By Gian Angnged

Even as the Philippines suffers one of the worst COVID-19 outbreaks in Southeast Asia, skepticism over vaccine safety and efficacy lingers among some Filipinos.

A nationwide Social Weather Stations (SWS) survey conducted from April 28 to May 2, 2021 showed that only 32% or 3 out of 10 adult Filipinos are willing to get vaccinated if granted a “chance to be given a free vaccine that can prevent COVID-19 which has been approved by the Food and Drug Administration.”

Meanwhile, a survey of 2,400 respondents conducted by Pulse Asia from February 22 to March 3 of this year showed that 61% or 6 out of 10 Filipinos did not want to get vaccinated. Similarly, in a December 2020 survey of 600 Metro Manila respondents by the University of the Philippines, only 25% stood in favor of the vaccine, 28% did not, and 47% were undecided.

Four months into the rollout, only about 7.1% of the Philippines’ total population has received at least one dose of the COVID-19 vaccine, and only about 2.4% of the country’s population has been fully vaccinated against COVID-19, with 9.53 million doses administered as of June 30.  

As the Duterte administration hinges the country’s pandemic recovery plan on mass inoculation—snubbing calls for other public health strategies like mass testing—vaccine hesitancy remains a major stumbling block.

Dengvaxia scare exacerbates eroding vaccine confidence

Vaccine confidence among Filipinos was already eroding even before the Dengvaxia scare, with data from the Department of Health (DOH) showing that the rates of fully immunized children steadily declined from as high as 85.61% in 2010 to 67.47% in 2017. 

The public’s distrust in vaccines only worsened when the Dengvaxia vaccine program erupted into controversy and spawned a political storm in 2018, with full immunization rates in the child population dropping further to 52.7% in 2019. 

To recall, the school-based dengue immunization program was launched in April 2016 under the late President Benigno Aquino III.  More than a year later, the program was suspended by the Duterte administration after Dengvaxia manufacturer, Sanofi Pasteur, declared that those who received the vaccine could be at risk of developing severe dengue if they had not been previously infected with the virus.

The deaths of several pre-teen students who received the dengue vaccine soon flooded news feeds, brewing anti-vaxx hysteria, and fueling public outrage.

Public Attorney’s Office (PAO) Chief Persida Acosta, whose clients were parents of children who supposedly died of Dengvaxia, only fanned the flames of the controversy, spreading unfounded claims about the vaccine. PAO forensic consultant Erwin Erfe also stated the deaths showed “strong links” to Dengvaxia, although he added the results are inconclusive. 

A panel of experts from the University of the Philippines- Philippine General Hospital later found that no death was directly linked to the vaccine.

Dengvaxia has been approved by regulatory authorities in other countries including Brazil, Singapore, and Thailand. In 2019, the vaccine was included in the World Health Organization (WHO)’s Model List of Essential Medicines.

Myths, misconceptions mar immunization efforts

In a country awash in vaccine misinformation and the exaggeration of negative news, it comes as no surprise that the main reason why Filipinos refuse to get inoculated against COVID-19 is the fear of possible side effects, according to the aforementioned Social Weather Stations (SWS) survey conducted from late April to early May.

Headlines of individuals suffering adverse reactions or even allegedly dying after receiving COVID-19 jabs have fueled widespread vaccine distrust among the public, with some saying they would rather use herbal remedies to protect themselves from the virus. Serious or long-lasting effects following COVID-19 vaccination are extremely rare.

Concerns that COVID-19 vaccines make you sick with the coronavirus, as well as doubts surrounding the shots’ safety and efficacy, are another major cause of hesitation. 

But none of the approved vaccines contain the live virus that causes COVID-19, so they cannot infect you with the virus. Furthermore, if an individual experiences a health problem following vaccination, that health problem may have occurred anyway even if the person didn’t get the jab.

Meanwhile, some Filipinos refuse the vaccine because they don’t believe that COVID-19 is real as they haven’t been infected with it despite frequently going outside, or they personally do not know anyone who has contracted the virus.

To combat these myths and misconceptions and encourage vaccination sign-ups, local governments have started offering reluctant residents—many of whom live in extreme poverty—incentives, raffling sacks of rice and grocery items, a house and lot, and even cattle to the immunized.

Similarly, the Office of the Vice President, in collaboration with the City Government of Manila and some private businesses, is offering P500 gas cards to the recipients of the Vaccine Express program, a drive-thru vaccine service for tricycle or pedicab drivers and delivery personnel who work in the city. The Vaccine Express program will be extended to Cagayan De Oro.

The DOH has also partnered with private businesses for its “RESBAKUNA” vaccination program, which offers discounts and freebies to those who have been vaccinated against COVID-19.

The Department of Labor and Employment (DOLE), meanwhile, is giving out bicycles and other freebies to its fully vaccinated employees. 

Counterproductive efforts to bolster vaccine confidence

While the national government, along with various local government units (LGUs), has encouraged Filipinos to get vaccinated against COVID-19 by offering incentives, its other attempts to speed up the jab rollout and reduce vaccine hesitancy have been slammed by members of the local medical community for being counterproductive.

In an effort to boost vaccine confidence, President Rodrigo Duterte received his first dose of China’s Sinopharm vaccine in early May in a live video streamed on Senator Bong Go’s Facebook page. 

The public display later backfired as Duterte drew flak from medical experts for taking a vaccine not yet approved for emergency use by the Philippine Food and Drug Administration (FDA) and not yet available to the wider population.

Concerns were raised that Duterte’s vaccination could affect Filipinos’ trust in the safety and efficacy of vaccines with Emergency Use Application (EUA). 

Later that month, the DOH announced its “brand agnostic” policy, which prevents local governments from announcing in advance the brand of COVID-19 doses they will offer in vaccination sites. 

Health Undersecretary Myrna Cabotaje explained that the brand of vaccines will only be disclosed to the public on-site before inoculation. Vaccine recipients who do not like the vaccine available will have to go to the end of the line again and give the slot to another, Cabotaje added.

Duterte himself issued the directive after seeing the lack of physical distancing in jab sites that administered Pfizer’s coronavirus vaccines.

Interior Secretary Eduardo Año meanwhile said the policy was issued to make people “overcome brand preference.”  He stressed that this move is necessary as the Philippines is “racing against time” to achieve herd immunity.

The “brand agnostic” policy was met with opposition from Filipino physicians, who argued that it would instead cause more vaccine hesitancy.

Gideon Lasco, a medical anthropologist and physician, stressed the significance of the principle of informed consent in medical ethics. “I am shocked that the DOH wants Filipinos to sign up for vaccination not knowing which brand they’ll get. If we are to build vaccine confidence and empower the people, they need more information, not less,” Lasco wrote.

Dr. Gene Nisperos of the University of the Philippines College of Medicine pointed out that the lack of transparency would only aggravate vaccine distrust: “Dear DOH at IATF, naniniwala talaga kayo na mas magpapabakuna ang mga tao kapag hindi nila alam ang ibabakuna sa kanila?! Yun ngang alam ng tao yung ibabakuna sa kanila eh hirap kayo manghikayat, yun pa kayang hindi nila alam?” 

“If people have doubts, address their questions. May data naman eh. Hindi yung pipila ka tapos malalaman mo na lang doon. Hindi naman mawawala yung doubts mo sa surprise na brand eh. May chance na umuwi na lang yung tao, nalagay pa at risk kasi lumabas para sana magpabakuna,” said fellow physician Jai Cabajar in a tweet.

The solution: educating, not instilling fear

Duterte’s latest bid to ramp up vaccination efforts and quell vaccine hesitancy came just a few days ago as he threatened to jail Filipinos who refuse COVID-19 jabs.

“Don’t get me wrong. There is a crisis being faced in this country. There is a national emergency. Kung ayaw mo magpabakuna, ipaaresto kita at ang bakuna, itusok ko sa puwet mo,” Duterte said on June 21.

Duterte also said he will order barangay captains to “find” and list down those who are unwilling to get vaccinated against COVID-19, adding that the Department of the Interior and Local Government (DILG) should oversee the effort. 

He also threatened to inject with Ivermectin—an anti-parasitic medicine for animals—persons who refused vaccination against the coronavirus.

Duterte, however, added that he will think about his latest arrest order very hard legally. “Pero pag ayaw niyo, ipaaresto ko kayo. That is in pursuance to a policy of crisis, itong health issue,” he said.

The President’s officials soon sought to clarify that it would not be a new policy.

Duterte’s threats to arrest those who refuse vaccines against COVID-19 were also met with criticism from lawmakers and healthcare workers.

Sen. Francis Pangilinan said intimidation would not solve the issue of vaccine hesitancy among the public. “Well, ang administrasyon, kung lahat ay dinadaan sa pananakot, ‘di ba, at pagkulong at pag-aresto, eh di sana maganda na ang kalagayan natin ngayon. So hindi ‘yan solusyon,” he remarked.

Pangilinan pointed out that the government must also turn its attention to other science-based solutions, including interventions, contact tracing, testing, information dissemination, and effective vaccine rollout, to address the pandemic.

Sen. Risa Hontiveros, for her part, said in a statement that it would not have been necessary to terrorize the people into getting vaccinated if only the country had a “sufficient and ample supply of safe and efficient vaccines that are suitable to their conditions; credible health information and education in the community, and an efficient vaccination system.”

She added that the Duterte government has failed to convince citizens of the safety and efficacy of vaccines in spite of the resources available. 

Dr. Gideon Lasco also slammed the administration anew for threatening the people instead of allaying their fears. “People’s hopes are more powerful than their fears. Far more than the barbaric threat of imprisonment or any other form of intimidation, what would truly motivate them to get vaccinated is the reassurance that doing so will be safe and beneficial for themselves and their families,” he said in a tweet.

Dr. Jai Cabajar voiced similar sentiments and underscored the importance of educating the public: “In Medicine, you have to look deep into why patients make certain decisions when it comes to their health. Most of the time, they just need guidance. Correct the misconceptions, educate them about vaccines, don’t threaten them.”

Indeed, the way to go in combating vaccine hesitancy is addressing the people’s concerns and providing them clear information—not threatening to arrest them and inject them with Ivermectin.