Commentary: A playbook for dealing with vaccine hesitancy

Vaccines are important because they 1) prevent severe disease and death 2) prevent even mildly symptomatic disease 3) prevent transmission of disease and 4) enable countries to reopen their economies. Vaccines were developed more than 200 years ago but in the 21st century, they are still recognized as a leading public health achievement, second only to reductions in child mortality, ahead of access to safe water and sanitation, and the prevention and control of malaria, tuberculosis and HIV/AIDS.

Before the measles vaccine became widely used in the 1960’s, hundreds of thousands of children contracted the disease and tens-of-thousands of them died or were left with disabilities. Measles is not the only vaccine preventable disease. The list grows longer and includes among others: smallpox, rubella and mumps, Hepatitis A and B, chicken pox, polio, influenza, diphtheria and tetanus.

If we relate that to the present experience with the use of vaccines for COVID-19, we can look to Israel for an example. Among the elderly, who were the first beneficiaries of COVID-19 vaccines in that country, the vaccine was found to be 98.9% effective at preventing hospitalizations and death. Presently, when more than 70% of adults have received their complete vaccinations against COVID-19, Israel has relaxed its rules on using face masks and social distancing.

The country is well on its way to resuming life as it was before the pandemic. The Israel experience demonstrates that COVID-19 vaccine works and we are hoping that we get our vaccination program really going soon. Right now, we are experiencing the biggest surge of COVID-19 in the country, with new cases averaging about 10,000 a day.

With our poor performance in testing, tracing, isolating and treating, it looks like our only way out of this pandemic is to vaccinate ourselves into herd immunity.

There are many aspects to getting a vaccination program working successfully, we need a steady supply of vaccines, we need the logistics to get them ready for administration and we need people to vaccinate. Not everybody is ready to get vaccinated and vaccine acceptance in the Philippines is a problem that we have to confront in this pandemic.

A study conducted by Larson et al shows that in 2015, 93% of Filipinos thought that vaccines are important, 82% thought that vaccines are safe and 82% thought vaccines are effective. In 2016 however, Dengvaxia occurred and by 2018, vaccine confidence in the country had dropped to an all-time low. In 2018, only 32% thought that vaccines are important, 21% thought that vaccines are safe and 22% thought that vaccines are effective.

The false narratives and accusations propagated against Dengvaxia and the people involved in the Dengvaxia vaccination program all served to make Filipinos fearful and distrusting of vaccines, big pharma, doctors and scientists and the government, particularly the Department iof Health and the Food and Drug Administraion. The loss of vaccine confidence brought about by the Dengvaxia experience has been carried over to the COVID-19 vaccines.

The survey conducted by Pulse Asia in the beginning of March 2021 showed that only 16% of the 2,400 surveyed in the Philippines were willing to be vaccinated for COVID-19 and 61% categorically stated that they would not take the COVID-19 vaccine. Nearly all were afraid of contracting COVID-19 but 84% of those who opt not to get vaccinated were worried about the safety of the vaccine and 7% were worried that the vaccine was not effective. It is evident that the country has a large problem with COVID-19 vaccine acceptance that it will have to deal with.

What then is our playbook for dealing with vaccine hesitancy where it is associated with low levels of public trust in the wider health care system? We need to fight disinformation on both the Dengue vaccine and the COVID-19 vaccine. We need to convince the people that Dengue kills but Dengvaxia does not and that science tells us that Dengvaxia is safe, effective and saves lives.

We need to convince people that COVID-19 is dangerous and the vaccine for it is safe and effective and will save people from severe disease and death. We need to build people’s trust in science, scientists and physicians and the public health system. We need to debunk dozens of myths being propagated by anti-vaxxers against the COVID-19 vaccines.

Next in our playbook is correcting deficiencies in the provision of public health services particularly related to the pandemic. It’s hard to deny that our performance in testing, tracing, isolating and treating for COVID-19 leave much to be desired. Social protection and assistance to individuals affected economically by the pandemic has also been inadequate. Finally, we dropped the ball in our handling of vaccine procurement early on, leaving us scrambling to get a supply of COVID-19 vaccines adequate for our needs. I do think that the IATF and the DOH are trying their best but at the moment, their best does not seem to be good enough, so they really have to do more, do things at scale, and on time.

Finally, even as we fight disinformation about the COVID-19 vaccine and as we correct the deficiencies and inadequacies in the delivery of health and social services in this pandemic, we need to give people hope. We need to assure the people that we can get out of this pandemic by working together and helping each other, by following the health protocols and by getting vaccinated.

We fight disinformation and give hope through communication and community engagement. All of us who want to encourage people to follow health protocols and get vaccinated will have to develop and align our messages and platforms across the public and private sector. We need to recruit multiple champions and influencers, chief among whom are our health care experts, but also celebrities, local chief executives, leaders of faith-based organizations and many others. We ought to activate communities and community-based organizations to talk about our situation, what we can do for ourselves and how we can help each other.

We need to assure the people that all the sacrifices we made in the past many months are not in vain – that we will be able to overcome COVID-19 if we work together, follow the health protocols prescribed by the medical experts and get vaccinated as soon as our turn comes. More immediately, we can encourage them by the facts that when we and our families and friends have been fully vaccinated, we will be able to visit each other indoors without a mask and face shield and we can hug and stay close to each other again. It won’t be long before we can travel domestically without a pre or post travel test; we will be able to travel domestically and internationally without quarantining after travel and we will be able to travel internationally without a pre- and post-test depending on our destination.

We need to keep two things in mind, even as we all struggle to overcome the COVID-19 pandemic. The first is, no one is safe until all of us are safe, so we must take the vaccine when our turn to be vaccinated comes. The second is, until all who are eligible have been vaccinated and we have attained herd immunity, we must continue to follow the health protocols. Stay safe, everyone.

Dr Esperanza I. Cabral is an internist-cardiologist, public health advocate and co-convenor of the Doctors for Truth and Public Welfare. She also served as secretary of the Department of Health (2010) and Department of Social Welfare and Development (2006-2009).