key: cord-0915320-37gkdt25 authors: Vergara, Raymond John D title: Social trauma as a contributory factor in Filipino’s vaccine hesitancy date: 2021-04-09 journal: J Public Health (Oxf) DOI: 10.1093/pubmed/fdab110 sha: ff14d4d6d25831a2ccb7601a4217c2b3d48c86f7 doc_id: 915320 cord_uid: 37gkdt25 Despite of the Government’s effort to persuade the public to participate in its vaccination program against COVID-19, vaccine hesitancy remains to be a big challenge in the Philippines. While various efforts were undertaken to promote the safety and efficacy of vaccines against COVID-19, it is imperative that the Philippine government considers social traumas as a factor in vaccine hesitancy. This study proposes Judith Herman’s stages of trauma recovery as a possible framework that could be utilize by the government in its drive to increase public trust. After extreme delays, the Philippine government has finally started its inoculation of COVID-19 vaccines. However, surveys 1 still show that there remains a significant level of hesitancy on COVID-19 vaccines, despite the massive campaigns staged by the government. In a recent correspondence in this journal, an emphasis on e ective communication was mentioned and suggested as a tool to minimize vaccine hesitancy and increase public trust. 2 The Philippine Government has been doing rigid vaccination campaigns highlighting the positive aspects of the vaccines. However, in developing strategies for an e ective campaign, it is vital that the government carefully consider the experiences and background of the people. This study highlights various Filipino experiences contributing to social trauma and ending up with vaccine hesitancy. The Filipino's social traumas on Dengvaxia vaccine and Geopolitics controversies remain to be predicaments that ought to be addressed in order to build public trust. In 2016, it could be recalled that the Philippines experienced one of the most controversial vaccinations in the history of the country that led to the death of over 600 people, mostly infants. To date, no government o cials and vaccine manufacturer has been held liable or formally penalized. Undoubtedly, the awful and traumatic Dengvaxia experience contributed to the level of vaccine hesitancy as early as 2018 3 and continues to a ect the trust of the people in their government. 4 On the other hand, despite the government's defense on the e cacy of certain Chinese COVID-19 vaccines, Filipinos remain to have a negative net trust rating to China with issues on the West Philippine Sea and COVID-19 virus as contributing factors. 5 With the harassment experienced in the West Philippine Sea, the Filipinos remain suspicious over the alleged goodwill of the Chinese Government in providing assistance for the Philippine Government's procurement of vaccines. As a matter of fact, a number of mayors shunned the use of Chinese-origin vaccines as their constituents aired their sentiments and distrust against the said vaccines. 6 Trust in vaccination could have increased if other brands of vaccines were prioritized. More so, several Filipinos have existing prejudices and negative experiences with the quality of Chinese products. 7 Undeniably, the ongoing vaccination of the Philippine government triggers back the social traumas Filipinos have experienced. With the existing social traumas of the People, the Philippine Government may continue to face vaccine hesitancy from the people. According to Judith Herman, traumas damage victim's 'ability to enter into a trusting relationship'. 8 Herman showed three stages of trauma recovery that may well be considered by the government in building public trust: safety, acknowledgement and reconnection. In the safety stage, Herman emphasizes the importance of establishing a safe environment. In this context, transparency remains indispensable and foundational. 9 Hence, the government may signify transparency by addressing controversies such as smuggled vaccines, selective vaccinations, vaccine prioritization and others. 10 The second stage of Herman's trauma recovery involves acknowledgment, justice, apology and forgiveness. As mentioned, no persons were held liable in the Dengvaxia case. Further, the government's diplomatic strategies with China cast doubts instead of trust among people. Such cases provoke questions of integrity of the government's impartiality. It is therefore necessary that the government embrace justice by subjecting people to accountability and avoid unnecessary appraisal of oppressors. More so, the government may at least consider the Filipino value of empathy 11 that is significant in building trust. In the final stage of Herman's trauma recovery, people finally liberate themselves from the trauma and accept that they could not undo the past. They finally recognize the fact that what happened in the past does not necessarily follow in the present or future. The minimization or elimination of vaccine hesitancy among Filipinos will be very challenging due to the preexisting conditions of social traumas. The Philippine government could not just demand to the people that they simply trust the process. Before even demanding trust, the government must first gain the trust of the people. Taking a cue from Judith Herman, it is hoped that the government takes into consideration transparency and justice as the core principles of the vaccination campaign. Nearly half of Filipinos opt out of COVID-19 vaccination, poll finds Building public trust: a response to COVID-19 vaccine hesitancy predicament Dengvaxia controversy: impact on vaccine hesitancy Dengvaxia mess resurfaces after latest poll showed only 32% open to COVID-19 jab Poll shows Filipinos trust US, Australia over China Cainta mayor backs out of Chinese vaccine talks as constituents reject it The call to boycott Chinese products Recovery from psychological trauma Building a Culture of Transparency in Health Care Make COVID-19 vaccination transparent, probe irregularities: senators Culture as a contributory factor in combatting the Covid-19 pandemic No funding was received from this paper. The author declares no conflict of interest in this paper.