Last week, this column mentioned “senseless interventions” against COVID-19 that we embrace despite a lack of scientific basis. This week we were treated to yet another quickly formulated, not entirely sound strategy: the “brand agnostic policy.” Under the policy, local government units will no longer announce in advance the brand of COVID-19 vaccine to be administered at a given site. This is a response to large crowds lining up at select vaccination centers when a more preferred brand was announced to be available, and the policy is proposed so that Filipinos can overcome their vaccine preferences. While we have been assured that all vaccines to be administered are FDA-approved under emergency use authorization, the issue has raised concerns about patient autonomy and informed decision-making.
There has since been clarification that there will still be disclosure of vaccine brands, but only prior to inoculation, and the Department of Health (DOH) has stated that it is open to reviewing this policy. Patients may refuse inoculation on-site if their preferred brand is not available, and may reschedule if needed. However, several concerns remain. A patient signing up for a vaccination slot, only to go home unvaccinated, will have risked unnecessary exposure. Moreover, the issue of crowding is better addressed by more efficient registration and crowd control, with no walk-ins. There is also the very real possibility that, for those already struggling with vaccine hesitancy, rather than sign up for an unknown vaccine, they might choose not to be vaccinated at all. Rather than just overcoming preferences, the move may contribute even more to vaccine hesitancy.
The quick solution of the brand-agnostic policy fails to recognize and address why such preferences exist in the first place. At the heart of the matter are the twin problems of vaccine preference and vaccine hesitancy. The first is characterized by a willingness to be vaccinated but only with certain brands, because of bad press on supposed adverse effects, or because of political links.
For instance, earlier this year, some refused to be vaccinated with certain Chinese-manufactured vaccines not just because of a paucity of data at the time, but also on principle of advocating more transparent vaccine procurement. Vaccine hesitancy, on the other hand, owes much to “anti-vaxx” conspiracy-rhetoric finding traction locally, as well as the Dengvaxia controversy. Both vaccine preferences and vaccine hesitancy are strongly linked to issues of public trust, which has taken hit after hit since the start of the pandemic.
Such concerns with miseducation are best addressed by improved health education and more government transparency, not less. The DOH, through online campaigns, appears to be trying on the education front. They share fact checks on trending posts with COVID-19 misinformation. But for the lay person it is difficult to look to the DOH as a strong, clear voice, given its track record of misleading data and its chief official’s past questionable statements and actions. There is also some effort on the part of government figures being publicly inoculated as good examples, but even this is an avenue for mistrust from the public: In light of rising tensions with China and the President’s keenness to maintain close ties even at the risk of losing public confidence, Mr. Duterte’s public support of inoculation with a Chinese-made vaccine does not necessarily foster much trust.
The government may take cues from suggestions of public health experts to counter vaccine rejection and hesitancy, such as multisectoral approaches, interfaith collaborations, and efforts to reach out and educate individual communities rather than relying on social media and news outlets. It may also hold accountable those who were responsible for the media circus of the Dengvaxia controversy and the subsequent drop in vaccine confidence.
The intervention that would probably make the greatest difference at this point, however, would be efforts to increase public trust—an objective not at all attained by a “brand agnostic” approach. The more government resorts to these draconian approaches, the more it shoots itself in the foot, contributing more and more to the erosion of trust—and at this point, who can blame the public?
It would be difficult to reverse the effects of a pandemic response characterized by lack of transparency in allocating resources and vaccine procurement, conflicting and confusing statements, and unscientific interventions. People are more likely to trust governing bodies that they deem to be competent, effective, noncorrupt, and honest. The first step would be increasing efforts toward education and transparency—to provide more information, rather than less.
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