Vaccine hesitancy: A nationwide challenge in the Philippines

The pandemic has been really hard for Heidi Fugero. 

The 42-year-old food stall worker from Antipolo City, a municipality in the sprawling Metro Manila area, is the breadwinner of her multigenerational household. She said she had “no choice” but to keep working while COVID-19 cases in the Philippines began to rise. 

This was particularly risky for Fugero, a breast cancer survivor and a diabetic. But even though the virus scares her, Fugero said she won’t get a COVID-19 vaccine because she fears its effects in light of her comorbidities.

“I’m afraid because I had breast cancer, because if I take [the COVID-19 vaccine], I might suddenly get weak.”

“It’s still in its beginning stage,” Fugero said through a translator. “I’m afraid because I had breast cancer, because if I take it, I might suddenly get weak.”

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Fugero said she’s heard stories from friends about people getting the vaccine, becoming weak and then dying. She plans to wait “a long time from now” to make sure the vaccine is safe — and it’s a sentiment her whole family and much of her neighborhood shares. 

Vaccine hesitancy is a nationwide problem in the Philippines, despite the archipelago having one of the worst COVID-19 infection rates in Southeast Asia. Cases have topped 1.1 million, mainly in the Metro Manila area; over 19,200 people have died. 

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Meanwhile, the vaccine rollout has been slow. 

To date, the Philippines has only inoculated less than 1% of its population of more than 108 million people. Still, even as doses trickle in, most Filipinos are hesitant to get the jab. A Pulse Asia survey released earlier this year revealed that 6 out of 10 Filipinos didn’t want to get vaccinated. 

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There are many reasons why, including rampant misinformation passed by word-of-mouth and conspiracy theories spread online about the vaccines. 

Many Filipinos also say they don’t want to get vaccinated because there aren’t yet enough vaccines in the country for everyone to get inoculated properly or that they’re waiting for better options to arrive. Most of the doses that have come to the Philippines are from China and not as effective as Pfizer or Moderna. 

Additionally, vaccine appointments can be an arduous, inefficient and time-consuming process that has many people thinking twice about whether it’s worth it. 

This has health professionals understanbly frustrated, particularly since just a handful of years ago, the Philippines had some of the highest vaccine confidence in the world. 

Vaccine trauma 

So what went wrong? 

Experts point to the DengVaxia controversy as the reason Filipinos lost faith in vaccines so quickly. The debacle, which involved a Dengue fever vaccine made by the French pharmaceutical company Sanofi, continues to loom large in the minds of Filipinos.

“Dengue fever is an endemic disease in the Philippines,” said Dr. Madeline Ong, a researcher at Ateneo School of Medicine and Public Health. “So in 2016, when the dengue vaccine, or more commonly called DengVaxia, became a viable vaccine as recommended by the WHO [World Health Organization], it was a big deal for the country.”

The program, which aimed to vaccinate 1 million 9-year-olds through their schools, was rolled out in April 2016.

Then, more than a year later, Sanofi came out with a devastating statement that basically said: Children who have never had dengue fever would be at a higher risk of getting hospitalized or having a severe case of dengue if they’re infected after getting vaccinated with DengVaxia. 

After that, Ong said things “spun out of control.”

Related: The biggest challenge for vaccine workers in Pakistan? Staying alive. 

Stories of mothers who believed their children had been harmed by the vaccine spread like wildfire. Government agencies publicly blamed each other, emotional hearings were broadcast and an investigation was launched. 

“I think this [dengue fever] controversy sort of ran in a protracted nature. … It wasn’t a one-week or a month event. We were hearing about DengVaxia for a really long time.”

“I think this controversy sort of ran in a protracted nature,” Ong said. “It wasn’t a one-week or a month event. We were hearing about DengVaxia for a really long time.”

Even though the deaths of only three children were found to have been linked to DengVaxia, Ong said public confidence was crushed. Surveys following the controversy found that the Philippines’ confidence in vaccines tanked from 93% in 2015 to 32% in 2018. 

Dr. Joshua San Pedro, with the Manila-based nonprofit Coalition for People’s Right To Health, which earlier this year gave the Philippine government’s response to the pandemic an “F,” said he’d prefer to say the country is traumatized rather than hesitant. 

Health professionals have their work cut out for them, he said because a lot of the public just does not believe the government will have their backs if something goes wrong with the COVID-19 vaccines, too. 

Government information about vaccines has been prolific but it has also been confusing and even contradictory at times. For instance, earlier this month, President Rodrigo Duterte got inoculated with China’s Sinopharm vaccine, which isn’t even one of the seven approved vaccines in the Philippines’ arsenal. 

Related: France launches citizens’ collective to tackle vaccine skepticism

After receiving backlash, Duterte sent many of the Sinopharm doses back to China. That same week, the WHO approved the vaccine for emergency use.

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San Pedro said bad messaging from the government “leads to a lot of fake news and misinformation.” His group is working to combat that with education and by meeting the public on a cultural level to calm their fears.

“Instead of scaring them by telling them that if they don’t get vaccinated you won’t be able to travel, you won’t be able to go to work, we are really focused on discussing it as a right.”

“Instead of scaring them by telling them that if they don’t get vaccinated you won’t be able to travel, you won’t be able to go to work,” he said, “we are really focused on discussing it as a right.”

Ultimately, though, getting vaccinated is a decision people have to make for themselves, San Pedro said, and it’s likely going to take some time for the Filipino people to gain back their confidence in vaccines.

Time they may not have.