Vaccine preference: A matter of trust

The main problem that COVID-19 vaccine rollouts everywhere have had to confront is vaccine refusal or hesitancy, not brand preference or vaccine “choosiness.” Vaccine preference has been observed particularly among those who have already made the decision to be vaccinated. This suggests that, rather than being a mere expression of colonial mentality — as presidential spokesperson Harry Roque derisively calls it — this pickiness could be the product of rational calculation.

In banning the disclosure of the brand of vaccine to be administered until just before the vaccine is given, President Duterte may be violating the right of informed consent. But, more than this, he could be sowing the seeds of further distrust in the vaccination campaign itself.

Studies have noted that people who refuse or are hesitant to be vaccinated are mostly worried about the adverse or side effects. If they are fit, they may believe that their natural immune system is enough to protect them from the COVID-19 disease. If they have health problems, they may think that the adverse effects of the vaccine, no matter how mild or temporary, could trigger a condition their bodies might not be able to take. In their view, therefore, these vaccines are either unnecessary or potentially harmful.

Those who have overcome these fears and are willing to be inoculated remain in the minority in many countries, including ours. The most recent Pulse Asia survey puts this number at 16 percent, with 23 percent saying they have yet to make up their minds. In contrast, 61 percent of the respondents said they would refuse to be vaccinated against COVID-19. This figure is much higher than the 47 percent recorded in its January survey.

On the other hand, the latest Social Weather Stations (SWS) survey reports figures showing a higher acceptance of vaccination — quite possibly because the fieldwork was conducted (April 28-May 2, 2021) just after the sudden spike in new COVID-19 cases heightened public fears of the disease. The SWS study found that 32 percent were willing to get vaccinated, 33 percent were unwilling, and 35 percent were uncertain. These are the most encouraging numbers we have seen so far.

With the expected arrival in the coming months of more vaccines from other manufacturers, it is reasonable to assume that vaccination willingness may further improve, especially if more neighborhood vaccination sites open up, waiting times are shortened, and the process of enlistment is made easier. I think we may also expect that those who, after much thought, have decided to be vaccinated, will want to have a choice as to which vaccine to get once more COVID-19 vaccines become available. Understandably, this may compound the problems of the vaccine rollout, but it is something that cannot be ignored.

A study done in Canada set out to determine “if Canadians actually care which vaccine they get” and what the reason for this might be. In a report published in March 2021 by the Public Policy Forum, professor Peter Loewen writes: “The answer is yes, and to a degree which may matter materially for the distribution of vaccines.”

Like the Philippines, Canada has tried to solve the problem of vaccine procurement amid uncertain global supply by getting COVID-19 vaccines from various sources. Accordingly, federal regulators have approved the vaccines produced by four companies, namely: Pfizer-BioNTech, Moderna, Oxford-AstraZeneca, and Janssen. (The study was done before Janssen was added to the list.)

Due to space limitation, I will not discuss the study’s interesting methodology. But here are its key findings:

Canadians prefer the Pfizer and Moderna vaccines to the AstraZeneca vaccine;

Canadians evaluate the efficacy and safety of Pfizer and Moderna higher than AstraZeneca;

Differences in brand preferences exist among those who are vaccine willing, not those who already express vaccine hesitancy; and

The performance features of vaccines matter for Canadians’ vaccine preferences, and these effects are more pronounced among those already willing to take vaccines.

The study examines what is behind vaccine preference, and why it seems more pronounced among those who are ready to be vaccinated than among the unwilling and undecided. The short answer is: The willing are precisely those “who follow science more closely.” To these people, the vaccine’s country of origin was not important; protection against mild and serious illness was. But—what mattered most to them was the effectiveness of the vaccine they are taking against the variants!

This was the study’s most fascinating finding, and it’s worth repeating it: Vaccine choice figures most prominently among those who, having followed the science and listened to the experts, are concerned to know if the vaccine they are getting will protect them against the new variants. To them, vaccines are not created equal.

The findings from the Canadian study may or may not apply to Filipinos. But, whether or not vaccine preference reflects unexamined cultural biases, it is important to remind those who make decisions in our name that “public beliefs matter, because they guide behavior.” This is true for any society.

Even if the beliefs of ordinary people may not always accurately reflect findings from clinical trials and from the real world, telling them they cannot choose because the authorities say “the best vaccine is the one that’s available” is no way to build trust in vaccines.