Exploring the challenges and interventions of urban-poor vaccination in the Philippines

Keywords:

• Urban-poor
• vaccination
• institutional collaboration
• Philippines

This article responds to:

The urban-poor vaccination: Challenges and strategies in low-and-middle income countries

Dear Editor,

I came across an interesting article regarding urban-poor vaccination in low- and middle-income countries. The authors rightfully presented the challenges faced by these settings, which include informal employment, frequent migration, unfavorable vaccine scheduling, and some sociocultural factors. In the same way, the strategies recommended were active community engagement, multifaceted vaccination strategies, and adaptable/flexible immunization services.¹ I firmly support the authors’ claims and want to flesh out some of these challenges and strategies by presenting specifically the context of the Philippines, a lower-middle-income country. I also propose additional interventions to increase the vaccination rate in Metro Manila for better public health.

The Philippines’ current population (2024) is 118,811,224, based on the latest United Nations data projections. In Metro Manila, it is estimated at 14,941,953. These estimates represent the urban agglomeration of Manila, which typically includes Manila’s population in addition to adjacent suburban areas.² The country has become mostly urban due to migration. It is estimated that about 20% of the country’s urban population is poor. Of these, 96% live in houses with rudimentary flooring, and two-thirds do not have electricity and their own toilet. Only one-fourth is functionally literate and did not undergo any post-elementary education.³ Concerning employment, poverty is a result of low earnings rather than joblessness. Significant underemployment, rather than unemployment, poses a bigger challenge to the well-being of the urban poor. The majority of workers are trapped in low-skill and low-wage informal employment. The importance of wage incomes for urban well-being is evident, as 62.22% of the urban poor rely on wages and salaries for their primary income.⁴

On health matters, the urban poor have a very high disease burden, are prone to outbreaks, and have other unique health issues. Approximately 80,000 children under five years old die every year due to preventable and treatable conditions, such as vaccine-preventable diseases, diarrhea, pneumonia, neonatal disorders, and others.³ In September 2019, the Department of Health (DOH) confirmed the reemergence of polio (vaccine-derived poliovirus, VDPV) in the Philippines and declared a national polio outbreak. The reemergence comes almost 20 years after the Philippines had been declared polio-free in 2000. In the same year, there was also a measles outbreak. Based on the DOH’s Measles and Rubella Surveillance Report and WHO Epidemiological Overview 2020, between January 1 and December 31, 2019, a total of 47,871 measles cases, including 632 deaths, were recorded.⁵ Poor immunization coverage is the root cause of the measles and polio outbreaks.

Zimba et al. proposed multifaceted vaccination strategies such as mobile vaccination using mobile vans, opening vaccination sites at busy places like markets, churches, big malls, bus depots, and stadia, and providing vaccines on weekends when people are free. These are excellent ways to address the problems of vaccine availability and accessibility. However, since one of the significant challenges of urban poor locals in Metro Manila is poverty, what can motivate them are incentive-based programs. Like the experience during the COVID-19 pandemic, where community pantries were available and were flocked by many urban poor locals, the government can also imitate this by providing something for the families of vaccines in the form of food or money. It will surely be an effective strategy. The only problem is sufficient funding for it. However, if private companies and non-governmental organizations (NGOs) come to aid and donate, then there will be no obstacle to success.

Another intervention is to rebuild the value of trust in vaccines. The issue of vaccine hesitancy remains significant in the country, especially in the urban poor areas, because of controversies and myths. Some locals still welcome the idea that vaccines will cause death, just like what happened in the dengvaxia controversy. The dengue vaccine was allegedly linked to the deaths of several children. The vaccine manufacturer’s announcement regarding new findings on the small but increased risk of severe dengue for vaccinated seronegative patients caused turmoil as various people claimed that the vaccine caused deaths and that health authorities were corrupt.⁶ Some vaccine myths include: the development of the vaccine was rushed; vaccines can give you COVID-19; those who recovered from COVID-19 no longer need the vaccine; vaccines can alter your DNA; vaccines can cause infertility among women; vaccines can cause allergies and many others.⁷ To address this, the different institutions in the country must collaboratively help one another organize the dissemination of information regarding the influential role of vaccines in ways accessible to locals. The best way to do this is the optimum use of social media, where a big chunk of the locals’ time are spent every day, and more vaccine drives/caravans in public places.

A country’s overall well-being includes everyone, meaning no one is left behind. The different disease outbreaks affect us in various degrees and can incapacitate public health longer than expected. However, no health crisis can defeat us if everyone is willing to perform their role and walk the extra mile, especially for the poor and vulnerable.

Acknowledgments

I thank De La Salle University for continuously supporting my research endeavor.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.