(This is the conclusion of the SunStar Philippines special report on efforts to defeat the Covid-19 pandemic through vaccination.)

TWO recent surveys indicated that Filipinos have yet to overcome vaccine hesitancy arising from the Dengvaxia controversy.

More than four out of 10, or 44.1 percent, of the 15,651 participants in the University of Santo Tomas Covid-19 vaccine awareness team survey either hesitated or said they will not / probably not get the vaccine against coronavirus disease 2019 (Covid-19).

The survey was conducted from January 16 to 30, 2021 on several social media platforms. No reasons were given for their refusal to receive the vaccine.

Six out of 10, or 55.9 percent, said yes / probably yes. Almost half of the respondents, or 45.7 percent, said they prefer the vaccines made in the United States (US) or Europe while 50.9 percent said they will use any safe and effective vaccine.

A Pulse Asia survey conducted among 2,400 respondents from November 23 to December 2, 2020 also showed that nearly half, or 47 percent, said they will not get the vaccine.

Nearly a third, or 32 percent, said they will get vaccinated while one in five, or 21 percent, were unsure.

The results were worse in the Visayas and Mindanao, where 55 percent and 48 percent, respectively, said no.

In terms of income classifications, 43 percent of class ABC, 46 percent of class D and 56 percent of class E said no.

Concerns over the safety of the vaccine were cited as reason for refusal or hesitancy by more than eight of 10, or 84 percent, of the respondents.

Vaccine hesitancy, or the delay in acceptance or refusal of vaccines, has been blamed for the low immunization rates in the country since the Department of Health (DOH) suspended its dengue vaccination program.

The program was suspended on December 1, 2017 after vaccine maker Sanofi Pasteur revealed new findings that its anti-dengue product, Dengvaxia, poses greater risk of severe dengue fever to those who have not been previously infected with the virus.

This led to the filing of cases against DOH officials, who were blamed for deaths believed to have been caused by Dengvaxia. Former DOH secretary Janette Garin and nine others were indicted for reckless imprudence.

In 2019, DOH blamed vaccine hesitancy for the measles outbreak. Measles is a vaccine-preventable disease.

In the first quarter of 2020, full immunization coverage in children hit a record low of 7.0 percent, less than a third of the quarterly target of 23 to 24 percent and about half of the 16 percent average pre-Covid-19 accomplishment.

This was, however, also due to the pandemic-related lockdown.

Fully aware of the challenges in the implementation of a vaccination program against Covid-19, the government has launched a massive information campaign.

Transparency is key

DOH Undersecretary Myrna Cabotaje, in a virtual learning session for the media on January 29, 2021, said transparency is the key factor in encouraging Filipinos to receive the vaccine against Covid-19.

She asked that those who receive the vaccine first “spread the word” and help build public trust in vaccines.

WHO consultant Suzanne Brownlow Kerba, in the same session, said health workers should be aware of possible side effects and explain these well to the public.

She said the public may confuse these side effects with Covid-19 or flu symptoms and may worry that the vaccine gave them Covid-19.

Kerba said health workers should emphasize to the patients that side effects indicate a good immune response, and are temporary.

It is important that vaccine recipients return for the second dose even if they experience unpleasant side effects after the first dose, she added.

She said adverse effects could include allergies to a component of the vaccine, quality defects in the vaccine, and human errors.

The keys to effective communication are honesty, empathy, respect, humility, resolve and partnership.

“We come back down to trust because if the people are not trusting what the DOH is saying, what the media is saying, we are in a quandary so those groups have to provide trust,” she said.

Behavioral approach

Dr. Elisse Nicole Catalan, who has a master’s degree in public health from the Icahn School of Medicine at Mount Sinai Hospital in New York, said anxiety about the vaccine can be attributed to fear of the unknown, misinformation and distrust.

She said the government's knee-jerk reaction to provide information without a behavioral approach is inadequate.

“There needs to be a careful consideration of how people will consume the information and this same message should cleverly also act as a tool to assist in an individual’s decision-making process,” she said.

She suggested the use of the “nudge theory”, or the behavioral economics concept of libertarian paternalism, to influence the public’s decision while respecting their freedom of choice.

“How can this be done? People need to be shown that the direct result of their vaccination will benefit their communities, and contribute to attaining herd immunity that will allow us to go about our lives like we did in 2019 (e.g. mask-less, no lockdowns),” she said.

“People need to know that if they refuse to be vaccinated, cases will continue to rise, bringing about the threat of a bigger outbreak that can result in more variants and mutations,” she added.

Catalan also said the government needs to show exactly how the vaccination program will be conducted, and that it will be easy, accessible, and safe.

“People need to know how the vaccinations will be conducted and what to expect. Will it be available in every barangay or district hospital?” she said.

The government has drawn up a national deployment and vaccination plan, a detailed action plan to carry out the vaccination program over the next three years. Local government units (LGUs) have also been directed to localize this plan.

Read: Special report: Government prepares for vaccine rollout

Vaccine confidence

Catalan said the government can promote vaccine confidence by asking prominent figures, celebrities and athletes to help in the campaign.

She noted that several first world leaders have come forward and were vaccinated publicly.

In Indonesia, social media influencers were vaccinated and asked to spread the word about the vaccine.

Several other countries encouraged vaccine recipients to share their personal experiences about the process.

Catalan also said there should be a dedicated resource to address queries about possible reactions after inoculation and a clear plan on what one needs to do if he/she feels unwell after the jab.

Under the deployment and vaccination plan, an incident command system will be established to monitor all vaccination-related concerns.

Vaccine recipients will be monitored for 30 minutes to one hour after inoculation for any adverse reactions. If they experience adverse reactions after they’re cleared, they are to immediately inform a doctor or a barangay health worker, or go to a hospital.

The government has adopted VigiFlow, a management system for recording, processing and sharing reports of adverse effects, DOH Undersecretary Maria Rosario Vergeire said in a virtual press conference on January 27.

Trainings have also been conducted to capacitate healthcare workers and alert them to any adverse events.

Vaccine operations centers have been established in all regional offices and town hall meetings to increase vaccine awareness were being conducted, Vergeire added.

Catalan said there needs to be a multi-sectoral effort to encourage all citizens to get vaccinated.

Both the public and private sectors must target communications to different segments of the population, and recognize the need to communicate in all major languages and dialects in the country.

She suggested that telecommunications companies be asked to provide reminders and factoids via text messages and e-commerce apps display nudges to the public while people online shop.

“This pandemic is one war we all need to win together. We have no choice but to fully commit and go all in. This virus has crippled our lives and livelihood for a year and counting. We can’t afford a moment more,” she added. (With Third Anne Peralta-Malonzo / SunStar Philippines)

Part 1: A shot in the arm

Part 2: A matter of choice

Part 3: Government prepares for vaccine rollout