Flu vaccination in the Philippines: challenges and interventions

Dear Editor

Influenza (Flu) is one of the most common illnesses in the Philippines, especially during the holiday season due to the sudden weather change. In its latest disease surveillance report, the Philippines’ Department of Health (DOH) warns the public concerning the 114,127 cases and counting influenza-like cases from 1 January to 12 August 2023. The cases were 52% higher compared to the 74,957 reported during the same period last year. ¹ Seasonal influenza (the flu) is an acute respiratory infection caused by influenza viruses. There are four types of influenza viruses: A, B, C, and D. Influenza A and B viruses circulate and cause seasonal epidemics. Influenza type A viruses are known to have caused pandemics. Seasonal influenza can spread quickly in schools, shopping malls, marketplaces, and other crowded areas. When an infected person coughs or sneezes, droplets containing viruses are dispersed into the air and can infect persons nearby. The virus can also be spread by hands contaminated with influenza viruses. Influenza can worsen symptoms of other chronic diseases, and severe cases can lead to pneumonia and sepsis. There are around a billion cases of seasonal influenza annually, including 3–5 million cases of severe illness. It causes 290,000–650,000 respiratory deaths annually, and 99% of deaths in children under five years of age with influenza-related lower respiratory tract infections are in developing countries. ²

The Philippines is considered one of the developing countries with underdeveloped public healthcare systems. Although there are many highly skilled healthcare workers, some lose the determination to stay in their chosen work due to complaints from their employers, especially from the government’s lack of support. Aside from human resources, the health facilities and surgical equipment must be improved, especially during emergencies. This claim was validated during the surge of the coronavirus disease 2019 (COVID-19) cases, where there was a significant shortage of hospital beds, mechanical ventilators, vaccines, oxygen tanks, personal protective equipment, and other essential medical needs. There were 23 beds per 10,000 individuals in the National Capital Region, less than 10 per 10,000 individuals for the rest of the country. Case isolation, contact tracing, and physical distancing are recognized as the backbone of effective COVID-19 control, and this was inadequate and insufficient in the country even before the pandemic. The limited investment in healthcare infrastructure and a shortage of healthcare workers curtail the system, while inequalities in healthcare delivery further jeopardize access to services. ³ There are other weak areas in the county’s public healthcare system, and one of them is the low vaccine rollout despite its availability because of vaccine hesitancy.

The challenge of vaccine hesitancy

Vaccines are essential to control influenza and are considered the best way to prevent it. Safe and effective vaccines have been used for more than 60 years. Immunity from vaccination goes away over time, so annual vaccination is recommended to protect against influenza. ² While DOH recommends an anti-flu shot yearly, many Filipinos are still hesitant to get vaccinated. Some reasons for the refusal point to the following barriers ⁴ :

• Vaccination is not a priority; consumers are ‘too busy’ to get vaccinated

• Consumers believe they are at low risk of contracting influenza

• Consumers, mainly elderly, lack awareness of the severity of influenza

• Consumers lack access to the influenza vaccine and are unaware that free vaccine is available for certain groups

• Vaccines can be ‘expensive’ to some Filipino families

• Vaccines sometimes arrive too late for adequate protection against the current strains

• A limited supply of free, government-sponsored vaccines is quickly exhausted

• Improper storage procedures may compromise the quality and efficacy of influenza vaccines

Aside from these barriers, another primary reason for current vaccine hesitancy was the unfortunate experience of many locals regarding Dengvaxia, a dengue vaccine that caused serious controversy. Several reported deaths of children allegedly linked to Dengvaxia surfaced as well. Relatives – and particularly mothers – of alleged Dengvaxia victims were organized. They were given a robust platform in mainstream and social media, further propagating deep concerns about vaccination for children among parents. Legally, the Food and Drug Administration approved the vaccine for use even before the vaccine rollout due to its available scientific evidence on safety and efficacy. However, despite the approval, the country still suspended the dengue vaccination program and permanently banned the vaccine in 2019. ⁵ Consequently, the damage was done, and public trust continued to dwindle for all other types of vaccines, especially the COVID-19 vaccines. They were seen negatively and hardly to be accepted by the public.

Proposed interventions against flu vaccine hesitancy

To improve flu vaccination rates, the government must, therefore, promote comprehensive awareness of the flu vaccine’s nature, benefits, and side effects through massive campaigns. The government can utilize all forms of mass media, especially social media platforms, to disseminate health information. The tasked health workers can also explain clearly what happened in the Dengvaxia controversy to clarify the fake news that damaged public trust in vaccines. In the same way, there must be a sufficient national budget for free flu vaccines in other age groups or, if not possible, a cheaper price so that ordinary citizens can avail. This is where private, non-governmental organizations and even different religious groups can help and collaborate with the government to ensure vaccine availability. Since senior citizens find it difficult to travel and go to vaccination sites, a house-to-house setup can be feasible. The health workers can first deliver the vaccine awareness program, after which the actual vaccination can be administered.

Conclusion

Flu continues to affect the health condition of many Filipinos regularly due to a sudden weather change. With this, flu vaccination remains the best way to prevent the illness. As low flu immunization rollout becomes a recurring problem, the government must double its efforts in addressing the issue of vaccine hesitancy among the locals. This effort can be made possible with the collaborative effort with other institutions, who indeed aim for the good health of everyone.