Vaccines in the Philippines: A research agenda for the social sciences
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The ongoing coronavirus pandemic has entered a phase in which political and public attention has moved to vaccination: What are the available vaccines, how effective are they, which of them should the government procure, how soon can we get them, and will people actually be willing to get vaccinated.
As in other aspects of COVID-19, the social sciences have a big role to play not just in documenting the pandemic response or making sense of what the pandemic tells us about culture and society but in using our analytic and methodological tools to improve our response.
One immediate area that needs to be analyzed is the politics of vaccination and how this unfolds at different levels—from the geopolitical to the national and local. Clearly, vaccines have emerged as part of the ‘medical populism’ (Lasco & Curato, 2019) of politicians. Medical populism is a political style that simplifies and dramatizes health crises while forging divisions among ‘the people’ and dangerous others. We see this coming to the fore today, with vaccines being touted as the simplistic solution to the pandemic and vaccine deals being turned into spectacles, including by LGU officials. How does this politics interact with regulatory processes, and what are its ultimate consequences?
An accounting of the politics of health, however, is incomplete without looking at the ethnographic realities of what anthropologists call “local vaccine culture” (McKnlight & Holt, 2014). Elsewhere, for instance, such scholarship has traced people’s ‘anti-vaxxer’ sentiments to broader mistrust towards the government and the medical establishment (e.g., Wada & Smith, 2015; Freeman et al., 2020). In our own survey of vaccine scandals around the world (Lasco and Larson 2019), we found that such scandals do not happen in a vacuum and tap into previous negative perceptions of, and experiences with, the healthcare system.
But vaccine cultures are ‘local’ for a reason, and we do not have a full picture of what informs Filipinos’ reasons to desire—or avoid—vaccines today. While we can point to surveys as giving as some ideas (e.g., the Pulse Asia survey late last year showing that only 32% of Filipinos are willing to receive shots), only in-depth scholarship and qualitative methods can put these survey results into context. News reports suggest that indigenous notions of intersubjectivity can amplify fears—as when Aeta mothers refuse measles vaccines for their children, fearing that they will affect the health of the whole family. In what ways do the recent health crises—from the dengue vaccine scandal in 2017 to the dengue outbreak in 2019 and the ongoing pandemic—inform people’s attitudes about vaccines? Where have they gotten their knowledge, and who in the community—or in the country—will they trust for future information?
Importantly, this project extends to virtual communities and networks. Some vaccine scholars, for instance, have looked at YouTube to probe how anti-vaccine myths are shared online (e.g., Zuk & Zuk, 2020); news agencies are already reporting anti-vaccine rumors being shared on Facebook. Taking off from previous research on internet trolls (e.g., Ong & Cabañes, 2019), the architecture of these virtual networks necessitates exploration, bearing in mind that while they can be politically- and/or economically-motivated, they are also underpinned with organically-held, locally-shared beliefs.
Moreover, there is a need to apply other analytic lenses on the topic of vaccination, including how vaccine programs are enacted within the wider healthcare system and how they fall into pre-existing fault lines of health inequity and structural violence. Who will get the vaccines first, and who stands to benefit from them the most—medically, economically, politically?
This brings us to another key area: history. Scholars and policymakers alike will also profit from a historicization of immunization in the Philippines, from the Spanish colonial period and the famed Balmis Expedition onwards. Notable in this project would be historical analyses of government immunization programs, its successes, its global connections, as well as its local instantiations. What were the attitudes of Filipinos towards vaccination when it was first introduced, and how have these changed over time? Which campaigns were effective in convincing parents to have their children immunized? (Just to give one recent example, it is now largely forgotten that in the 1990s, an anti-tetanus vaccine campaign was launched by anti-abortion groups, causing immunization rates to plummet.)
Meanwhile, social scientists can also work in communications research, bringing in qualitative methods to identify heuristics and biases in the Philippine context. Ultimately, these studies can inform vaccine safety communication: an established field in global health but one that has received very limited local scholarship.
. . . we need the social sciences to animate our understanding of vaccines and society in the past, present, and the future. For ultimately, vaccination is not just a public health intervention but a political project and a cultural practice: one that is revelatory of challenges—epistemic and otherwise—as well as socio-economic realities.
The above is surely an incomplete survey and surely many of our colleagues are already pursuing, or considering, various research topics around immunization and COVID-19 in general. Granted, the pandemic has also limited the means to do research, but there are methodological adaptations and innovations include virtual ethnographies (Helpfully, organizations like UGAT have organized webinars to facilitate learning about these methods). One challenge for institutions is to support researchers both in terms of facilitating funding and research process, from inception to dissemination. While there are funds for health research (for instance, in PCHRD), social scientists have not been able to avail of these funds for a various reasons, including not having the resources or time to make proposals. And yet, despite these difficulties, we need the social sciences to animate our understanding of vaccines and society in the past, present, and the future. For ultimately, vaccination is not just a public health intervention but a political project and a cultural practice: one that is revelatory of challenges—epistemic and otherwise—as well as socio-economic realities. What is at stake in this scholarship is not just the success of our COVID-19 response but our ability to improve public health in general and meet future health challenges while asserting the social sciences’ crucial role in this effort.
REFERENCES
Freeman, D., Waite, F., Rosebrock, L., Petit, A., Causier, C., East, A., … & Lambe, S. (2020). Coronavirus conspiracy beliefs, mistrust, and compliance with government guidelines in England. Psychological Medicine, 1-13.
Lasco, G. & Curato, N. (2019). Medical populism. Social Science & Medicine, 221, 1-8.
Lasco, G. & Larson, H. J. (2020). Medical populism and immunisation programmes: Illustrative examples and consequences for public health. Global Public Health, 15(3), 334-344.
McKnight, J. & Holt, D. B. (2014). Designing the Expanded Programme on Immunisation (EPI) as a service: Prioritising patients over administrative logic. Global Public Health, 9(10), 1152-1166.
Ong, J. C., & Cabañes, J. V. A. (2019). When disinformation studies meets production studies: Social identities and moral justifications in the political trolling industry. International Journal of Communication, 13, 20.
Wada, K. & Smith, D. R. (2015). Mistrust surrounding vaccination recommendations by the Japanese government: results from a national survey of working-age individuals. BMC Public Health, 15(1), 426.
Żuk, P. & Żuk, P. (2020). Right-wing populism in Poland and anti-vaccine myths on YouTube: Political and cultural threats to public health. Global Public Health, 15(6), 790-804.
Gideon Lasco, MD, PhD is a physician, medical anthropologist, and writer. He is senior lecturer at the University of the Philippines Diliman’s Department of Anthropology and research fellow at the Ateneo de Manila University’s Development Studies Program. He obtained his medical (MD) and master’s degrees (MSc in Medical Anthropology) from the UP College of Medicine, and his PhD in Anthropology from the University of Amsterdam.
The ongoing coronavirus pandemic has entered a phase in which political and public attention has moved to vaccination: What are the available vaccines, how effective are they, which of them should the government procure, how soon can we get them, and will people actually be willing to get vaccinated.
As in other aspects of COVID-19, the social sciences have a big role to play not just in documenting the pandemic response or making sense of what the pandemic tells us about culture and society but in using our analytic and methodological tools to improve our response.
One immediate area that needs to be analyzed is the politics of vaccination and how this unfolds at different levels—from the geopolitical to the national and local. Clearly, vaccines have emerged as part of the ‘medical populism’ (Lasco & Curato, 2019) of politicians. Medical populism is a political style that simplifies and dramatizes health crises while forging divisions among ‘the people’ and dangerous others. We see this coming to the fore today, with vaccines being touted as the simplistic solution to the pandemic and vaccine deals being turned into spectacles, including by LGU officials. How does this politics interact with regulatory processes, and what are its ultimate consequences?
An accounting of the politics of health, however, is incomplete without looking at the ethnographic realities of what anthropologists call “local vaccine culture” (McKnlight & Holt, 2014). Elsewhere, for instance, such scholarship has traced people’s ‘anti-vaxxer’ sentiments to broader mistrust towards the government and the medical establishment (e.g., Wada & Smith, 2015; Freeman et al., 2020). In our own survey of vaccine scandals around the world (Lasco and Larson 2019), we found that such scandals do not happen in a vacuum and tap into previous negative perceptions of, and experiences with, the healthcare system.
But vaccine cultures are ‘local’ for a reason, and we do not have a full picture of what informs Filipinos’ reasons to desire—or avoid—vaccines today. While we can point to surveys as giving as some ideas (e.g., the Pulse Asia survey late last year showing that only 32% of Filipinos are willing to receive shots), only in-depth scholarship and qualitative methods can put these survey results into context. News reports suggest that indigenous notions of intersubjectivity can amplify fears—as when Aeta mothers refuse measles vaccines for their children, fearing that they will affect the health of the whole family. In what ways do the recent health crises—from the dengue vaccine scandal in 2017 to the dengue outbreak in 2019 and the ongoing pandemic—inform people’s attitudes about vaccines? Where have they gotten their knowledge, and who in the community—or in the country—will they trust for future information?
Importantly, this project extends to virtual communities and networks. Some vaccine scholars, for instance, have looked at YouTube to probe how anti-vaccine myths are shared online (e.g., Zuk & Zuk, 2020); news agencies are already reporting anti-vaccine rumors being shared on Facebook. Taking off from previous research on internet trolls (e.g., Ong & Cabañes, 2019), the architecture of these virtual networks necessitates exploration, bearing in mind that while they can be politically- and/or economically-motivated, they are also underpinned with organically-held, locally-shared beliefs.
Moreover, there is a need to apply other analytic lenses on the topic of vaccination, including how vaccine programs are enacted within the wider healthcare system and how they fall into pre-existing fault lines of health inequity and structural violence. Who will get the vaccines first, and who stands to benefit from them the most—medically, economically, politically?
This brings us to another key area: history. Scholars and policymakers alike will also profit from a historicization of immunization in the Philippines, from the Spanish colonial period and the famed Balmis Expedition onwards. Notable in this project would be historical analyses of government immunization programs, its successes, its global connections, as well as its local instantiations. What were the attitudes of Filipinos towards vaccination when it was first introduced, and how have these changed over time? Which campaigns were effective in convincing parents to have their children immunized? (Just to give one recent example, it is now largely forgotten that in the 1990s, an anti-tetanus vaccine campaign was launched by anti-abortion groups, causing immunization rates to plummet.)
Meanwhile, social scientists can also work in communications research, bringing in qualitative methods to identify heuristics and biases in the Philippine context. Ultimately, these studies can inform vaccine safety communication: an established field in global health but one that has received very limited local scholarship.
. . . we need the social sciences to animate our understanding of vaccines and society in the past, present, and the future. For ultimately, vaccination is not just a public health intervention but a political project and a cultural practice: one that is revelatory of challenges—epistemic and otherwise—as well as socio-economic realities.
The above is surely an incomplete survey and surely many of our colleagues are already pursuing, or considering, various research topics around immunization and COVID-19 in general. Granted, the pandemic has also limited the means to do research, but there are methodological adaptations and innovations include virtual ethnographies (Helpfully, organizations like UGAT have organized webinars to facilitate learning about these methods). One challenge for institutions is to support researchers both in terms of facilitating funding and research process, from inception to dissemination. While there are funds for health research (for instance, in PCHRD), social scientists have not been able to avail of these funds for a various reasons, including not having the resources or time to make proposals. And yet, despite these difficulties, we need the social sciences to animate our understanding of vaccines and society in the past, present, and the future. For ultimately, vaccination is not just a public health intervention but a political project and a cultural practice: one that is revelatory of challenges—epistemic and otherwise—as well as socio-economic realities. What is at stake in this scholarship is not just the success of our COVID-19 response but our ability to improve public health in general and meet future health challenges while asserting the social sciences’ crucial role in this effort.
REFERENCES
Freeman, D., Waite, F., Rosebrock, L., Petit, A., Causier, C., East, A., … & Lambe, S. (2020). Coronavirus conspiracy beliefs, mistrust, and compliance with government guidelines in England. Psychological Medicine, 1-13.
Lasco, G. & Curato, N. (2019). Medical populism. Social Science & Medicine, 221, 1-8.
Lasco, G. & Larson, H. J. (2020). Medical populism and immunisation programmes: Illustrative examples and consequences for public health. Global Public Health, 15(3), 334-344.
McKnight, J. & Holt, D. B. (2014). Designing the Expanded Programme on Immunisation (EPI) as a service: Prioritising patients over administrative logic. Global Public Health, 9(10), 1152-1166.
Ong, J. C., & Cabañes, J. V. A. (2019). When disinformation studies meets production studies: Social identities and moral justifications in the political trolling industry. International Journal of Communication, 13, 20.
Wada, K. & Smith, D. R. (2015). Mistrust surrounding vaccination recommendations by the Japanese government: results from a national survey of working-age individuals. BMC Public Health, 15(1), 426.
Żuk, P. & Żuk, P. (2020). Right-wing populism in Poland and anti-vaccine myths on YouTube: Political and cultural threats to public health. Global Public Health, 15(6), 790-804.
Gideon Lasco, MD, PhD is a physician, medical anthropologist, and writer. He is senior lecturer at the University of the Philippines Diliman’s Department of Anthropology and research fellow at the Ateneo de Manila University’s Development Studies Program. He obtained his medical (MD) and master’s degrees (MSc in Medical Anthropology) from the UP College of Medicine, and his PhD in Anthropology from the University of Amsterdam.
The ongoing coronavirus pandemic has entered a phase in which political and public attention has moved to vaccination: What are the available vaccines, how effective are they, which of them should the government procure, how soon can we get them, and will people actually be willing to get vaccinated.
As in other aspects of COVID-19, the social sciences have a big role to play not just in documenting the pandemic response or making sense of what the pandemic tells us about culture and society but in using our analytic and methodological tools to improve our response.
One immediate area that needs to be analyzed is the politics of vaccination and how this unfolds at different levels—from the geopolitical to the national and local. Clearly, vaccines have emerged as part of the ‘medical populism’ (Lasco & Curato, 2019) of politicians. Medical populism is a political style that simplifies and dramatizes health crises while forging divisions among ‘the people’ and dangerous others. We see this coming to the fore today, with vaccines being touted as the simplistic solution to the pandemic and vaccine deals being turned into spectacles, including by LGU officials. How does this politics interact with regulatory processes, and what are its ultimate consequences?
An accounting of the politics of health, however, is incomplete without looking at the ethnographic realities of what anthropologists call “local vaccine culture” (McKnlight & Holt, 2014). Elsewhere, for instance, such scholarship has traced people’s ‘anti-vaxxer’ sentiments to broader mistrust towards the government and the medical establishment (e.g., Wada & Smith, 2015; Freeman et al., 2020). In our own survey of vaccine scandals around the world (Lasco and Larson 2019), we found that such scandals do not happen in a vacuum and tap into previous negative perceptions of, and experiences with, the healthcare system.
But vaccine cultures are ‘local’ for a reason, and we do not have a full picture of what informs Filipinos’ reasons to desire—or avoid—vaccines today. While we can point to surveys as giving as some ideas (e.g., the Pulse Asia survey late last year showing that only 32% of Filipinos are willing to receive shots), only in-depth scholarship and qualitative methods can put these survey results into context. News reports suggest that indigenous notions of intersubjectivity can amplify fears—as when Aeta mothers refuse measles vaccines for their children, fearing that they will affect the health of the whole family. In what ways do the recent health crises—from the dengue vaccine scandal in 2017 to the dengue outbreak in 2019 and the ongoing pandemic—inform people’s attitudes about vaccines? Where have they gotten their knowledge, and who in the community—or in the country—will they trust for future information?
Importantly, this project extends to virtual communities and networks. Some vaccine scholars, for instance, have looked at YouTube to probe how anti-vaccine myths are shared online (e.g., Zuk & Zuk, 2020); news agencies are already reporting anti-vaccine rumors being shared on Facebook. Taking off from previous research on internet trolls (e.g., Ong & Cabañes, 2019), the architecture of these virtual networks necessitates exploration, bearing in mind that while they can be politically- and/or economically-motivated, they are also underpinned with organically-held, locally-shared beliefs.
Moreover, there is a need to apply other analytic lenses on the topic of vaccination, including how vaccine programs are enacted within the wider healthcare system and how they fall into pre-existing fault lines of health inequity and structural violence. Who will get the vaccines first, and who stands to benefit from them the most—medically, economically, politically?
This brings us to another key area: history. Scholars and policymakers alike will also profit from a historicization of immunization in the Philippines, from the Spanish colonial period and the famed Balmis Expedition onwards. Notable in this project would be historical analyses of government immunization programs, its successes, its global connections, as well as its local instantiations. What were the attitudes of Filipinos towards vaccination when it was first introduced, and how have these changed over time? Which campaigns were effective in convincing parents to have their children immunized? (Just to give one recent example, it is now largely forgotten that in the 1990s, an anti-tetanus vaccine campaign was launched by anti-abortion groups, causing immunization rates to plummet.)
Meanwhile, social scientists can also work in communications research, bringing in qualitative methods to identify heuristics and biases in the Philippine context. Ultimately, these studies can inform vaccine safety communication: an established field in global health but one that has received very limited local scholarship.
. . . we need the social sciences to animate our understanding of vaccines and society in the past, present, and the future. For ultimately, vaccination is not just a public health intervention but a political project and a cultural practice: one that is revelatory of challenges—epistemic and otherwise—as well as socio-economic realities.
The above is surely an incomplete survey and surely many of our colleagues are already pursuing, or considering, various research topics around immunization and COVID-19 in general. Granted, the pandemic has also limited the means to do research, but there are methodological adaptations and innovations include virtual ethnographies (Helpfully, organizations like UGAT have organized webinars to facilitate learning about these methods). One challenge for institutions is to support researchers both in terms of facilitating funding and research process, from inception to dissemination. While there are funds for health research (for instance, in PCHRD), social scientists have not been able to avail of these funds for a various reasons, including not having the resources or time to make proposals. And yet, despite these difficulties, we need the social sciences to animate our understanding of vaccines and society in the past, present, and the future. For ultimately, vaccination is not just a public health intervention but a political project and a cultural practice: one that is revelatory of challenges—epistemic and otherwise—as well as socio-economic realities. What is at stake in this scholarship is not just the success of our COVID-19 response but our ability to improve public health in general and meet future health challenges while asserting the social sciences’ crucial role in this effort.
REFERENCES
Freeman, D., Waite, F., Rosebrock, L., Petit, A., Causier, C., East, A., … & Lambe, S. (2020). Coronavirus conspiracy beliefs, mistrust, and compliance with government guidelines in England. Psychological Medicine, 1-13.
Lasco, G. & Curato, N. (2019). Medical populism. Social Science & Medicine, 221, 1-8.
Lasco, G. & Larson, H. J. (2020). Medical populism and immunisation programmes: Illustrative examples and consequences for public health. Global Public Health, 15(3), 334-344.
McKnight, J. & Holt, D. B. (2014). Designing the Expanded Programme on Immunisation (EPI) as a service: Prioritising patients over administrative logic. Global Public Health, 9(10), 1152-1166.
Ong, J. C., & Cabañes, J. V. A. (2019). When disinformation studies meets production studies: Social identities and moral justifications in the political trolling industry. International Journal of Communication, 13, 20.
Wada, K. & Smith, D. R. (2015). Mistrust surrounding vaccination recommendations by the Japanese government: results from a national survey of working-age individuals. BMC Public Health, 15(1), 426.
Żuk, P. & Żuk, P. (2020). Right-wing populism in Poland and anti-vaccine myths on YouTube: Political and cultural threats to public health. Global Public Health, 15(6), 790-804.
Gideon Lasco, MD, PhD is a physician, medical anthropologist, and writer. He is senior lecturer at the University of the Philippines Diliman’s Department of Anthropology and research fellow at the Ateneo de Manila University’s Development Studies Program. He obtained his medical (MD) and master’s degrees (MSc in Medical Anthropology) from the UP College of Medicine, and his PhD in Anthropology from the University of Amsterdam.
