On September 19, 2019, 19 years after the Philippines was declared polio-free, the Department of Health (DOH) confirmed one polio case of a three-year-old girl from Lanao del Sur in Southern Philippines. In addition, a second case has been confirmed in Laguna and the poliovirus has also been detected in samples from sewage in Manila and waterways in Davao, leaving millions vulnerable
. Widespread misinformation and panic-triggering statements from the government circulated online and on television caused this re-emergence.
There is no cure for polio. However, it is a preventable disease. According to the World Health Organization, the polio vaccine can protect a child for life but a community must have a high rate of vaccination to prevent outbreaks. Parents just need to make sure that they get their children vaccinated.
Polio should not exist in the Philippines, or anywhere else in the world.
Despite this, there has been an alarming trend in declining trust in vaccines globally and the difficulty in achieving high vaccination coverage in the Philippines exhibits one of the worst cases. Confidence in the safety and effectiveness of vaccines is down to 21% in 2018 from 82% in 2015 and vaccine confidence has dropped to 32% from 93% in the same period.
Reversing misinformation is difficult. The return of polio in the country proves that misinformation can be life-threatening.
Vaccine controversies and misinformation
A major reason why Filipino parents do not get their children vaccinated is the Dengvaxia or dengue vaccine controversy , which exploded in the Philippines in late 2017 and 2018. Sanofi Pasteur, the producer of Dengvaxia, reported in November 2017 that the vaccine protects individuals who have had prior infection but for those who have never had dengue and receive the vaccine, more severe cases may occur.
A number of deaths were subsequently brought to centre stage, blaming the vaccine. These were juxtaposed alongside heated and widely broadcasted Senate hearings and political statements from different state actors. News of this controversy spread like wildfire on traditional and social media, even when the deaths were not even proven to be caused by Dengvaxia yet, causing fear and vaccine hesitancy.
However, after the investigation of the DOH, no death has been directly attributable to the Dengvaxia vaccine. All deaths have been due to dengue or other diseases.
Immunisation becomes an emotional matter, deepened by behavioural biases, when you are a parent trying to protect your child. Once risks are presented regarding vaccines, a parent will instinctively be afraid and will cling on to that fear.
The aftereffects of misinformation were rapid and expansive.
In Metro Manila alone, 3,646 cases of measles were registered in 2018. By February 2019, the DOH declared a measles outbreak in Metro Manila. Based on the DOH Vaccine Preventable Disease Surveillance report for January 1 to May 25, 2019, there were 36,915 cases of measles-rubella in the Philippines and 497 deaths. Of these cases, 25,356 individuals or 58% were not vaccinated, 25% had incomplete doses, and 17% did not know their vaccination status.
The spread of false information on social media
People are susceptible to behavioural biases such as saliency bias for attention-grabbing information, overconfidence in beliefs despite limited evidence, confirmation bias when exposed to information that matches their own beliefs, and endowment effect or a sense of ownership for ideas. Once a belief is formed, there is little that can be done to change minds. These biases are especially prevalent on social media where a piece of false information can spread to thousands in minutes. The effects of such behavioural biases spread through social media were also seen in the 2016 Philippine presidential elections.
As of January 2019, Filipinos spend an average of ten hours and two minutes each day on the internet, via any device. Filipinos also have access to Facebook for free through telecommunications companies, without the need for a data plan or Wi-Fi. However, free access is limited access. Clicking on a link to access a news article or a website would require data, so Facebook is effectively the internet for these ‘free’ users. Consequently, conclusive headlines which advocate against vaccines or false news that pinned deaths to vaccination spread easily around the country.
The WHO conducted a study and found that Filipino parents identified fear of Dengvaxia as one of the top reasons for not bringing their children to immunisation. With the declaration of a polio epidemic in the Philippines, all efforts must be exhausted to end misinformation regarding vaccines and fight biases online and offline.
Fighting misinformation in society
Facebook and Instagram now direct people who search for vaccine hashtags to credible pages set up by the Centers for Disease Control and Prevention (CDC) in the United States and to the WHO everywhere else in the world.
This is a welcome start that can be strengthened through directing vaccine promotion content to vulnerable communities and removal of false information. Other social media platforms must follow suit and purposively fight misinformation on vaccines.
Biases are inherent in people and beliefs can be rigid once formed. Information campaigns must be deployed to urge parents to get their children vaccinated immediately. Similarly, behavioural biases can be used positively by making sure that immunisation is re-established as a desirable social norm and is easily accessible to families.
One unconventional but possibly effective approach in the Philippines is to have an evening telenovela scene with a popular character at an immunisation centre and a health advisory afterwards. To support the DOH, various sectors, and even popular media must get involved. Local government units’ proximity to communities and close connection with families must be fully utilised to ensure 100% immunisation.
As we have learned from the measles outbreak and return of polio in the Philippines, misinformation can kill. If we do not act swiftly and decisively, the next outbreak from yet another preventable disease would not be surprising anymore.
For a more in-depth review of related issues, read the case study, Behavioural Biases and Identity in Social Media: The Case of Philippine Populism, President Duterte’s Rise, and Ways Forward by Kathleen Rose Gatchalian Kho, written under the guidance of Assistant Prof Reuben Ng.
For more public policy case studies from the Lee Kuan Yew School of Public Policy, visit https://lkyspp.nus.edu.sg/research/case-studies/all-case-studies.
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