When Ken Alambra and Reina Sagnip started developing the Vaccine Queue Calculator — a website that estimates when an individual can get vaccinated — they created a formula that estimated that at least half of Filipinos would want to receive the vaccine once the government started rolling it out.

But most recently, Sagnip, a researcher at Omni Calculator, shared, “[We] updated the calculator because we saw a survey that said now only 32% of Filipinos would be willing to get the vaccine.” She was referring to the First Quarter 2021 Social Weather Survey, a nationwide survey, conducted through face-to-face interviews that revealed roughly only 3 out of 10 Filipinos are willing to be vaccinated.

The remaining seven either responded “uncertain” or “unwilling”, including Marco*, a 28 year-old social media specialist living in Makati City. “As an individual, nothing will change if I get vaccinated; I still need to wear a mask,” he said. “I can still get COVID — albeit a milder form. I can still be a carrier.”

Marco is one of the vaccine-hesitant: the 33% of respondents in the country who remain unwilling to get vaccinated.

“Vaccine hesitancy can be viewed as a continuum between vaccine refusal and vaccine acceptance, with most people somewhere in between most of the time,” said Unit Head of Research at San Beda College of Medicine, Dr. Julius R. Migriño, Jr.

Physician, scientist and World Health Organization (WHO) Digital Health Expert, Dr. Melvin Sanicas, who has spent over ten years working on drug and vaccine development around the world said, “Vaccine hesitancy is really complex and context specific, it varies across time, place and different vaccines… Vaccine hesitancy does not mean someone is an anti-vaxx. Most people just want to have more information to allay their concerns.”

At the moment, that information comes from channels both official (e.g. Department of Health, World Health Organization) and unofficial (i.e. peers discussing among themselves). Official channels are consistent in the message about three things:

1) How vaccines work (either it contains a weak version of the virus, training your immune system to recognize it and create antibodies; or in the case of mRNA vaccines, contains a blueprint for your cells to make a protein that triggers an immune response to produce antibodies).

2) The level of protection: While a vaccinated individual’s chances to contract COVID-19 do not drop to 0, vaccination lessens the severity of symptoms if you do contract it.

3) Safety protocols: Widespread inoculation does not equate to the total abandonment of mask-wearing, social distancing, and other safety protocols that emerged to reduce exposure, i.e. protect not just oneself, but the people around you.

As of July 27 only 7.9% of Filipinos have been vaccinated — despite over 27 million vaccine doses arriving in the Philippines (which can fully vaccinate 14.11% of the population.) Another 13.5 million doses (a combination of Sinovac, Sputnik V, Moderna, Novavax, Johnson & Johnson, and AstraZeneca) are expected to arrive this month.

According to National Task Force Deputy Chief Implementer Vince Dizon, the daily target is 500,000 daily vaccinations (whereas the current average is 250,000 shots per day).

But challenges surrounding logistics and access to supply delay deliveries of COVID-19 vaccines and slow down the country’s inoculation efforts.

Harder to probe are the effects of mindsets on the pace of inoculation. Two sentiments stand out in the SWS survey: a lack of trust, and disbelief that the vaccine is effective.

“Next time na lang”

Among those who are either uncertain or unwilling to get vaccinated, a primary reason cited is the fear of unintended effects on the body, which itself roots from information circulated online that the vaccine was developed too quickly (a claim that is refuted by scientists who say they were able to rapidly develop a vaccine not by trimming down the time spent on necessary steps, but by working on multiple steps simultaneously).

43 year-old banker Johnny* said, “‘Di pa ako convinced sa mga studies, rushed kasi yung vaccine eh. What if may mangyari sa akin lalo na dahil may high blood ako? (I'm still not convinced with the studies. The vaccine was rushed. What if something happens to me especially because I'm hypertensive?)”

59 year-old housewife Beth* echoed this sentiment. “It seems as if it was rolled out too quickly… We don’t really know what will happen after you get the vaccine. We don’t know what that will do to the body years from now.”

Camille, 25, a daughter of a family running a pharmaceutical company, shares that her parents ironically don’t give her and her siblings medicine when they’re sick, just vitamins and organics. “[Because] they know exactly what’s inside drugs, its chemicals, and what the different side effects are,” she said. “Whatever chemicals you put in your body, it could end up affecting you differently. I’m extra cautious because I [had] Bell’s Palsy and I couldn’t move half of my face. Until now, my neurologists don’t have a final answer for what caused it apart from that it was a random side effect. But what they told me is if my immune system was down, I could’ve gotten a virus from wherever and it could’ve attacked my system because it’s low.”

29 year old driver Nikko* also prefers to practice caution. “Nagbabase po kasi ako sa salita ng Diyos (My actions are based from the word of God),” he said. Nikko is a follower of Members Church of God International (MCGI). “Hindi ko naman kailangan ng mga [vitamins]. Para sakin, parang pinapakialaman mo yung katawan na bigay ng Diyos mo sa iyo… Paniniwala ko sa Diyos na kung hindi [ako] gumagawa nang labag sa utos niya, eh syempre, aalagaan niya ako. (I don't really need vitamins. For me, it's like you're tampering with the body that God gave you... What I believe is that if I don't do something that is against God's will, he will take care of me.)”

39 year-old security guard Jeffrey* said, “Kapag nilagnat po ako o kung ano pang side effects ‘yung mangyari, hindi po ako makakapasok sa trabaho (If I get fever or other side effects, I can't go to work).” Wary of downtime should he take the vaccine, the breadwinner of a family of six instead practices frequent handwashing, mask-wearing and social distancing. “Next time na lang po yung vaccine (I'll get the vaccine next time),” he said.

Similarly, Beth* said “It’s all in God’s time if I am meant to get the vaccine.” Regularly seeking guidance from her church’s pastor — including whether to get vaccinated or not, she shares that she already had a [vaccine] schedule. “But an admin personnel of that site called me a day before and told me I was suddenly waitlisted.”

Like Nikko, embedded in her questions of faith is a question of safety — something Migriño cited from a study published in the scientific journal Vaccine, which examined the interpretations of people who decline vaccination due to various religious reasons. “One international study showed that it is likely that people who refuse vaccines allegedly because of their religious beliefs may actually have underlying issues more akin to vaccine safety,” he said.

This hesitancy with vaccination is also shaped by our country’s history and events like the Dengvaxia controversy that started in 2017. “There are a lot of articles and some studies that point to this event as dealing a significant blow to the vaccination efforts of the government in that it decreased the vaccine confidence of people,” Migriño explained. The public health controversy concerns aiding dengue with the use of the Dengvaxia vaccine, created by French pharmaceutical company, Sanofi Pasteur. When reports alleging that a number of children had died because of the vaccine circulated, the Department of Health (DOH) suspended the school-based vaccination program in late November 2017.

According to an ongoing dissertation authored by Karl Patrick Mendoza, a PhD Research Candidate in Media and Communications, vaccine hesitancy is enabled by a particular culture of distrust formed by online news discourse on the Dengvaxia vaccine controversy. “Some even argue that the issue may have contributed to the drop in vaccination rates in 2018, the year which saw record-breaking increases in measles cases, [which is] one of the vaccine-preventable diseases,” said Migriño.

Perceived effectivity and urgency

In a webinar on COVID-19 vaccines and misinformation hosted by the Royal Society for Public Health last July 14, Sanicas explained through e-mail correspondence: “Vaccine decision-making is very complex — influenced by social norms and lived experience — not just access to facts. Now information flows in multi-directions, it is harder to trust expert sources.”

In the Philippines, this is illustrated by the conversation around efficacy rates — or performance in controlled clinical trials — of available vaccines.

To wit: Pfizer-BioNTech, an RNA vaccine, has an efficacy rate of 95.3% which means that people who received the vaccine during clinical trials were found to be at 95.3% lower risk of developing the disease compared to those unvaccinated. Moreover, it also reduces risk for hospitalization by 94% among older adults.

This information is readily available, if one can parse the string “Pfizer-BioNTech (BNT162b2): 95% (94.7%, 95% CI 90.3 to 97.6%) against symptomatic COVID-19, seven days after second dose” published officially in a node of the DOH website.

But more likely, the information reaches regular citizens through discussions in family chats, messaging groups, or with close personal friends or physicians.

36 year-old Tina*, who is pregnant with her first child, said she had originally planned to fly to the U.S. to get vaccinated because she wanted to get Pfizer-BioNTech vaccines — the only brand she would allow herself to get due to the sensitivity of her pregnancy. “Just so we can protect ourselves, protect the baby. It’s just better overall. If we can afford it, we can go, why not? And that was a big consideration. But thankfully, as we were planning to leave, the Pfizer vaccines arrived [in the Philippines] so we decided to try to get it here.”

Similarly, 72 year-old stroke survivor and kidney transplant recipient Paul* is holding out for a specific brand of jab. “Ang rinecommend lang kasi ng doctor ko ay Pfizer or Moderna (My doctor recommended Pfizer or Moderna). I was advised that I couldn’t take anything else because of the transplant.”

His daughter Maine*, 25, is more flexible: she immediately signed up for the vaccine when it was offered to their student body. “I live with immunocompromised people like my dad and my mom and with rumors that face-to-face classes [are resuming], instances where I have to see patients, I am terrified of bringing home a virus to them.”

26 year-old operations manager Melanie* had grown accustomed to reading the daily updates on the growing numbers of reported cases, but felt the virus drawing closer during the uptick in cases reported last March. “First, it was my aunt then it was my friend; after that came my friend’s mom or my friend’s dad followed by other people who are so close to me.” Soon after she signed up under the A3 category, she received her schedule for her first dose at her local LGU in Quezon City.

“We want to inform people because we don’t want them to just rely on emotions that just because the vaccines have finally arrived, it means we are done with the pandemic.”

 

Like the rest of those CNN Philippines Life spoke to, the numbers weren’t actually a concern but rather, knowing people who might be affected by one’s action (or inaction).

Sanicas offered an explanation on how most individuals interpret and understand reported figures surrounding COVID-19 vaccination. “Most humans don’t have a natural facility with numbers and probability. It’s not intuitive. When you tell someone that the chances of getting a particular vaccine-related adverse event is 1 in 1,000,000 they think it’s too high but when you tell them that 1-2% of those infected with COVID can die, they feel that the risk is too low so COVID is not a big deal.”

Since it’s impossible to know the true denominator, or the actual total number of infected individuals (“unless you test everyone”), he urges reporting bodies to make things more relatable or descriptive. “Say 3.3 billion doses of vaccines have been given, that’s more than all the population of China and India combined. And COVID has killed four million so far. Imagine the Philippine Arena with a seating capacity of 55,000. Four million is almost 73 Philippine Arenas.”

To this end, efforts like the Philippines Vaccine Queue calculator and Herd Immunity Tracker aim to provide the public with better information. “We want to inform people because we don’t want them to just rely on emotions that just because the vaccines have finally arrived, it means we are done with the pandemic,” Sagnip, who is trained in communications research, explained. “We don’t want to scare people, but we need them to know the reality [and] to have an idea of how long the pandemic might last.”

Persuading self and others

To persuade more people to take the vaccine, organizations and local government units are carrying out initiatives that address concerns among the hesitant, or incentivize with a freebie. These include Quezon City’s Bakuna Nights, which provide immunization for employed citizens after working hours, Vice President Leni Robredo’s drive-thru bakuna service Vaccine Express, and Love Yourself PH’s vaccine registration drive where they gave out free condoms and lubricants after the second dose. Restaurants and dining establishments have also set up discounts, incentives, and promotional schemes for vaccinated individuals. Private companies and businesses have also taken action to procure their own supply to protect their employees.

Mark*, a 26 year-old co-founder of a small and medium enterprise, placed an order for Moderna vaccines for their lean team of employees last April. “Our employees were having a difficult time procuring vaccines from their respective LGUs. The online sign-ups for LGUs would usually take a long time to process, and most of the time, there wouldn’t be any confirmation at all so [our team] felt lost,” he said. Mark also considers their decision to purchase vaccines for their employees as their contribution to herd immunity. “A lot of businesses have been hit hard by the pandemic and we want to do all we can to improve the outlook of the economy.”

Now, Melanie*, an operations manager of a local food kiosk chain, is feeling the urgency. “Suddenly, these numbers started to have faces and they were faces I actually knew.”