Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY
March 30, 2021

DEPARTMENT MEMORANDUM
No. 2021- 0157

FOR: ALL UNDERSECRETARIES AND ASSISTANT

SECRETARIES; DIRECTORS OF BUREAUS, SERVICES AND
ENT FOR HEALTH DEVELOPMENT; ISTE F
HEALTH BANGSAMORO AUTONOMOUS REGION IN
—-

MUSLIM MINDANAO): EXECUTIVE DIRECTORS OF

SPECIALTY HOSPITALS AND NATIONAL NUTRITION
COUNCIL: CHIEFS OF MEDICAL CENTERS. HOSPITALS,
ANI A 1 IT . P DENT THE
PHILIPPINE HEALTH INSURANCE CORPORATION:
DIRECTORS OF PHILIPPINE NATIONAL AIDS COUNCIL
AND TREATMENT AND REHABILITATION CENTERS, AND
OTHERS CONCERNED

SUBJECT: Implementing Guidelines for Priority Group A3 and Further

Clarification of the National Deployment and Vaccination Plan for
COVID-19 Vaccines

I. RATIONALE

On March 1, 2021, the National Government has initiated the rollout of the COVID-19
Vaccine Deployment Program with the use of the SARS-COV-2 Vaccine (Vero Cell)
Inactivated CoronaVac (SinoVac) and Astrazeneca COVID-19 vaccine, in efforts to: 1)
reduce morbidity and mortality while maintaining the most critical essential services; 2)
protect those who bear significant additional risks and burdens of COVID-19 to safeguard
the welfare of others; 3) substantially slow down rate of transmission and minimize
disruption of social, economic, and security functions; and 4) responsibly resume social
and economic day-to-day operations and activities.

The issuance of Department Memorandum No. 2021-0099, otherwise known as the

“Interim Omnibus Guidelines of the Implementation of the National Vaccine Deployment
Plan for COVID-19”, provided the necessary guidance for the prioritization, allocation,
distribution, and appropriate administration of COVID-19 vaccines in the country.
This issuance aims to provide further guidance on implementation of simultaneous
vaccination to Priority Groups, and implementing guidelines for Priority Group A3:
adults with controlled comorbidities.

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II. GENERAL GUIDELINES
A. The National COVID-19 Vaccine Deployment Program is an additional strategy to
complement the existing implementation of the Prevention, Detection, Isolation,
Treatment, and Reintegration (PDITR) strategies which shall remain to be the
cornerstone of the country’s response to prevent further transmission. The improved
PDITR Plus (intensified PDITR and simultaneous vaccination) Strategy shall be a
shared responsibility of the national government, local government units, private
sector, and the general public.

B. The Department of Health (DOH) Task Group Immunization Program, with the
Department of Information and Communications Technology (DICT), shall ensure
that a platform for both electronic and manual masterlisting are available for the entire
population that is collected and used consistent with Data Privacy Law:
1. A national electronic self-registration system is preferable, linked to local
government platforms. Alternatively, a platform or website may be developed
wherein all electronic self-registration platforms and processes for manual
registration are consolidated.
2. To reduce barriers in masterlisting, processes should allow simultaneous
collection and registration across all priority groups, and should not be limited
to the specific targeted Priority Groups only.

3. The information and data fields to be collected prior to the vaccination day
should include data that can allow identification and verification of the
population to their respective Priority Groups, especially as the national
government ramps up vaccine deployment to the general population.
4. Local government shall ensure manual processes for masterlisting are
available to their population, and submit the same through endorsed platforms
of the DICT;
5. Task Group Demand Generation shall consolidate, publicize, and disseminate
electronic and manual platforms for masterlisting through official channels.
C. The speed and the impact of the National COVID-19 Vaccination Program shall be
maximized while taking into consideration the currently available evidence on the
COVID-19 vaccine’s ability to protect against severe COVID-19 and deaths.
Simultaneous deployment to succeeding Priority Groups shall be allowed, provided
that adequate measures to reach eligible individuals both electronically and manually
are in place, that deadlines for “Last Mile Masterlisting” defined as targeted outreach
to specific groups are adequately publicized, and that LGUs and vaccination sites are
ready for implementation.
1. The Vaccine Cluster shall maximize and ensure appropriate reach of Priority
Al eligible population especially in high burden areas to be identified by DOH
or the Interagency Task Force for Emerging and Infectious Disease
(IATF-EID), before proceeding to simultaneous implementation in succeeding
priority groups.
2. An adequately publicized Last Mile Masterlisting campaign for Priority Group
Al, with communication strategies targeted for dissemination to the eligible
 population (instead of just to local government units and implementers), is
recommended. This provision does not prohibit eligible Priority Groups to be
vaccinated after the deadline if deemed appropriate by the head of the
accountable institution.

Local government units shall tap local offices, interest groups, or chapters of
health professional societies to ensure adequate reach especially of Priority
Group Al.6 in the Last Mile Masterlisting Campaign. Priority Group Al.6
which encompasses all workers that are not based in health facilities that
provide COVID-19 case management, screening at borders and points of
entry, or management of specimens. For example, this group shall encompass
all other healthcare workers such as community based health workers,
midwives, dentists, pharmacists, pharmacy assistants, company healthcare
workers, private duty nurses and caregivers, funeral staff, among others.
For the allocation of Astrazeneca vaccines and other incoming doses,
simultaneous deployment to Priority Group A2 (Senior Citizens) shall be
implemented consistent with D.C. No. 2021-0101 Section C.
For the 400,000 doses of SINOVAC vaccines delivered on March 24 and 1
Million doses on March 29, 2021, simultaneous deployment to Priority Group
A3: (Adults with Controlled Comorbidities) shall be implemented consistent
with the following interim guidelines detailed in Section III-C of this
guidelines.
Simultaneous vaccination of succeeding priority groups (especially when
vaccine supplies from multipartite agreements come in) shall adhere to the
operational guidelines developed by the Department of Health and Vaccine
Cluster, as endorsed by the Interim National Immunization Technical Advisory
Group, and as approved by the Interagency Task Force for Infectious and
Emerging Disease.
D. Implementation of the vaccination program shall be coordinated with the assistance of
military and uniformed personnel (MUP), the private sector, and with support from
other national government agencies, especially to fulfill the following:
I. Streamline on-site processes through the completion of documentation and
screening processes prior to the actual date of vaccination and strategic
scheduling of vaccine recipient;

Designate and utilize larger vaccination sites as necessary, with observance of

the respective allowed maximum capacities of such sites;

Maintain minimum public health standards particularly on physical distancing

measures,
Delegate administrative and ministerial functions (such as registration,
counselling, crowd control, etc.) to non-healthcare workers to reduce workload
of healthcare workers during actual inoculation dates;
Maximize business processes to ramp up the vaccination program such as but
not limited to the following: marketing, organizing, managing manpower, and
A

employing responsive Information and Communications System (ICT)

solutions; and
6. Ensure continuous vaccination activities even during weekends and holidays.
If physical and human resources are available, 24/7 vaccination may be done.
. Current vaccine-specific implementation guidelines shall remain in effect for
succeeding incoming vaccine supplies unless otherwise revised by the Public Health
Services Team in line with updates of the Philippine FDA’s Emergency Use
Authorization. Specifically, these issuances include:
1. Department Memorandum No. 2021-0114: “Guidelines on the Management
and Administration of the Initial 600,000 Donated SARS COV-2 Vaccine
(Vero Cell) Inactivated CoronoVac (Sinovac) Doses”. Administration

2. Department Memorandum No. 2021-0123: “Interim Guidelines for the

Management and Administration of the AstraZeneca (ChAdOx1-S
[recombinant]) COVID-19 Vaccine” respectively.

It is further clarified that Sinovac is not recommended for adults with uncontrolled or
poorly controlled comorbidities.
1. Other vaccines consistent with their EUA may be used for adults with
uncontrolled comorbidities.

2. Sinovac may be given to adults with clinically-controlled disease

comorbidities and not in active disease, further defined in succeeding
provisions.

. It is further clarified that all Filipinos including overseas Filipino Workers, and other
groups with legal residency status in the Philippines (i.e. foreign nationals, diplomats)
shall be included in the priority group appropriate to their circumstance. For example,
said individuals meeting the eligibility criteria for Priority Group A2 (senior citizens),
Priority Group A3 (adults with controlled comorbidities), and the like may masterlist
~
with their respective local government units (LGU) subject to supply availability.

ITI. IMPLEMENTING GUIDELINES

A. Masterlisting and Scheduling in Vaccination Sites
1. Local government units shall lead in the masterlisting of the respective general
population, consistent with their roles in profiling the health status of their
constituents as stipulated in the Universal Health Care Act. Such masterlisting
may be done through the following measures:
a. Coordination with institutions where the eligible population belongs to
such as workplaces or health facilities;
b. Coordination with organized senior citizen, patient, or interest groups.
This includes disease-specific support groups and palliative care,
hospice groups if available;
“

¢. Coordination with public and private health facilities, and professional

medical societies to encourage patients to masterlist in their respective
LGUs;
d. Open call to eligible population through the use of appropriate media
platforms and house-to-house visits to populations by community health
workers, consistent with minimum public health standards; and

e. Existing disease registries of the LGU, if available.

2. All Filipinos shall indicate their interest to be vaccinated through their LGUs
based on the address of their permanent or current residence or workplace.
The DICT must ensure that the Vaccine Information Management System -
Information Registry shall check for duplication across different LGUs
through its centralized data warehousing platform.

3. For the groups specified below, LGUs shall ensure vaccination is conducted
or scheduled either in a separate site/ facility stated below or in current LGU
vaccination sites but at a separate date from the other population:

a. People living with HIV, through the HIV treatment hubs, to keep
privacy and confidentiality of patients, provided that the treatment hubs
have adequate human resource and capability to conduct the vaccination
based on the National Vaccination and Deployment Plan.
b. People affected with Tuberculosis, through the TB-DOTS centers,
provided that assigned health workers and TB patients have adequate,
appropriate Personal Protective Equipment (PPE). Patients with
multidrug-resistant tuberculosis (MDR TB), through the Programmatic
Management for Drug resistant Tuberculosis (PMDT) treatment
centers/satellite treatment centers, must be strictly vaccinated on a
separate place or schedule, ensuring that health care workers are
equipped with N95 masks and other appropriate PPEs.

c. Bed ridden patients at home and/or in institutions (home for the aged,
nursing homes, infirmaries, etc.), wherein LGUs may schedule on-site
vaccination teams, ensuring appropriate processes and mechanisms for
Adverse Events Following Immunization (AEFI) referral such as
ensuring availability of ambulances. Medical clearance and dialogue
with the attending physician is necessary for bed ridden patients.
d. LGUs should develop a mechanism for citizens at home with medical
clearance for vaccination to be scheduled for vaccination.

B. Identification and Utilization of COVID-19 Vaccination Sites

1. Off-site or non-health facility based sites (e.g. schools, gymnasiums, treatment hubs,
etc.) that fulfill guidelines set in the NVDP, Department Memorandum 2021-01 16
 entitled “Interim Guidelines on the Identification and Utilization of COVID-19
Vaccination Sites”, and subsequent guidelines shall be allowed to operate as a
vaccination site, provided they are linked to a licensed health facility (such as public or
private hospital or rural health units). The licensed health facility shall assist in
ensuring the readiness of vaccination sites, especially regarding the management of
AEFI. Larger sites that allow for efficient and safe vaccination operations and
compliance to minimum health standards are preferred.

2. The only allowed non-fixed site COVID-19 Vaccination Implementing Units and
Vaccination Sites shall be in the instance of home-based vaccination of homebound
senior citizens or adults with comorbidities. In these instances and consistent with
guidelines for medical clearance, LGUs shall ensure medical clearance for bed-ridden
patients from attending physicians prior to the vaccination day. There must be
appropriate health teams to do the vaccination and referral systems to health facilities
on standby. Facilitated transportation of these individuals to vaccination sites is
preferred, if feasible.
3. All vaccination sites shall ensure compliance to minimum public health standards
consistent with Administrative Order 2020-0015 or the Guidelines on the Risk based
Public Health Standards for COVID-19 Mitigation and Department Memorandum
2020-0268 or the Interim Guidelines on Health Facilities in the New Normal.

4. LGUs shall ensure that the vaccination sites can reach all sectors and communities,
workplaces, or establishments within one hour of travel from each resident. LGUs may
facilitate transportation of recipients for hard-to-reach areas of the community
provided minimum public health standards are met.

5. The Local Vaccine Operations Center (LVOC) shall ensure that the designated
COVID-19 vaccination sites shall comply with the standards and requirements
prescribed in the LGU Assessment Tool, as specified in the Department Memorandum
No. 2021-0116 . The LVOC shall monitor and ensure compliance of vaccination sites
during actual vaccination.

C. Priority Group A3: Adults with Controlled Comorbidities

1. Eligibility

a. Any adult between 18-59 years old with any controlled comorbidity can be part
of Priority Group A3.
b. Priority shall be given to adult whose comorbidities are among the top causes
of COVID-19 and national morbidity and mortality for prioritization to include
chronic respiratory disease, hypertension, cardiovascular disease, chronic
kidney disease, cerebrovascular disease, malignancy, diabetes, obesity, chronic
liver disease, neurologic disease, and immunodeficiency state.

¢. Any of the following may be provided as proofs of comorbidity issued within

the past 18 months:

i. Medical certificate from an attending physician;

ii. Prescription for medicines;

 ili. Hospital records such as the discharge summary and medical abstract;
iv. Surgical records and pathology reports
2. In case of limited vaccine supply, further sub-prioritization of Priority Group A3 shall
be done based on geographic burden of COVID-19 disease and LGU vaccination
readiness.

Additional precautionary measures for implementation of vaccine deployment with

Priority Group A3 shall be as follows:
a. Administration of vaccines shall take into consideration specific comorbidities
indicated as contraindications and precautions in vaccine product list or in the
EUA issued by the Philippine Food and Drug Administration.

b. Vaccines shall not be administered to those with uncontrolled or poorly

controlled comorbidities, and those in active disease

D. Medical Clearance
I. Those belonging to the following A3 sub-groups need to secure a physical or
electronic medical clearance prior to vaccination from either their specialist or
attending physician through any means such as but not limited to teleconsultation,
consultation at designated facilities, hubs, RHU or other primary care centers
designated by the LGU:
a. Autoimmune disease
b. HIV

c. Cancer/ Malignancy
d. Transplant Patients
e. Undergoing steroid treatment
f. Patients with poor prognosis/ Bed-ridden patients

The medical clearance process for these groups shall enable individual risk-benefit
assessment by the attending physician. It may be presented in electronic format, with
the full name of the attending physician and their corresponding contact details for
verification. It shall be issued by licensed physicians or may also come from referral
apex hospitals, through telemedicine and Rural Health Units.
Those with other comorbidities not previously specified do not need medical
clearance prior to vaccination but shall still undergo screening on vaccination day for
active disease.
Local governments shall ensure that primary care facilities have coordination and
referral mechanisms with the nearest Apex hospitals and training on Clinical Practice
Guidelines that will serve as guidance on providing medical clearance to those with
comorbidities who cannot consult at hospitals.
 5. To reduce barriers in vaccination, LGUs shall ensure that the systems providing for
medical clearances to the appropriate A3 subgroups shall be accessible and available
to all members who need to secure a medical clearance prior to vaccination.

E. Deferment Guidelines
1. Potential vaccine recipients who are screened on the day of the vaccination and are
found to have any of the following shall be considered as in active disease and thus,
will be deferred for vaccination:

a. With symptoms of COVID-19 or their comorbidity;

b. Abnormal vital signs including heart rate, respiratory rate, and blood pressure
(as defined in E.4) even after monitoring for 60 minutes;

c. Have had attacks, admissions, or changes in medication for the past 3 months.

2. Assessment of eligible deferrals shall be based on the clinical judgement of the

physician at the COVID-19 vaccination site. Reasons for deferral need to be
adequately explained to the potential vaccine recipient.
3. Eligible vaccine recipients who at the time of consultation, fall under the categories
specified in DM 2021-0099 Section II1.I4 shall also be deferred for vaccination.
4. Patients presenting with hypertensive emergencies (sBP > 180 and/or dBP >120 with
signs and symptoms of organ damage) shall not be vaccinated and must be referred to
the emergency room immediately. Vaccination shall be rescheduled until the condition
is clinically controlled.

5. DC 2021-0101 Section D.1.g which states “For individuals who became COVID-19
positive after receiving the first dose of vaccine, they should not be given the 2nd
dose. For standardization and effective implementation of AEFI monitoring and
causality investigation, vaccination can be restarted after 90 days with a new first dose
of vaccine.” is amended for implementation uniformity. All vaccine recipients who
contracted COVID-19 after the first dose may be given the second dose provided a
recommended interval of 14 days from recovery or completion of treatment are met,
without restarting the vaccine dose schedule.

F. Additional processes and activities in the vaccination sites

1. Parallel activities that may or may not be related to vaccination shall be allowed to be
conducted in vaccination sites provided that:

a. Activities are done in a separate adjacent area from the vaccination and
monitoring area (not in the vaccination site);
b. Strict adherence to minimum public health standards are met, especially
having appropriate engineering and administrative controls against crowding;
 Implementation of the vaccination program and parallel activities fulfill
maximum capacity requirements consistent with the epidemic risk levels and
guidelines of the DOH and IATF-EID;
Activities are done after the vaccination proper, and not as a prerequisite to
vaccination; and

Implementing the parallel activities does not impact the efficient operations of
the vaccination program which is of utmost importance.

2. Local government units shall coordinate with PhilHealth Local Health Insurance
Offices to enable on-site PhilHealth support in designated vaccination sites such as
but not limited to PhilHealth membership updating or registration to primary care
providers, subject to rules and regulations of PhilHealth. LGUs and PhilHealth shall
ensure all vaccine recipients shall be provided financial coverage especially in terms
of AEFI and healthcare up to one year after vaccination.
3. Other parallel activities may include:

a. Registration to the National ID through the Philippine Identification System

(PhilSys) on site, in coordination with the National Economic Development
Authority (NEDA) and the Philippine Statistics Authority (PSA).
b. Access to other essential local government services as a one-stop-shop, if
relevant to specific eligible vaccine recipients scheduled on those days.

Registration into local disease-specific groups or release of information

materials related disease prevention and control.

4. LGUs and head of vaccination sites shall ensure that preconditions stated above are
met prior to implementation of parallel activities.

For dissemination and strict compliance

By Authority of the Secretary of Health:

MARIA ROSARIO $. VERGEIRE, MD, MPH, CESO IV

OIC - Undersecretary fof Health
Public Health Services Team