Behind vaccine hesitancy

The latest Pulse Asia findings on Filipinos’ attitudes toward the COVID-19 vaccines, though not unexpected, still must have come as a surprise to those in charge of the vaccine rollout. Released last Friday, when the country registered its highest number of new coronavirus cases per day at almost 10,000, the results showed that only 16 percent of those surveyed are ready to be inoculated, 61 percent will refuse, and 23 percent are undecided.

Instead of diminishing, vaccine hesitancy among our people has gone up. Using face-to-face interviews with a random sample of 2,400 respondents, the study was conducted from Feb. 22 to March 3, just when the first donated vaccines were starting to be administered to frontline health care workers. A previous Pulse Asia survey, done in January this year, showed only 47 percent were unwilling to be vaccinated.

The hesitancy appears to cut across regions and socioeconomic classes. It is not something one can easily dismiss or reverse. People are very much aware of the risks of catching the virus. Ninety-four percent of respondents, the same survey reports, are anxious that they or their families could get the disease. Yet, the majority don’t see the vaccines as the solution. Even if offered free, they will refuse inoculation out of fear of adverse effects.

This fear is not irrational. The top reason cited by 84 percent of those who resist vaccination is the safety factor. This is followed by the uncertainty they feel about these vaccines’ effectiveness in stopping the spread of the virus.

It’s important to know not just the reasons people give for their hesitancy, refusal, reluctance, or skepticism. It is equally essential to understand how they commonsensically arrive at their own conclusions.

Consider the safety issue. I think that, by now, many people know that these vaccines are all new and are indeed experimental. They have also heard of potential adverse effects like blood-clotting, which, even if rare, only confirms their generalized anxiety over the unforeseen effects of anything being injected into the body. As our kasambahay put it: “Minadali kasi, kaya hindi pa alam kung ano’ng mga epekto nito sa katawan (Their development was rushed, so no one really knows their effects on the body).”

I believe this concern is not entirely unfounded. These new vaccines have not undergone trial over a long period. That’s why government regulatory bodies everywhere have given them “emergency use authorization,” rather than full approval.

The authorization is based on favorable “interim” findings from ongoing clinical trials attesting to their general safety and relative efficacy. Experts themselves say it typically takes many years before vaccines are fully approved for general public use. But, since the world faces an emergency, countries find themselves having to decide whether to buy and use these vaccines now, or to wait for more definitive findings about their efficacy and safety.

The vaccine manufacturers themselves are quite open about their products’ limitations. Even as they are keen to introduce them into the global market, they are not prepared to accept liability for their general use. Governments that decide to administer these to their citizens must themselves shoulder the indemnification of any harm or injury on persons that may result from their use. This condition, I suspect, was initially rejected by the Duterte administration, which is why it was late in ordering the vaccines.

How is a reasonable person supposed to take this? In the ordinary course of things, I suppose that patients (or their relatives), who must choose between the certainty of death and the small chance of getting well, would generally grab the cure offered by anything experimental. So, too, governments facing the reality of rising deaths and overcrowded hospitals might easily see the justification for acquiring the experimental vaccines.

But, the choices are not anything like that at the personal level. The average person will likely not view the situation as a choice between becoming gravely ill or dying and getting well. The ordinary person is not a patient; he or she is not unwell. Between getting inoculated as a protection against being sick and refusing an experimental vaccine that may or may not cause adverse effects—majority of Pulse Asia’s informants are saying they would forego the vaccine.

Informed choice is very important. But, one must wonder if there’s not too much and too little information out there at the same time. There is too much information about the pace of vaccine rollouts in different countries and the mad scramble for the limited supply of vaccines in the world market. There’s also too much information and alarm about the rising number of deaths and new infections.

But, in contrast, there’s very little information about: the efficacy of these vaccines against the new variants, whether they protect against severe disease or also against infection, the duration of the protection they give, whether there will be a need for follow-up booster shots in the future, and, indeed, what adverse effects/events have been most notable among the vaccinated—just to mention a few.

As an educated layman seeking to know more about these issues, I have spent a lot of time reading reports written by reputable science reporters. On the basis of this limited knowledge, I myself have decided that I will take the vaccine. But that’s just me. I’m not in a position to tell others who resist the vaccine that they are wrong. We’re both treading on supposed knowledge.