Vaccine amateur hour

Why was a hospital chief the first Filipino to get the COVID-19 vaccine? And why did government executives follow suit at the head of the line? If the showmanship was meant to communicate confidence and safety, it did neither.

The vaccine rollout was theatrical performance we’ve seen before. If experts, usually in white coats, stand on their vaccine soapbox and if important officials get the first jabs, preferably in front of cameras, the rest of us should supposedly get over ourselves and just “trust the science.”

The science is more complicated.

In South Korea, the first vaccine was given to a care worker. In Singapore, it was a senior staff nurse. In the UK, a 91-year-old grandmother. In Germany, a 101-year-old citizen. Sandra Lindsay, a Black critical care nurse, was the first recipient in the US—a point not lost on many in the black and brown communities with a long history of suspicion and distrust of American health care. And in the US state of Texas, the first jab went to a service worker who cleans the emergency room.

The choice to have these women get the first jabs was not an accident. They are based on psychology and behavioral science—the other crucial field, along with the humanities, that our public health response has disregarded in the past 12 months. The “stop worrying and being scared” remarks from the health secretary was about as helpful as, say, a plea directed at Filipinos living with depression to “stop being sad and stay positive.”

A sizeable and stubborn number of Filipinos are hesitant about taking the vaccine, or are refusing outright to do so. Perhaps if so-called influencers take it in front of the cameras, this would help stem the tide and increase vaccine uptake.

Or not. High-level officials and government executives are not psychologically or emotionally relatable. Dr. Gerardo Legaspi, the Philippine General Hospital director, is a capable stalwart who is well-deserving of a first jab. But his position in the vaccine line was not empathetic even if it was well-meaning.

We are more likely to follow others’ advice if they are like us. Doctor Legaspi is from the rare breed of impeccable physicians we admire and respect but can never quite relate to, and therefore he is less influential for public communication and the need for a change in our private behavior. The person who is better at this would be the barangay health worker, frontline nurse, or hospital custodian—those whose thoughts and feelings more mirror our own.

The burden of this pandemic has also disproportionately weighed on women. They have lost jobs more than men. They are busier at home more than men. Our health workers, undervalued and beyond exhausted, are mostly women. Yet the first vaccine in the country went to a man.

Vaccination is also a social activity. We fit our behavior to the actions and expectations of others. When we see health providers taking the vaccine, it normalizes the behavior. However, we are more likely to imitate this social norm if we trust the decision-makers peddling it, especially in situations fraught with ambiguity.

“Safe,” “evidence-based,” and “facts” are inked into our public health messaging, as if lack of understanding is the primary driver of vaccine hesitation or refusal. It goes without saying that combating misinformation and conspiracies should be part our vaccination portfolio. But this overreliance on so-called “science” is misplaced confidence on facts as influential, and an underestimation of emotions as the persuasive element in targeted behavior. Our national emotions are fueled by mistrust.

The sight of privileged men queue-jumping the vaccine line does little to dispel that mistrust. If the vaccine works, it reinforces their privilege. If it doesn’t work, it confirms our questions about its safety.

None of this is a secret, but psychology and behavioral science are not integrated in any meaningful way into our guidelines or messaging. Our public health response is instead preoccupied with and seduced by the medical canon.

The vaccine rollout at PGH was amateur hour.

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Dr. Ronald del Castillo was a professor of psychology, public health, and social policy, and is a consultant on social and behavior change communication. The views here are his own.