Written by Ramsha, Pakistan

Edited by Felicia M. Baxter MD MBA

This is the follow up article on vaccine hesitancy in Asia from an Asian perspective.

Vaccine hesitancy in various regions across the globe is hampering the goal of achieving herd immunity to control the spread of the Covid-19 to end the pandemic. Although this phenomenon is not homogenous in nature and varies across and within countries, but it is adversely affecting global vaccination efforts nonetheless. This is evident if we consider the case of Japan and Philippines, two Asian island nations that have little in common other than a similar geography, and yet both exhibit moderate levels of vaccine hesitancy among their populations despite having different cultures, traditions and societal structures.[1]

Levels of vaccine hesitancy in both nations can be gauged through the three C’s (Convenience, Complacency and Confidence) model developed by the WHO’s Sage working group.[2] Various social, cultural and historical considerations are at play but it is these three main factors that influence the decision making of an individual, either for or against getting vaccinated, public confidence in particular is the main deciding factor when compliance is can be achieved and convenience of getting vaccinated isn’t an issue as is the case in Japan and the Philippines.

In Japan, the major contributing factor to vaccine hesitancy is public mistrust and the lack of confidence, both in the vaccines as well as the state. Bitter memories of vaccine related incidents in the past have led to rising vaccine skepticism and hesitancy that is now apparent in Japan. The current uneasiness can be traced back to the mumps and measles vaccinations that began in the early 90’s but had to be discontinued after speculations rose about how they were contributing to higher rates of aseptic meningitis. More recently, in 2013, the Japanese health ministry had to withdrew its recommendation for shots of human papillomavirus (HPV) vaccine after claims of its side effects such as severe headaches and seizures were unearthed by the media. Despite the vaccine having passed clinical trials, vaccination rates fell dramatically from over 70% to under 1% after the media highlighted the potential side effects of getting vaccinated.[3]

A similar story can be observed in the case of the Philippines, geography aside, public mistrust in vaccines in also common in both nations and coincidentally due to the same reasons, bitter experience of the past that has led to widespread discontent and fear towards both the state and its health institutions in the backdrop of the Dengvaxia controversy in 2017 when the media similarly magnified the side effects of the Sanofi Pasteur’s anti-dengue vaccine. The fear, mistrust and vaccine hesitancy that was caused by this revelation would have subconsciously become a part of people’s psyche, leading to hesitancy in getting vaccine jabs for Covid. This was one of the reasons for the recent protests against the vaccines, in a direct violation of public health protocols citing concerns of skepticism regarding vaccination and public resentment.[4]

Therefore, both of these cases serve as a testament to the fact that how public acceptance and trust in the state and its institutions plays a crucial role in the success of any vaccination program that is initiated. The lack thereof, can give rise to skepticism about getting vaccinated and even lead to growing public resentment, and this resentment in turn, can manifest itself in the form of protests against the state, as mentioned above in the case of the Philippines.

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[1] Vaccine hesitancy and vaccination passports – a Japanese study. (2021, September 26). News-Medical.net. https://www.news-medical.net/amp/news/20210926/Vaccine-hesitancy-and-vaccination-passports-e28093-a-Japanese-study.aspx

[2] Confidence, complacency, convenience model of vaccine hesitancy. (n.d.). Local Government Association. https://www.local.gov.uk/our-support/coronavirus-information-councils/covid-19-service-information/covid-19-vaccinations/behavioural-insights/resources/3Cmodel-vaccine-hesitancy

[3] Huang, G. (2020, December 23). Japan’s bitter vaccine history creates hurdle in COVID-19 fight. The Japan Times. https://www.japantimes.co.jp/news/2020/12/23/national/japan-vaccine-history-coronavirus/

[4]  Fear, mistrust, and vaccine hesitancy: Narratives of the dengue vaccine controversy in the Philippines. (n.d.). PubMed.