THE DEPARTMENT of Health (DOH) declared a polio outbreak on September 19 after confirming the Philippines’ first polio case in nearly two decades since being hailed free from the disease in 2000. The DOH confirmed another case only a day later. Before these cases, the nation was rocked by two massive disease outbreaks in the past year alone: Dengue and measles. However, these outbreaks could have been prevented by herd immunity—a phenomenon wherein even unvaccinated members of the community are “walled-off” from the disease due to high immunization rates.
The Sanofi Pasteur Dengvaxia scandal of 2017 kickstarted the wide-scale vaccine hesitancy in the country when 19 children who received the vaccine in a government-sanctioned immunization program supposedly died of dengue after being vaccinated. One year later, the Department of Health (DOH) claimed that only 60% of children were receiving their scheduled vaccinations, far from the annual target of 85-90%.
For many parents, the controversy decreased the credibility of healthcare professionals and their trust for any kind of vaccine. In response, various programs to promote immunization awareness have been launched. In line with a worldwide campaign called “Protected Together: Vaccines Work!”, UNICEF Philippines, the DOH, and the World Health Organization held community engagement services to give on-site injections and educational seminars in April 2019. Despite this, the public is yet to fully trust the practice of vaccination.
However, wide-scale attempts to convince the public of the safety of vaccines will remain ineffective unless we lend an ear to the reasons for such fears. Rebuilding public trust is not an isolated endeavor, it involves a collaborative, multi-sectoral effort from national and local government units, non-profit organizations, and community leaders.
Facing the enemy
Discourse on the ground must be brought to light. Authorities must take into account the public’s subscriptions to traditional and religious healing practices as well as their indigenous beliefs about healthcare—health initiatives must not impose sudden change, but exhibit respect and sensitivity to the customs of the people.
A study published in the Journal of Community Genetics presented cases in which Filipino patients heavily relied on cultural beliefs, such as sumpa, namaligno, or kaloob ng Diyos, to determine and address the cause of illnesses, rather than to seek proper medical procedures. Community health workers who tried to administer vaccines were even tagged as “child-killers” and were chased out by stone-throwing parents who feared for their childrens’ welfare. In the Aeta community of Nabuklod, healthcare officials were shunned after the Dengvaxia scandal broke out because of a belief that any harm that comes to a child will affect their parents as well.
Much has been invested on mass immunization programs, but little has been done to open avenues for the public to air out their concerns on vaccines without the threat of being belittled by healthcare professionals.
The absence of conversation, accompanied by information that does not directly address their apprehensions, may make parents and guardians feel ignored by healthcare providers, further fueling the misunderstanding and fear of immunization.
A herculean task
Key institutions will have to engage with the discourses on the ground. Creating spaces for dialogue with the citizens is a collaborative, multi-sectoral effort from government and non-profit organizations, medical professionals, community leaders, and the general public. Townhall discussions, door-to-door campaigns, and forums can be organized at the barangay-level to be able to craft more specific, directed, and culturally-sensitive campaigns towards the issue.
After the declaration of the polio outbreak, Secretary of Health Dr. Franciso T. Duque III urged parents, healthcare professionals, and local leaders to take on more active parts in the vaccination drives nationwide.
However, it is not enough to call for people to believe in immunization after two years of widespread distrust. There must be a reassurance that their fears and apprehensions are being heard and understood by those in charge. The government must be willing to lower themselves to the ground, speak with the communities affected, understand—and not condemn—their cultures, and collaborate with them to reach the goal of eliminating vaccine hesitancy and achieving a better state of public health for all.
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