Countering vaccine hesitancy: Lessons from India, Indonesia, and the Philippines

Article | 29 April 2021

When rising transmission rates and death toll from the coronavirus disease (COVID-19) pandemic made daily headlines in 2020, health experts, policymakers, and the general public looked forward to effective vaccines to end the COVID-19 crisis. Before 2020 ended, several vaccines had been produced and distributed—with frontline health workers, elderly people, and people with comorbidities usually (and rightly) prioritized.

While governments and the private sector are still working on procuring more vaccine doses to inoculate a majority of the population, another issue has sprung up—vaccine hesitancy. Not a few people from all over the globe have shunned outright the thought of getting vaccinated. A number of factors contributed to this hesitancy. In webinars organized by the BMJ, Asian Development Bank (ADB), and United Nations Children’s Fund (UNICEF)1, health experts discussed the causes of vaccine hesitancy in their respective countries and their recommendations to counter it.

India

 Press Information Bureau, Government of India
Healthcare workers administer COVID-19 vaccines in India. Credit: Press Information Bureau, Government of India

Vaccine hesitancy in India was predominant during the early stages of vaccination, according to Dr. Vinod Paul, Head of India’s COVID-19 task force and National Institution for Transforming India Aayog member. Dr. Paul said that some people were concerned with the efficacy and possible unwanted side effects of the vaccine. There was even a widely-circulated rumor that the vaccine caused infertility, which was a blow to the vaccine system that the government set up.

To counter this skepticism, India asked health worker associations to issue statements in favor of vaccination. India also capitalized on using mass media to broadcast people getting vaccinated. Influential people were also tapped to appeal to the public to get vaccinated. Dr. Paul said that when the vaccine priority list moved to people over 60 years of age, after inoculating frontline health workers, India’s Prime Minister took a vaccine jab to further foster trust in getting vaccinated. India focused on getting across two key vaccine messages: 1) vaccines provide protection against COVID-19; and 2) vaccines are safe. 

Indonesia

Local public servants and elderly citizens get their COVID-19 vaccine in a public hospital in Malang City, Indonesia
Local public servants and elderly citizens get their COVID-19 vaccine in a public hospital in Malang City, Indonesia. Credit: ADB

The issue of a “haram” vaccine led some in Indonesia to hesitate in getting the country’s COVID-19 vaccine. Indonesia previously rolled out a measles-rubella childhood vaccine campaign in 2017 with the goal of eliminating measles by 2020. Despite the Indonesian Ulema Council’s reassurance that the measles-rubella childhood vaccine was safe, some parents still refused to have their children vaccinated because the vaccine on offer was “haram”, or forbidden for Muslims because it contained traces of pork. 

To avoid a replay of the same “haram” scenario, the Indonesian public has been assured that Sinovac’s COVID-19 vaccine is safe, as well as halal.

Philippines

A healthcare worker prepares for the Philippines’ regular vaccination program for children
A healthcare worker prepares for the Philippines’ regular vaccination program for children. Credit: ADB

The Philippines’ dengue vaccination program, which began in 2016, was suspended following the vaccine manufacturer’s release of new findings that the vaccine increases the risk of severe dengue. This issue bred mistrust in government vaccination programs that resulted in a steady decline in childhood immunization.

The country is still in its initial stage of vaccination for COVID-19—the national vaccine program only started in March. Dr. Gideon Lasco, a senior lecturer and research fellow, recommended that the government should understand and address the sources of people’s mistrust in the vaccine. Primary care workers and village midwives, as well as religious groups and community organizations, should be engaged to improve communication regarding COVID-19 vaccines.

“If we do not educate households and communities and they have the wrong information, then we can have the best vaccines in the world but people will not take them,” said ADB’s Health Sector Group Chief Dr. Patrick Osewe.

This series of webinars is part of ADB and BMJ’s ongoing partnership following the launch of a COVID-19 Information Centre for health care professionals in November 2020. Read the news release

The website provides nurses, doctors, and other health care professionals in ADB’s 49 members in Asia and the Pacific with free, readily available, and convenient access to the latest evidence-based guidelines and tools for the diagnosis, management, and prevention of COVID-19. The COVID-19 Information Centre is available in English, Mandarin, and Russian. Visit the website


1UNICEF participated in the first webinar only.