Combatting Vaccine Hesitancy in the Philippines

Ever since the virus struck the country, the Philippine government has consistently stated that vaccination is the only true way to recover from the COVID-19 pandemic. With this, one may think that the commencement of the country’s vaccination program at the beginning of March would finally mark the end of a year-long pandemic. For some this may be the case but for a whole lot of others, the vaccines only contributed to their uncertainty and fear.

Hindered by trauma, doubt and lapses in the country’s vaccination program, this plummeting vaccine confidence remains a major hurdle in the country's attempt to obtain true recovery—especially when the success of the vaccination program is closely associated with the achievement of herd immunity.

A report stated that the Philippine government aims to vaccinate 70% of Filipinos this year, but as of writing, only around 5.75% of the country’s population have received the first of two doses of the vaccine and only 1.98% of the population has received both jabs.

While the lapses in vaccine attainment and rollouts may play a big role in this, the growing vaccine hesitancy among the country's citizens is also another side of the spectrum worth considering.

Vaccine hesitancy in the Philippines

According to the World Health Organization (WHO), vaccine hesitancy refers to the “reluctance or refusal to vaccinate despite the availability of vaccines” and is influenced by factors such as complacency, convenience and confidence.

Last 2015, the Philippines had one of the highest rates of vaccine confidence in the world. However, recent surveys show otherwise.

According to a survey conducted by the Social Weather Station (SWS) last September, only two-thirds of Filipinos were willing to be vaccinated for COVID-19. More recently, a Pulse Asia survey showed that 61% of Filipinos refuse to be vaccinated. What went wrong, then?

This issue on vaccine hesitancy can be rooted back to 2016 when the Dengvaxia controversy broke out and worsened under the Duterte administration.

At that time, a school-based anti-dengue immunization program was initially implemented and led by the Department of Health (DOH) under the Aquino administration. A year after its implementation, a national health scare erupted when Sanofi, the pharmaceutical company that produced Dengvaxia, declared that the vaccine can cause an increased risk of severe dengue for people who are not infected by the virus prior to immunization.

Afterwards, several deaths allegedly and wrongly linked to Dengvaxia were reported. And coupled with politicians pointing fingers, this led to a serious vaccine scare that manifested even years after the controversy.

Even before the COVID-19 pandemic, the measles outbreak that happened sometime in 2019 was attributed by the DOH to vaccine hesitancy. The WHO identified that aside from lack of time among households to have their children be vaccinated, this hesitancy is also caused by fear due to Dengvaxia.

With trauma still fresh in the minds of a lot of citizens, this could have factored in their refusal to be inoculated for the COVID-19 virus.

To add to that, the country’s smuggling issue at the start of the procurement of vaccines may have also brought impact to the citizens’ perception on the vaccine rollout.

Last year, the government faced criticisms for inoculating some of its public sector officials, including the Presidential Security Group (PSG), with unregulated and yet unapproved vaccines from China. Furthermore, DOH secretary Francisco Duque III also drew flak for “dropping the ball” in making arrangements with Pfizer for the vaccines.

Presently, vaccine hesitancy is also being fueled by the reported side effects of the vaccines, which in turn furthered the distrust for certain brands. Duterte’s refusal to receive the Sinovac vaccine didn’t also help in the country’s campaign against vaccine hesitancy.

A more recent SWS survey released on May 20 found that months since the vaccination program started, only 32% of adult Filipinos are willing to be vaccinated and the top reason was fear over vaccination side effects.

However, it is important to note that according to the Centers for Disease Control and Prevention, these side effects are “normal signs that your body is building protection”.

The DOH also said that there is a slim chance of getting severe and risky adverse effects. It is better to get the vaccine for safety than not having protection at all.

Taking into mind all these factors, battling vaccine hesitancy is indeed not a piece of cake. But one way the government has addressed this is to rely on the “role-modeling” aspect of the vaccination program.

The Government’s Response

Healthcare workers were first in the long line for inoculation, as they should be given their nature of work amid the pandemic. Yet, apart from that reason, this is also done to boost public confidence.

But how convincing could this be when some elderly officials refused to be inoculated at the beginning of the vaccination program, while our healthcare workers had to comply and make-do with vaccines having low efficacy rate?

And as if that was not confusing enough, Duterte declared his preference for Sinopharm, which is the same controversial vaccine given to his PSGs back in 2020. And just last May 3, the president got inoculated with this vaccine despite its exclusion in the list of COVID-19 vaccines approved by the Food and Drug Administration (FDA).

Another way the government has decided to address issues on vaccine hesitancy is by enticing people through offering incentives.

For instance, San Luis town in Pampanga has a raffle called “Baka para sa Bakuna” where a citizen is qualified to win a cow after being vaccinated. A similar raffle is also being held in Sucat, Muntinlupa City where citizens are given a chance to win 25 kilograms of rice.

Spokesperson Harry Roque also recently suggested a similar strategy to be done for Pantawid Pamilyang Pilipino Program (4Ps) beneficiaries.

In his May 18 public address, Roque has proposed to make vaccination among the conditions for (4Ps) beneficiaries in claiming their cash aid.

This statement seemingly contradicts what the government has stated since the start of the inoculation program, and which Roque reiterated in the same public address: “Walang pilitan sa bakuna.”

To address biases and distrust in certain vaccine brands, the Department of the Interior and Local Government (DILG) declared a “brand agnostic” policy where LGUs are given orders not to announce in advance the vaccine brands used at particular centers.

However, despite this policy being practical and perhaps indeed needed to avoid people from flocking in particular centers that provide vaccines of their preference, we must take in mind that this policy should not take away our right to informed consent.

Instead of keeping people in the dark, the government, partnering with different health organizations, must further improve its ongoing campaigns in making sure that right information about the vaccines reach the public.

At some point, government information has been abundant, but it has also been very confusing and contradictory. In fact, a lot of webinars have been hosted to give the public vital information about the vaccines yet the issue of vaccine hesitancy still remains.

Furthermore, the misleading messages from the government does little to no help in combating fake news and misinformation.

In a report, Dr. Joshua San Pedro from the Manila-based nonprofit Coalition for People’s Right to Health stated that the most effective way of addressing vaccine hesitancy is by discussing it as a right.

Indeed, it is important that while we aim to achieve our target herd immunity as soon as possible, we must learn to combat this hesitancy through education and by directly and properly addressing the valid fears of the public instead of adding to it.

In a time of global public health emergency, vaccines are indeed the most feasible solution. The country must hence reinforce its vaccination program through consistent messaging, transparency and more respect for science.

The public needs not another reason to fuel their uncertainty and fear —we have had enough of that since the beginning of the pandemic.

The government must use this time to utilize what’s left of the public's trust and prove that they can do what they’ve failed to do throughout the course of the pandemic —to assure that they are on the same side of the public, acting for our well-being and safety. Not for their own misplaced priorities.