Herd immunity: The battle against vaccine hesitancy in the Philippines

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Singapore: At the end of every month, residents in the Philippine town of San Luis tune into Facebook Live to watch the raffling of a cow.

Soon after the winning ping pong ball is drawn, the district’s mayor, Jayson Sagum, arrives at the house of the successful ticket holder and delivers the prize himself.

Jayson Sagum, the mayor of San Luis in the Philippines, presents a cow to a raffle winner.Credit:Municipality of San Luis

The scheme, which began in July and is due to run until mid-2022, was devised by Sagum as an attempt to reduce vaccine hesitancy in the municipality in Pampanga province, north of Manila, and on that score it has been a success, according to San Luis’s disaster management officer Ardee Taruc.

“Even if you only have your first shot you are already included in the raffle,” he said.

“But if you are fully vaccinated you have two entries for the raffle.”

About 15,000 of the town’s 60,000 population have now been fully vaccinated and have two tickets a month to win one of the cows, which have been donated by local business figures.

Supply of the vaccine, Taruc said, was now San Luis’s biggest problem.

“Vaccine hesitancy in our municipality has a low percentage because of the raffle,” he said.

“We are dependent on the supply of the provincial government. Of course, the provincial government is depending on the national government.“

The Philippines, which remains in the grip of the virus after more than 40,000 deaths, is a vaccine laggard even in south-east Asia, which aside from Singapore has been anything but a frontrunner on the rollout.

With less than a quarter of the population of 110 million fully vaccinated, gaining access to enough doses is a continuing issue even as infections have halved from last month’s peak of more than 20,000 a day.

But while there have been other incentive programs around the country like San Luis’s cow raffles, with bags of rice a common prize, vaccine hesitancy remains an enormous hurdle.

President Rodrigo Duterte last month raised the prospect of making vaccination against COVID-19 mandatory and this week the outgoing populist leader had another lightbulb moment.

“I know many people are still hesitant,” Duterte said. “That’s the problem. Those people do not want to get vaccinated.

“Let’s enter their houses and vaccinate them while asleep.“

Filipinos are at least more willing to have the vaccine than they were earlier this year, according to a recent survey by polling group Pulse Asia.

It found the percentage of respondents prepared to be immunised against the virus had risen from 16 per cent to 43 per cent between February and July.

However, that still left 36 per cent of the 2040 participants who said they were not going to have a vaccine, with a further 16 per cent undecided and the remaining participants having already had one or both shots.

Safety fears and concern about side effects were the primary reasons given for reluctance followed by questions about the effectiveness of vaccines in the Philippines’ inventory, more than half of which are Chinese Sinovac.

But the proliferation of disinformation particularly on social media, something the Philippines leads the world in time spent using, is a major obstacle.

Philippine President Rodrigo Duterte receives his second dose of Sinopharm in July.Credit:Malacanang Presidential Photographers Division

Philippine Foundation for Vaccines executive director Professor Lulu Bravo is helping lead a solidarity movement of medical frontliners trying to tackle fake news about vaccines and said hesitancy was largely among the elderly and those in low socio-economic groups.

“It’s mainly the influence of Facebook, false news, disinformation and the fact that [people] are not reachable by [government] campaigns,” she said.

A controversial world-first dengue vaccine rushed out to thousands of school children in 2016 also led to confidence in vaccines plummeting before the pandemic. The program was halted a year later when the French manufacturer revealed the vaccine, Dengvaxia, could potentially increase the risk of severe dengue for children who had not previously been infected with the mosquito-borne disease.

Three years later, there are still more than a dozen cases before the courts over deaths allegedly arising from Dengvaxia, although Bravo does not believe the vaccine was responsible.

She and other public health experts have tried to persuade the government to approve its use again in the Philippines.

“We feel it could lessen the hesitancy should the government bring it back saying there was no evidence, no proof, that Dengvaxia killed those kids,” she said.

“A lot of people cannot still forget about Dengvaxia, I can tell you.”

Dr Anthony Leachon, a former senior advisor to the Philippines virus taskforce, does not blame that scandal for the country’s COVID-19 vaccine hesitancy, instead taking aim instead at the government’s management of the rollout.

He said delays in the procurement of millions of Pfizer doses from the United States and the vaccination of Duterte himself with Chinese-made Sinopharm donated before it was approved for use highlighted the government’s failures.

Adding to Manila’s troubles is advice from a World Health Organisation expert group this week that a third shot should be given to people over 60 who have been vaccinated with Sinovac or Sinopharm.

“I think there is a widespread awareness of the public and the perception that Sinovac may not be effective,” Leachon said.

“I’m sure people are reading right now the efficacy rate of vaccines, considering every Filipino, I would say, has a relative or a friend in the US.”

Leachon is far from alone in the medical fraternity in fingering government shortcomings for the Philippines’ woes.

With the Senate in Manila investigating accusations of corruption in the awarding of COVID-19 supply contracts, a group of more than 300 doctors and prominent medical identities released a statement on Tuesday slamming authorities’ handling of the virus, saying “unmitigated and shameless greed is being flaunted to our faces”.

“The Filipino people are losing their lives, their livelihood and their hope,” the statement said.

“What more proof is needed to convince us that the respect that they deserve from their leaders has been wanting at best, and nil at worst?“

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