One of the regrettable responses to vaccine-hesitant Filipinos is the way their fears or doubts are characterized as poor information that requires correction. They’re told to be discerning, especially on social media, and to be mindful of misinformation. They’re reminded to trust the medical facts. It has become a catechism. But these repeated assurances from government officials and public health experts exacerbate a problem that has been largely overlooked — that knowing the scientific evidence does not necessarily change behavior.
Filipinos refusing the vaccine is concerning, but the “trust the science” retort is just as disappointing. We need to reach as many people as possible with the correct information, they say. We should make Filipinos understand that the vaccine is safe and effective, they urge. We need experts to lecture in webinars. We need explications through “Frequently Asked Questions” pubmats on social media.
This zeal to educate “the masses” is a long-held comfort zone. In the 1930s, so-called correct information dominated public health interventions of the Philippine Health Service. Dr Jacobo Fajardo and later Dr Jose Fabella insisted that the success of health depended on reeducating Filipinos about the rudiments of sanitation, hygiene, and their peculiar habits. Changing these, according to Dr Fajardo, “can be accomplished by one means — education.”
This hygienic citizenship probably helped decrease endemic diseases. Whether education directly contributed to some aha! moment, followed by voluntary behavior change, is harder to say. There was one pesky problem at the time: American occupation, racism, and a general sense of telling Filipinos what to do. Context matters.
The emphasis on trusting the medical facts is the sine qua non in the past 10 months. Scientists and experts are tasked with defending these facts. Correcting others is a satisfying mission.
It also reflects a broader self-indulgence within Philippine public health. It embodies the privileging of biomedical interventions and the preference for the medical establishment.
We have to do better.
The temptation to correct implies that vaccine-hesitant Filipinos either lack factual information or do not understand it. The evidence from psychology and behavioral science does not support this. There is no conclusive evidence that those who fear or doubt vaccines are less educated, have less access to valid information, or are less capable of picking through it.
The intuition to refute misconceptions with evidence is also tricky. The more we are exposed to myth-busting information, the less likely we might get vaccinated. This is because repeated exposure to myths, even when told they’re patently incorrect, reinforces misinformation we already hold. In a randomized trial published in Pediatrics in 2014, one group showed lower intention to vaccinate after being advised that there is no link between the measles-mumps-rubella vaccine and autism. Knowing the right information is not the same as doing right by it.
A separate 24-country study is also helpful. Published in Health Psychology, it found that beliefs in conspiracies were strongly linked to higher anti-vaccine attitudes. This was both amusing and remarkable given what study participants had to consider. Was there a nefarious secret plan implicated in the death of Princess Diana? Did the American government have prior knowledge of the 9/11 terrorist attacks? The findings are instructive because the “we need to listen to experts” pronouncements are counterproductive. For those with high conspiratorial beliefs, “trust the science” is proof of a conspiracy because dissent is swiftly invalidated and disavowed.
The same study reported that people who did not like to be told how to think also scored high on anti-vaccine attitudes. In the recent Senate hearing, one vaccine expert said, “We really need to rely on experts to tell us what to do next.” The psychological science suggests that her reassurance might have the opposite effect.
The Philippines was included in that multinational study, which was completed before the Dengvaxia fiasco. And here is the kicker: the average score on anti-vaccination attitudes was highest among the Filipino participants.
Here is a way forward. For one, scientists and experts should publicly acknowledge the prospects, even if small, of a vaccine-related conspiracy. Then, they should engage in meaningful two-way conversations about how these myths and misinformation inflate the dangers and blur the benefits.
Stories and images should also focus on how not getting the vaccine can impact our most vulnerable — the children. What would happen to a child whose caregiver is chronically ill because she chose against taking the vaccine? Consider a TV ad showing that she infected her own child. Dramatic narratives are effective. Webinars are not.
For another, experts and decision-makers should not be the public face of the vaccine. And who cares what celebrities or social media influencers think about it? Health communication is more productive with familiar and relatable faces. A barangay health worker, yes. A DOH official, no. A mother working from home, yes. A politician, no. A local religious leader, yes. A well-known virologist, no.
Psychology and behavioral science matter in public health but seem immaterial to our COVID efforts. Expert-led, “evidence-based” education is preferred. But it is not education in the empowered sense. It is not the nation-building, citizen-of-the-world kind of education. That would require deeper engagement with people’s underlying motivations, behaviors, and meanings. Instead, it is education through correction — the one-way explanations from people who claim to know better to people who, they claim, know much less. – Rappler.com
Ronald Del Castillo, PsyD, MPH, FRSPH, is a professor of psychology, public health, and social policy and is a consultant on social and behavior change communication. The views here are his own.