Misinformation, infighting, backlash, and an ‘endless’ recovery; policymakers recount challenges and mitigating measures after a vaccine scare in the Philippines

Figures & data

Figure 1. Description of study recruitment, data collection and analysis.

Table 1. Demographic profiles of the respondents.

Characteristics	(n = 19)	%
Sex
Male	5	26.3%
Female	14	73.7%
Civil Status
Single	7	36.8%
Married	12	63.2%
Age Group
<30 years	1	5.3%
30–40 years	6	31.6%
41–50 years	5	26.3%
>51 years	7	36.8%
Cadre
Medical Doctor	16	84.2%
Registered Nurse	1	5.3%
Communications officer	2	10.5%
Number of years working as policymaker (within a vaccination specific role)
<10 years	13	68.4%
10–20 years	4	21.1%
>20 years	2	10.5%

Figure 2. Policymaker’s perspectives on a vaccine scare and actions taken to bolster vaccine uptake in the Philippines.

Table 2. Experiences and perceptions of policymakers on vaccine scare in the Philippines.

Themes	Illuminating Quotes
The scare – the case of Dengvaxia
Loss of trust, distorted narratives and personal guilt	‘So, that time [during the Dengvaxia controversy] we had to move around every school. I was with people from the Department of Health (DOH), whom I didn’t know, and only met there and then … It was hard … being the punching bag of somebody and I don’t like that. No one should lie and just tell the parents the truth, that it was not the Department of Education (DepEd)’s program alone. It was the program of the government … it was a tripartite [of DepEd, DOH and Executive Branch of the government], a collaboration but the main decisionmakers are not from DepEd right?’ [MD, 20 years]
	‘I felt ridiculous for one thing to see how the government allowed non-scientific people to distort the narrative … That has damaged the reputation of the Department of Health, the programs it has managed … including those who were involved in the decision making …. We felt very ridiculous and betrayed by those who proclaim to be experts in public health … and they have caused great disservice by alluding to something that is not true.’ [MD, 4 years]
	‘The rumors spread very quickly … the social media facilitated the spread of inaccurate information that isn’t helpful. It has been very damaging … and we suffered a lot.’ [MD, 2 years] ‘Oh my God. Oh my! I got pissed with those [false information]. The TV is exaggerated. … You can see the reaction of the mothers “Hey! Let’s not get vaccinated, that is deadly”. You know, these rumors that are not true spread quickly.’ [MD, 16 years]
The fallout unfurls – domino and spillover effects
Spillover effects to other vaccine programs and beyond vaccination	‘So, ah dengue vaccine had a negative impact on the overall national immunization program in the Philippines. But I don’t want to take dengue vaccine as a sole issue. … However, I agree to some extent it has caused some public distrust.’ [MD, 20 years]
	‘But of course, there is really fear, we even see its effect in our deworming program … Our coverage was 63%, then there was Dengvaxia, it goes down to 32%. … imagine how our deworming program became the collateral damage.’ [MD, 16 years]
The fallout deepens amid the COVID-19 pandemic
Challenges to maintain vaccination structures and COVID-19 vaccination discourses	‘In some areas, vaccination coverage declined by more than 50% [during COVID-19]. … Because of the community lockdown, the health center cannot deliver wider services … the parents cannot go out of their home; health workers also cannot move freely.’ [MD, 29 years]
	‘So, with the COVID vaccine introduction, we must be very careful … COVID vaccine also can suffer the same fate as the dengue vaccine. … I am a little worried that people again will distrust again the routine immunization, also because antivaccine group might use this opportunity.’ [MD, 20 years] ‘If there is any consolation in this COVID pandemic, it is that people are more aware of the vaccine. … Hopefully it will bring back that kind of confidence to all vaccines.’ [MD, 2 years]

Table 3. Strategies to bolster vaccine uptake in the Philippines.

Key Findings	Illuminating Quotes
Rebuilding trust in the government
Transparency	‘[The government] should have only one voice, and be open … You have to be sincere, provide a level of openness and sympathy to the people, that is very important at the service delivery. We should not force the people … we should not hide some information to the people you know, we should be open.’ [MD, 20 years]
Clear vaccine messaging
Tailor-fit communication (highlight benefits, discuss the risks)	‘I think what you should talk about is how are we going to communicate risks to the public. So, you don’t need to tell the mothers each issue and all detail about the molecular issues, you know … You make them scared. But you cannot hide those, so you must find the balance … Again, it all depends on the mother’s knowledge.’ [MD, 20 years]
Traditional media education	‘We should educate the media people first. If the media become aware and educated, then they will communicate correct messages. Because they know what the truth is … The dangerous thing is when these people don’t know what the truth is. They are just like an intermediary between the government and the people. That is the risk.’ [MD, 16 years]
Use of social media	‘One is to innovate the marketing skills, making it simpler, easy to understand. And they [the World health organization] really has to convey a good picture how beneficial it [the COVID-19 vaccine] will be. That can be turned into a presentation ... maybe delivered via social media or Facebook.’ [MD, 5 years]
Engage with religious leaders, celebrities and/or public figures	‘You [should] consider the local context and make use of specifically local influencers. So, it could be the mayor or maybe the wife of the mayor or the governor. It will help a lot.’ [MD, 16 years] ‘We sit down with the religious leaders [and] discuss the importance of vaccines … in ensuring the communities’ safety. Then, we arrive at an agreement. Once we have that agreement, mothers agree for vaccination.’ [RN, 2 years]
UnderstandVH groups	‘The first thing you need to do is read about the antivaccine group … Read about them very well, what they are saying. What they do is, they twist science … so that is the place where you must go and check correctly. You must answer that point. Don’t go and say this is a scientific vaccine, that this is based on science.’ [MD, 20 years]
Fostering HCWs’ communication skills
Risk communication	‘The people have great respect for the clinicians. And remember when there are problems with the vaccines, they go first to the hospital … When the doctor says “Oh, this is because of the vaccine”, game over … we are done. The doctor is knowledgeable to properly advice, but you know the doctor should nicely communicate it … For me, the number one priority is our clinicians.’ [MD, 20 years]