namin sa aming mga paciente because this is very important in making our patients and their families adhere to vaccination because it may scare and second would be if I am in primary care what would be the logistical support that I need to prepare if in case there would be national rollout and then probably the last is if in case I would have people or patients who would have this reaction what would I do as a physician in the frontline so I was so happy that Dr. Myrisha gave us the proper information and in fact when she said the experience in other countries because we don't have vaccination yet yet andaming rumors na naririnig tayo that really scared most of us so malaki talaga yung message that majority of the reaction is reactogenic and it's not really allergens so yun na lang on point na na hindi talaga allergens ang dapat natin isipin second is based dun sa mga datos na nakita sa ibang bansa nakita na yung allergens kung meron man so which is very good again because that would now be a very um a good point to discuss with our patients and trying to address misperceptions or misinformation or probably fear or anxiety in getting the vaccine and then I think yung aking pagkaintindi dun sa different kinds of vaccine was very well put ang simple na siya siya alam natin may dada ting sa ating bansa so may baka may mauna clear yung kanyang description on those yung saino ba corona vaccine yung bansa yung model na and Pfizer atyapasibol yung mga AstraZeneca and all yung table sa dulo which is the organization is sharing all the medical communities would be now in the front line in discussing vaccination fears to patients this is very powerful too and we have to understand how we communicate with our patients so kung baka anubayo strategic communication or proper language in sharing the information that we have and then yung I think on my end as a primary care physician pagkaintindi ko dun sa risk stratification is very wonderful so you have to look at which among your patients would be high risk moderate risk and lowest and there are action points so that means to say if I am a practitioner and I am handling a patient and I have this risk stratification I know what to do I know how to discuss with my patient so that my patient would have informed decision making hindi lang yung blind following what should be done or what should not be done so yung yung mga dino very very important sa explanation yung doctor recto and then last siguro I have to say is that what we are experienced because I experienced being screened for possible vaccination the people who are asking questions are very very very careful and specific in the questions so it's my responsibility as a person to honestly disclose what I have and what I don't have because in doing so you will have the right information and you will be categorized properly at the same time when you get vaccinated you know that you will be observed 15 minutes or you will be observed 30 minutes based on your risk and then there will be now explanation again that after I take my vaccination there will be monitoring the appropriate safeguards to make sure that our vaccination program will be implemented properly and well. Siguro sa aking pagmimila nilay habang nakikinidahok ay doctor Mary yung isang isang part lang for example if I have a patient who has probably severe allergic reaction unfortunately na wala na siya sa hospital and then sa Sabihin kailangan talaga bumalik siya sa hospital and then pag uwi kailangan ng assessment will immunologist or allergologist so siguro yung din ng kailangan isipin marami ba tayong allergologist allergist sa buhong Pilipinas and I think I really appreciated my reading of doctor Mary's presentation saying if you have questions please go to this website I think that is what we need we need the assurance that at the end of the day there is someone who can respond to what we need so yun lang po maraming salamat and I really appreciated the lecture Thank you very very much for that reaction please stay with us doctor for the panel discussion we're going to answer some questions now we've invited somebody Karen Davila to give a reaction so TVUP please let's play her video what an amazing presentation and I think that's actually information that we really need today and as a media practitioner I'd have to say this that not a lot of Filipinos understand essentially the difference between all the vaccines that's out in the market because what's been in the news lately is essentially about the controversy surrounding the vaccines for example the alleged corruption in purchasing Sinovac or cutting the deal with Sinovac or the alleged preference for the Chinese vaccine let's say of course also the inherent bias that we ourselves have as Filipinos with vaccines coming from western countries like from the UK and the US that I believe many Filipinos essentially don't really or have not taken the time to understand how each vaccine is made and how each vaccine actually gets into your body and how your body can actually absorb it and these biases or the stereotyping of let's say a certain product just because it's come from a certain country I believe doesn't make good for the Philippines as a whole because what happens is our own biases sometimes they prevent us from actually getting vaccinated and then the other problem you have is because of the lack of information and also the mixed information that's coming out at times from the Philippine government is you have Filipinos with eroding trust and confidence in having themselves vaccinated I'll give you an example I for one, I am a mother with a son that has autism and because I treated my son 19 years old and that's David I treated my son in a very revolutionary way with his autism I got in touch with a different set of doctors when he was much younger and these set of doctors coming from the US advocated for later vaccination on children they advocated for certain types of vaccines that didn't have mercury as the binder or they advocated for vaccines that weren't 5-in-1 or 3-in-1 but the difference is I was able to handle that because I was able to dive into complete research on how to treat my second child to make sure and at least prevent the chances of him having autism again but I've been asked Karen with David you are an anti-vaccine advocate no, I am not it's not true I have been vaccinated recently during COVID for anti pneumonia I've been vaccinated for anti flu as well and I know anytime soon I also need to be vaccinated for anti shingles I am not an anti-vaccine advocate however for very young children I believe depending on the child that there are some options the brand of the vaccine and the kind of the vaccine and how it's put together if you choose to do it 5-in-1 or 1-at-a-time but COVID is a whole different situation I believe that we, number 1 have the responsibility to encourage Filipinos to be vaccinated and there are many reasons why this one thing to be part of herd immunity and not sila na herd immunity na di hindi na ako kailangan magpabakuna you cannot imagine how many Filipinos think that way and because of that you will have low numbers of Filipinos wanting to be vaccinated so the question is will I be vaccinated absolutely yes I would be and I feel it's important not just for ourselves but for the economy as well regarding the Philippine society of asthma and allergy I am super impressed with the paper they put together is because it actually explains the difference of the reactions of getting vaccinated reactogenic reaction and an allergic reaction are two different things and number 1 it also teaches the importance of how we should give post care after a vaccination and what specifically struck me with this information is the fact that the vaccines that are quite popular in the world today that use technically mRNA have never been used on humans before and that to me was quite surprising in the sense of do people really understand that it's the first time and yet the trust factor with these brands are high so that's a good thing but I just hope that there's an understanding of it another thing is the fact that let's go to China for example I feel that with all due respect I feel that the Chinese vaccine has gotten a lot of flak I mean the negotiations were interruption issues were issues that are very different from the effectivity of the vaccine but I'm doing several interviews now regarding that with Sinovac coming in first and no less than Dr. Rot Jean Solante said that in the absence of another vaccine in the market he would still encourage frontliners to get vaccinated with Sinovac because he believes that some protection is better and no protection at all and considering that you have Chinese vaccines that have been used to inoculate frontliners in Brazil 12,000 of them also in Indonesia also in Turkey in Chile I think that we have to step back and look at vaccination as a whole there's also the issue of availability because it matters that there's a bigger chance for you to save a life with COVID-19 and then the more are vaccinated as you can reopen the economy so if you ask me the biggest challenge we have other than the vaccine actually arriving is the biases that we Filipinos have what's very interesting in the tabulation also of Dr. Solante is although the WHO did endorse AstraZeneca for all age groups is technically the effectivity of AstraZeneca is only 70% and that's so ironic because it's such a popular brand and I don't blame because my parents want AstraZeneca and yet you have Sputnik v. Gamalaya that ranks 93% in overall effectivity and I wonder if the Philippines as a whole has ever actually looked to Russia because well it's not exactly a country in terms even of branding that many of us are familiar with but vaccination has revealed so many things the inequality of countries when it comes to a global pandemic such as this I think the biggest one is pharma companies being commercial companies essentially will give first to branding countries they call it origin countries research based countries and we've heard of countries that's even bought and ordered more vaccines beyond their population which was quite surprising and yet you have LMICs or lower middle income countries like the Philippines that aren't really in the priority list of the likes of Pfizer and Moderna for example so it also makes thinking of how do you survive also as a developing nation you'd have to really also check your allies within you your neighbors on how you can band together in a way because for example you have countries like Israel that are producing their own and prioritizing on their own population first and then number two is it's also bought us with everything that's been said about the vaccine that last presentation is how Dr. Lulubravo also in the past has advocated that the Philippines should be a vaccine producing economy and she said this in the 80s and we've never done it and what's surprising is you have vaccine companies supplying raw materials to certain countries and they're producing the vaccine and us they can't even do that you can't even have Sinovac or let's say Astra throw in raw materials to the Philippines and we manufacture it ourselves so I think it's an eye-opener to us all number one is the need to understand how a vaccine works on your body and how you should care for yourself after being vaccinated to take out biases that you have and stereotypes that you have on certain brands and open yourself to the bigger picture of what is the purpose of vaccination which is essentially to unburden the healthcare system to prevent you essentially from getting fatal COVID and all vaccines are stabulated all regardless of the brand prevent you from getting severe COVID all regardless of what vaccine it is whether it is Pfizer to Sinovac all of them will prevent you from getting severe and fatal COVID so that alone is important the WHO saying that the threshold for vaccines really is above 50% and we wonder that maybe in the past when you've taken a flu vaccine it didn't mean you wouldn't get the flu but it would lessen your chances of making the flu very strong and number three also looking not just at preparedness but also us as a country on are we ready for the aftercare do all our health workers doctors, nurses understand do people understand that if you get severe allergic reaction to a vaccine when do you go to a hospital because as the presentation shows there is such a very thin line between a reactogenic and an allergic reaction and also what you call a case where in your body goes to into some kind of allergic shock and so those that's quite important to understand when you take your second shot of the vaccine and I do know of some people that are waiting for the one dose Johnson & Johnson and I just saw it in the news that Johnson & Johnson says that it's safe and effective even if it's one shot but I'm hoping still that we don't have to wait that long because it might be too long and the fourth and the fifth is overall for the country to start thinking of what do we do after this this is not going to be the last pandemic that's going to hit us we have to be able to be self-sufficient in some way even if sadly we didn't put enough into research and development with our own scientists I believe our scientists are good enough to be able to produce a local vaccine but if not then at the very least I do hope we move to a phase where we can manufacture our own vaccine and just have raw materials sent to us but overall with all the information that was given to us and it's a lot to digest is really the issue of is the information campaign enough is it enough are we doing what we need to do to encourage people to be vaccinated when politicians say I'll do it first, let me be the first I'll show you does that really inspire hope is that really what people want to see or do people really need to be put together in groups you know with the absence of ABS CBN now there's that lack of reach in terms of a nationwide massive campaign to be able to inform the public on television repeatedly the benefits of being inoculated so that is my reaction to it and I genuinely appreciate this paper because it's so informative for a layman the perspective of someone like me to understand the difference between a viral vaccine an mRNA vaccine, a protein subunit vaccine, a whole virus and there are other two more actually there are six types two that did not undergo clinical trials so they're not as popular but that's how I would react to it that time to equip yourself and make sure that we make the effort for people to understand in the simplest of terms in the simplest of terms just how important this vaccine is and how to manage the effects after so thank you so much okay thank you so much that was Karen Davila thank you so much for finding the time to give us a reaction Karen's been interviewing so many people and I think it's also given another take another angle for all of us so we'd like to call everyone back into the panel so we're going to call Dr. Romelle Marisha Dr. Lailani and I think if Karen joins us it would be great but I don't know if she's going to be with us on the air we're going to have also VP VP Nanny Perna joining us on the panel but before we go into any discussion Raymond would you like to introduce the audience to our panelists so we'd like to start now by letting the panelists know who's on who's in the webinar panelists please open your cameras and your mics okay thank you Dr. Susie for our panelists benefit po nearly half of our attendees are joining us from the National Capital Region followed by attendees from the Northern and Southern Luzon and then from Central Luzon there is well a little over 1% watching us from outside of the field very consistent with our previous webinars for our line of work also again very consistent with our previous webinars mas marami po ang mga nurses na nanonod po sa atin followed by those in the medical profession yung po ang others po talaga napakalaki po na so we would need to break it down especially because we don't have much by the way of policy, legislation and media attendees po so I'll stop there so that we could discuss items 3, 4 and 5 later on we'll answer the questions later and let's start the panel discussion so I just like to throw a question to everyone on our panel so Dr. Ramel said it's the light at the end of the tunnel 11 months na tayong nag-aantay ito na so I think we're gearing up for vaccination responding to questions of the public and reassuring people that this is very important if we are to move forward and for our country not to collapse everyone is getting vaccinated around the world and we're preparing so I think my question is what else do we need to do in terms of reassuring the public so Karen even mentioned communication I think the Philippine society for allergies my immunology is doing its thing but it looks like we need to do some more because there are still questions there are still doubts anyone can start answering the question anyone wants to start Dr. Romel okay aside from our society the society also partnered with the department of health we have a core group that usually do media guesting and we have a speakers bureau in the DOH that do we are deck or scheduled every week to meet the public on how vaccine works and how we should be not afraid of being vaccinated so there's a great mileage in media I just hope people would listen and not be narrow focus they should have an open mind and see so the targets would be to decrease and increase acceptance so showing them the advantage everything on the table so that they can make informed decisions empowering them gusto natin Marisha go ahead we are only 134 allergies in the country and if it's about allergy awareness and vaccines we are at hindi namin kaya but really we have been reaching out even on our own initiatives to partner with any organization that would like us that would need our help to our website and also with the press now with the media because sometimes our media they're very enthusiastic in helping us promote but sometimes the messages are not and are quite so we are really here to help out and reach out so that we can give the right information especially about allergy reactions which seems to be what people are scared about yeah great speaking of the media would you like to comment on that? yes what Dr. Marisha and Dr. Lobo have pointed out are the bayanihan efforts of our medical community and together with that one the private sector for example has participated in this but I do agree with Karen that there is a lack of an information drive that will reach down to the grassroots down to the people who will be vaccinated themselves and that's where we should be also focusing our efforts on so together with our medical experts who have this wealth of information and great communication skills as well we need to go down to that level I have a little COVID communication project that I'm working on with the DOSP and it's actually funded by DOSP and we are contributing towards that we want science based correct information to destroy myths destroy the pseudo science so that's where we want to go into we want to collaborate with the different media institutions and the reality is social media is what is very strong but social media is not cheap because social media is also not all that free so kailangan talaga nagbayanihan efforts down to that will reach everybody the biases that were pointed out a little while ago that are unfounded they have to be erased and put on top on the top mind of people is that vaccination being vaccinated is what is necessary now great doctor leilani apostol please kasi family physician and we actually have a lot of members in the whole country as have been pointed out by VP there should be a collaboration with health professionals medical doctors on how to probably communicate properly your issues about COVID vaccine and that is what we are looking for also in the vaccination program of the government we have to have hands on deck we have to work together to get the same message because the problem is we have different sources it's so noisy out there imagine na lang po yung simple paciente litong-litong napo paanong gagawin so saan pa siya dapat pahunta so pupunta yan sa doctor na malapit sa kanya I think that should be the strategy cascade or disseminate information because at the end of the day we just say something but it didn't empower at all the patient and there's no decision hindi na pabahung na kasi maslalo nagkaroon na akakot so I think literacy program should be part of the vaccination program that's my take yeah I think that's consistent with what Dr. Romelo saying that we need to empower our patients to tell them the truth give them the facts tell them this and that and it's up to you our people are very intelligent we should not underestimate the intelligence of the Filipino they can discern so I think we just need to cut through the noise and really work together mukang yan ang message natin ngayon tayo all of us all of you are here with us on the webinar we can play a big role in dispelling some of the dark parts of this discussion that is not necessarily Raymond we have two members of our audience who you're going to allow to open their cameras let's go Raymond okay thank you Dr. Suzie so as Dr. Suzie mentioned we have two really health facility chiefs that we want to be able to ask and give their opinions po with regards to and ask your questions po on that topic first person that we will be calling is the medical director of Apayaw Pagayan Medical Center Dr. Veronica Rivera Dr. Rivera okay go ahead ma'am with your question po good afternoon to all first and foremost I would like to say thank you to Dr. Recta for the well informed lecture regarding COVID vaccine as a physician inclination all possible questions in mind I think was already discussed regarding the side effects for the local systemic and allergic reactions the absolute and the relative contraindications the types of vaccines where does COVID vaccine belong as an internist now it would be safe for me to answer questions of my patients dog am I safe to receive the vaccine when, where and why if yes and about and what if not the lecture seems to discuss the low risks the moderate risks and even the severe risks now it is very clear and very informative but the problem is one concern will the other patients be able to finance themselves how much would it be what would be the costs will the government or even the DOH will provide a particular guidelines on this and would the payment also will be standardized so it would be better if some guidelines or even standard pricing on this would be free for all of us so I think this is one of the most important questions to answer some other patients in our private practice now as a physician am I also a candidate I think yes so it would be important for me to be vaccinated because I am a frontliner but as a mother would by my be effective also to my four kids they are all young less than 18 years old it would be safe for them just a clear answer of yes or no okay to our speaker Dr. Recto your lecture is very much informative and thank you for that okay looking forward for a better everything thank you DOH and I hope that this COVID will end keep us all safe and God bless us all thank you okay thank you very much that was Dr. Veronica Rivera who is the head of the Apaya Okagayan Medical Center and Raymond let's go to some response questions anybody wants to respond may I start well the concerns of Dr. Rivera are very valid unfortunately we do not have the answers we do not hold the answers to that in this forum I think this is really about the roll out about the costing etc this is actually a government directive and effort so we are waiting for that but regarding your question about can children see the COVID-19 vaccine well so far the studies have been done in adults 18 years old up to 60 years old or 59 years old most of the studies so remember these vaccines that we have in the country are still under EUA so they are not yet FDA registered this is the only age group that has been PED that can receive the vaccines below the age of 18 so far there are no studies yet and also based on the priority session the children are not put as high priority for vaccination mainly because they usually present with mild symptoms compared to the adults okay thank you Raymond let's take our next question okay thank you so much Dr. Recto for answering that could we could we ask Dr. Romeo Tawason who is a practicing clinician over at Bataan General Hospital and Medical Center to ask his questions to the panel yes thank you Dr. Raymond and good afternoon everyone specially to Dr. Susie Mercado and also to Dr. Recto for that very informative discussion about the relationship or the facts about the COVID-19 vaccine and the allergy so before I erase my question let me express my profound gratitude to the people behind this webinar especially to the University of the Philippines Manila National Telehealth Center so I learned a lot from this webinar since I attended my first I attended the first offering of this webinar last year so actually I have three questions in my mind first to our dear presenters and doctors how common is allergic reaction or anapilaxis to COVID-19 vaccines specifically after the second dose of the vaccination because some literatures say that major or serious side effects may occur after the second dose of COVID-19 immunization that's my first question second what do you think would be our risk communication strategy and courage those individuals with different types of allergy plus they have their comorbidity to get vaccinated and then my third and last question if you will permit again to raise this question do you think is it necessary or advisable for us to be part of assessment again to us our potential vaccinist if they have their allergic reaction to polyethylene glycol or polysorbate thank you very much so yes I hope I will remember all the questions so the first question I think would be Dr. Tawason can you refresh me my first question actually Dr. Recto is it common or how common is allergic reaction or anapilaxis to COVID-19 vaccine especially after the second dose is it possible to have a delayed reaction to COVID-19 vaccine because some literatures says serious side effects may occur after the second dose well you know theoretically for an allergic reaction to occur you have to have a previous exposure most of the time although there are certain antigens that on the first exposure you will get a reaction already now if it is possible that a patient can develop an anapilaxis to the second vaccine yes it is possible but again as you see the reaction rates are very low so that is the reason why we are always imparting in all vaccination centers to monitor the patient at least 15 to 30 minutes but we really want 30 minutes after the vaccination now whether they will react after that there are also a few but this is more rarer than having it within the first four hours of vaccination so yes you can react but it doesn't when you have the first reaction to the first dose obviously you cannot have the second dose now if you go to react to the second dose it will only be noted when you have the vaccine and we can monitor you so that is the first question the second is about about those individuals with different types of allergic reaction plus they have also the comorbidity how are we going to encourage them to get vaccinated so i think you're referring to other comorbidities outside allergy so let's say may asthma may kaya problem pa actually there is no contra indication to that you have to make sure though that allergic reactions are better controlled that's why we want if you look at the re-statification those that are low risk are those with controlled allergies controlled asthma controlled rhinitis if they are uncontrolled for some reason sana i-control niya muna control na siya then babantayan lang siya so if they have comorbidities like cardiac problems, diabetes not cancer sorry diabetes let's say they have a pulmonary problem this can actually or a renal problem you can still vaccinate in fact na sa top of the list rin yan those with comorbids because they are basically more prone to developing COVID-19 compared to a healthy individual and the third pa thank you doctor and then the third question is is it advisable doctor rector to include as part of our screening or history taking again to those potential vaccinis if they have this allergic reaction to polyethylene glycol or polysorbate before they get vaccinated okay unfortunately I do not have a testing facility or a laboratory test to identify polyethylene glycol antibodies here in the Philippines even abroad it's experimental in the laboratory setting so really I guess you will never be able to predict that but if a patient has had a previous severe reaction to a vaccine or maybe had a previous severe reaction to a chemical then they can ask their allergies to find out if that particular reaction was induced by polyethylene glycol because we can source that but otherwise if you do not have access to the allergies it's really just monitoring after 30 minutes because we never know who patient will react or not so ready lang tayo lagi thank you very much thank you very much Romy from Bataan at Bataan and thank you very much Dr. Rektor Marisha okay so I think Raymond we're approaching the top of the hour we'd like to go now to the answers to the questions that were asked okay so let's go to question I think 3, 4, 5 yes okay I'll read off the questions for one by one at least one of our panelists can answer question number 3 a reactogenic reaction is not the same as an allergic reaction 70% of our attendees answered too so maybe someone can share actually this is the right answer it's true okay thank you Dr. Rektor and Dr. Lobo question number 4 it's multiple choice majority of the COVID-19 adverse reactions are mild reactogenic reactions include pain tenderness and swelling and can be managed with supportive care mild allergic reactions such as rashes can be managed with antihistamines and 92% answered all of the above Dr. Lobo Dr. Lobo I don't see the question mild reactogenic reactions are usually managed locally for example pain on the injection site would be managed with your code compresses and rashes can also be managed by antihistamines that's true so it's all of the above okay question number 5 it reads the risk of severe allergic reactions such as anapalaxis is rare option B should be managed promptly with epinephrine 0.3 to 0.5 ml intramascular option C should be observed at least 30 minutes post vaccination at the vaccine center and option D which is what 78% of our attendees selected all of the above so that's actually correct all of the above so I think our doctors are ready and I'm nervous thank you pa and the number 6 is the final question in our poll the only current contraindication of COVID-19 vaccination is an immediate allergic reaction of any severity of previous dose of COVID-19 vaccine and any of its components with 88% of our attendees answering through tama po ba ang kalayang sagot yes okay okay, thank you very much okay, so very interesting na go ahead Raymond no, it's just very impressive that a lot of our attendees really are paying attention especially with two of only 134 allergy specialists in the panel po very important that really took the time to really nanamnamin po ang learnings from this webinar we are also showing po the assessment questions for our panelists I'll just read off the list before we go on with the parting words from our panelists number 1 pan pan pan pan pan pan pan pan pan pan pan pan pan pan pan pan are all of our speakers. So we're going to start with VP Nenny, Perna Nenny, please give your parting message. Yes. Public health concerns are communication concerns. I think that was what was made clear not only in today's but especially in today's webinar. The concerns of COVID-19 particularly as we approach a potential solution, vaccination must be addressed. And this is a solution where the responses of our people, the individuals who voluntarily give themselves for vaccination is what is important. So public health concerns, communication concerns, the approach to this one is, and the term seems so tried, but it is true. It is an all of society approach. Everybody should be by any hand when it comes to communicating about vaccinations against COVID-19. Thank you very much. Thank you very much. Vice U.P. Vice President Elena Perneu, head of the Office for Public Affairs. Dr. Romel Lobo. We usually ask what COVID-19 vaccine is right for me. The answer to that question is whatever vaccine that the government will offer to you that has a UAE approval and has gone to the rigors of evaluation by our technical advisory group are usually effective and safe for you. And remember, having any vaccine will always be better than not being vaccinated. That's one. Please do not also forget that after being vaccinated, one should always practice minimal health standards. No, you still have to wear your mask. You still have to wear your face shield limit. You have social distancing limit interactions for 15 minutes. Try to see if you can do this in an open field. Which means that kahit po nabakon naan tayo, wala po kasi 100% vaccine na mag-co-over ng protection. You may have pa rin po chance. So, kailangan po magpapraktis pa rin tayo ng minimum health standards. With that po, I hope we encourage you to be vaccinated. Thank you very much, Dr. Romel. Dr. Marisha. So, we really appreciate your taking time to listen to us because we really have this advocacy in our society, PSAAI, to help allay vaccination fears and hesitancy, especially about allergic reactions. We hope that with this talk, you have been assured somehow and that we are actually here to help you in whatever capacity we can. Just go and contact us. At www.psAAI.org to help you with your concerns regarding COVID-19 and vaccination. So, I really hope we all get vaccinated very soon. Thank you very much, Marisha. Dr. Laylani. Ako po, simple lang po. I really appreciated the word or the statement of Dr. Lobo. He said, vaccination saves lives. So, if we put that in our minds, and probably for physicians like me who are in the front line, maybe the way we move forward is really understanding the evidence and make that evidence translated to simple terms so that our patients will understand what we're talking about and that their fears are being addressed. There are a lot of expectations in the COVID-19 vaccination program of the government. And we feel the tension, actually, currently. And my message is, be informed. That is important. Be informed. Understand what's happening and help other people be informed. Also, correct misperceptions or misinformation. So, tanggalin ang agam-agam. I hope that our patients who are listening don't be scared in getting vaccinated because it really would save us. So, malami salami. Thank you very much, Dr. Laylani. We have with us the Dean of the U.P. College of Medicine who's going to give a brief synthesis of our whole webinar. So, I'd like to welcome Dr. Charlotte Chong. Yes, Susie. Thank you very much for inviting me again at the U.P. to give the closing remarks. It's been a very good session. I would like to congratulate the group for the 42nd webinar on Stop COVID-19. We were first, of course, given the data regarding how our Stop COVID-19 webinar has gone to be able to have 100% penetrance in terms of regional regions of the Philippines. The data are very clear. We have had about 110,000 attendees. We've had about more than 100 geopolitical regions represented. 14 countries have been covered by our webinar series and 54 hospitals. And we'd like to congratulate the TV U.P. to the leadership of VP Nany Pernia. We've been able to achieve this. We would like, of course, to thank Dr. Marisha Recto, immediate past president of PSS AI for her very clear lectures. It's been highlighted by our reactors. It's clear that we have algorithms in place. Malino naman po kung ano po yung mga difference ng reactogenicity sa allergic reaction at dahil dyan napaka rare naman po ang reaction in terms of allergic reactions to this vaccination. We should feel safe that we can be vaccinated. The reaction of Dr. Lani Nicadembus regarding the fact that this is very important information even for primary caregivers, primary healthcare practitioners is very, of course, very relevant. It has to be very clearly laid out for them so that they are able to communicate clearly also to the patients. Ang alam ko po, even with my own clinics, my patients would ask me, dok, papapvaccinate po ba ako? And you have to be able to clearly tell the patient why, bakit ka magpapvaccinate? Para maintindihan niya where you are coming from. And I think that's where the challenge is and that has been clearly spelled out by the second reactor by Karen Davila. The fact that there's a lot of political noise, political noise, corruption, all those issues, na talagang it makes everything very confusing. And we have to be able to delineate the issues. Hindi ibig sabihin may political ramifications ang Sinovac, hindi ka nang papapvaccinate ang Sinovac, kasi minakita ko mga ganun comments. You cannot look at that particular angle, but look at it from the safety issue, look at it from the perspective that we will need to have everybody vaccinated in order for our economy to open up and for us to be able to move forward. Other than that, we will not be able to move forward with this COVID-19 pandemic. Now, with a 50% effectivity rate of Sinovac, it's very clear that we need almost 100% of our population to be vaccinated. If we have 95%, siguro mga 70% because there's a formula that has to be followed. Pero if we're going to have majority of our population to have Sinovac vaccination, then lalong kailangan na mas marami magpavaccinating for us to be able to move forward. And I think that should be very clearly laid out. Kahit anong vaksinho na available, na-approvedo ng FDA, I think it's been clearly pointed out, we need to have ourselves vaccinated. And there are special populations like children na hindi pahoklado na data. And I think that has been clearly pointed out by Dr. Marisha Recto that we need to wait for the data to come out regarding vaccination in those populations, especially in children under the age of 18. Vaccines like Astra are available for all age groups, even for those who are more than 65 years old, so I'd like to be able to say that there are challenges still and of course Karin developed pointed to us the fact that we need to look at the future. Tingnan po natin, how we can be able to produce our own vaccines. We used to produce our own vaccines, BCG vaccines we used to export before. What happened, I don't know, but I think we need to revisit that and be able to move forward in terms of vaccine resiliency. We need to be resilient as a nation for us to be able to be prepared for the next pandemic. And I think this is very important and now clearly, malino na malino na po iton which should all advocate for data as healthcare workers which should advocate for government to pour in the funds and invest in being able to prevent the next pandemic. Ito po siguro as we grapple with this pandemic we should be able to look forward. Kailangan ho natin ng disruptors. We've made some progress with all this that we've been doing. But Karen Daviles said, po kanong nga ba kung wala tayo ABS-CBN that can reach to the grassroots. We need to think how we will be able to reach the grassroots. Kung bawat doctor po ay lalabas at sa sabihin your helpers, your drivers, your communities at kayo mismo ay lalabas. Siguro naman ho yung mga 80,000 doctors makakalunin na impact. Lahat po ng nurses ko lalabas po para mag-information campaign lahat po na kumadrona lahat po ng ating mayors ating mga political leaders ay lalabas to pa makipagusap sa ating mga kababayan kung sa importansya ng vaccine ito ay siguro I will then move forward. So sabi nga po ni VP Pernya Bayanihan po dapat po walang iwanan. Lahat po tayo ay isang bankalamang hindi tayo pwedeng malunod pare-pareho at paraho natin makiwasan nyo lahat po tayo ay kailangan magpavaccinate and still use the minimum public health standards. I think this webinar is a very important webinar I'd like to thank again TV UP and I'd like to thank Susie Pineda Mercado and of course Raymond Francis Armiento for preparing for the 43rd it's almost 54 weeks ngapit na po tayo mag-one year ito sa stop COVID and hopefully by the time we reach that majority of our population would have been vaccinated. Marayong marayong. Misalamat po. Thank you very much. That's Dean Charlotte Chong Dean of the UP College of Medicine now always very visionary in giving her closing remarks to us. So I'd like to thank everyone. Thank all the speakers. I can see in the chat box people want to use Dr. Actos' presentation that's going to be available to you and you can watch the play back. I actually go back to the presentations because our doctors with a lot of time kinakarina po nilin paggawang ang powerpoint kita. So please go back and you can watch this again on TV UP, YouTube and on Facebook and I think we're putting on the chat how you can achieve this and the powerpoint presentations may correct are being sent to you by email. So for those of you who are teaching and want to use these slides we are making this all available to you. Okay. Next week, nakgo don't miss it. Ibaraman ang topic natin we're going to take a little bit of a break from vaccination but we're going to talk about tama ang bang pagsueldo sa mga health workers kasi alam nyo yung sabi nga niga pe ang mga months na tiba yung ibasen nyo nung simula di ka yung makaway bin ostracized discriminated may mga stress tayo may mga anxiety we're going to look at our health workers being paid properly so being sure I was talking about investments in in health in public health in vaccination and that includes investment in you in our people in our health workers. So that's our topic for next week don't miss it panang sobrang nang stress nagdug-dug stress pero may dug-dug bang bayad. We're going to talk about how compensation of health workers should be approached. Okay. Raymond, over to you. Thank you, Dr. Suzie and for those who would want to test their knowledge post the webinar we have posted our poll questions po again 3, 4, 5, and 6 so that you can test your knowledge based on learnings that you got from this webinar. So as Dr. Suzie mentioned very timely po ang ating topic for next week just because there is some controversy with regards to yung pangpapadala ang deployment ng ating mga healthcare workers the Department of Labor and Employments shall we say creative way of getting vaccines into that country so it all boils down po if we are really compensating our healthcare frontline workers enough not just during this pandemic but this was really a pre-COVID topic already So makita kita po tayo again next week it's the first week of March March 5th at 12 noon it's a day. Together let's stop COVID death. So keep safe keep healthy and see you online. Do I have strength to carry on? Oh God, how long must this go on? And need you here to keep me strong? I'm here to hold the line. Oh keep my word Until my time. Say his name to realize it's fine to be afraid. Just hold on to the world and hold on to the world So may we be able to Ishold on to the word he gave This time we'll come to pass Cos this salvation makes a last You'll carry you to see the break of day The others pained before my fears The others lost before my tears But right behind the mask I look into myself and ask Do I have strength to carry on But God, how long was this gone? I need you here to keep me strong I'm here to hold the light I'll keep my head up till my head's dying On my fears, the others lost before my tears But right behind the mask I look into myself and ask Do I have strength to carry on I need you here to keep me strong I'll carry you to see the break of day The others pained before my tears But right behind the mask I look into myself and ask Do I have strength to carry on But God, how long was this gone? I need you here to keep me strong I'm here to hold the light I'll keep my head up till my head's dying On my fears, the others lost before my tears