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

Abstract

Background Vaccine scares undermine longstanding global health achievements. Remarkably little data has documented the lived experiences of policymakers working amidst vaccine scares and navigating their fallout. As a result, chances and challenges of large-scale national recuperation efforts are poorly understood. Objective This study aims to explore the perspectives of policymakers involved in ongoing efforts to boost vaccine confidence in the Philippines following a 2017 Dengvaxia scare and the current COVID-19 pandemic. Methods Between August and November 2020, we conducted 19 semi-structured narrative interviews with purposively selected policymakers from governmental agencies and non-governmental organizations in the Philippines. Interviews were conducted online, transcribed, and analyzed following the tenets of reflexive thematic analysis. Results We present results as an emerging model that draws on a chronology conveyed by policymakers in their own words. The Dengvaxia scare proved ‘a decisive wedge’ that splintered Filipino society and pitted governmental agencies against one another. The scare stoked distorted vaccination narratives, which were ‘accelerated rapidly’ via social media, and ignited feelings of uncertainty among policymakers of how to convey clear, accurate health messaging and how to prevent drops in care-seeking more broadly. Conclusions Efforts to regain trust placed exceptional burdens on an already-strained health system. Respondent-driven recommendations on how to reinforce vaccine confidence and improve vaccination rollout include: developing clear vaccine messages, fostering healthcare providers’ and policymakers’ communication skills, and rebuilding trust within, toward and across governmental agencies. Further research on how to build enabling environments and rebuild trust in and across institutions remains paramount.

“Respect my opinion and I'll respect yours!”: Exploring the challenges, concerns, and informational needs of vaccine‐hesitant caregivers and pregnant women in the Philippines

“…Our findings also highlighted how social media altered communication and stoked widespread anxieties that permeated other contexts [55–57]. Fear‐based narratives are a common source of misinformation on social media, which has increased apathy and low public engagement [18, 58]. Through exaggerated and unfounded rumors and allegations, this infodemic caused fear and terror [59].…”

“…With changing trends in COVID-19 viral flares, and more information-and misinformation-about vaccine decision-making, public confidence in vaccines also suffers an uptrend or downtrend [67]. For instance, some studies in the Philippines highlighted how the Dengvaxia controversy has impacted the current acceptance of COVID-19 vaccines and that these new vaccines could have long-term consequences [29,30,68,69]. This volatility in vaccine information is pushing the public to turn against new vaccines and turn more to long-established vaccines.…”

“…This crucial problem has also been increasing in Asia, Africa, and South America in recent years [14][15][16]. Misinformation, mistrust in government and pharmaceutical companies, and religious or cultural views have all led to VH in many nations [17][18][19]. Some researchers have also concluded that VH was more prevalent in LMICs, where access to vaccines and health care may be limited and misinformation was more widespread [20,21].…”

Human-centred design bolsters vaccine confidence in the Philippines: results of a randomised controlled trial

“…Qualitative data collected amid HCD phases outlined the role of sociocultural context in shaping vaccine hesitancy in the Philippines and the widespread consequences of the dengue vaccine scare across various population strata. These findings highlighted the potential of real-life narratives in developing and honing an intervention rooted in the local context 27–29. Preliminary cartoon sketches and characters for the storyboards were presented and iterated along the way.…”

Interrogating Changes in COVID-19 Vaccine Intent During the National Vaccine Rollout in the Philippines

“…One of the ongoing challenges for this campaign is the vaccine hesitancy among the Filipino people (Alfonso et al, 2021). Though immunization rates had been relatively high in the Philippines for many decades, the controversial 2016 rollout of the dengue vaccine, Dengvaxia, triggered significant drops in the rates of immunization as Filipino parents refused to have their children routinely vaccinated against polio, chicken pox, and tetanus (Fatima & Syed, 2018; Smith, 2018; Reñosa et al, 2022).…”