RRL

Leigh, J. P., Moss, S. J., White, T. M., Picchio, C. A., Rabin, K. H., Ratzan, S. C., Wyka, K.,
El-Mohandes, A., & Lazarus, J. V. (2022). Factors affecting COVID-19 vaccine hesitancy among
healthcare providers in 23 countries. Vaccine, 40(31), 4081–4089.
https://doi.org/10.1016/j.vaccine.2022.04.097

Factors affecting COVID-19 vaccine hesitancy among healthcare providers in 23 countries

COVID-19 vaccine hesitancy and confidence in the Philippines and Malaysia: A cross- sectional
study of sociodemographic factors and digital health literacy

A key factor for the success of vaccination campaigns is people’s willingness to be vaccinated
once doses become accessible to them personally. Vaccine hesitancy is defined by the World
Health Organization (WHO) as the delay in the acceptance, or blunt refusal of, vac- cines. In
fact, vaccine hesitancy was described by the WHO as one of the top 10 threats to global health
in 2019 [5]. Conversely, vaccine confidence relates to individuals’ beliefs that vac- cines are
effective and safe. In general, a loss of trust in health authorities is a key determinant of vaccine
confidence, with misconceptions about vaccine safety being among the most com- mon reasons
for low confidence in vaccines
—----------------------------------------
RESULTS AND DISCUSSION

1. Brackstone K, Marzo RR, Bahari R, Head MG, Patalinghug ME, Su TT. COVID-19 vaccine
hesitancy and confidence in the Philippines and Malaysia: A cross-sectional study of
sociodemographic factors and digital health literacy. PLOS Glob Public Health. 2022 Oct
19;2(10):e0000742. doi: 10.1371/journal.pgph.0000742. PMID: 36962550; PMCID:
PMC10021455.

file:///C:/Users/HP/Downloads/journal.pgph.0000742.pdf

COVID-19 vaccine hesitancy and confidence in the Philippines and Malaysia: A cross-
sectional study of sociodemographic factors and digital health literacy

The main aims of this research were to determine levels of hesitancy and confidence in
COVID-19 vaccines among general adults in the Philippines and Malay- sia, and to identify
individual, behavioural, or environmental predictors significantly associ- ated with these
outcomes. Data from an internet-based cross-sectional survey of 2558 participants from the
Philippines (N = 1002) and Malaysia (N = 1556) were analysed. Results showed that Filipino
(56.6%) participants exhibited higher COVID-19 hesitancy than Malaysians (22.9%; p < 0.001).
However, there were no significant differences in ratings of confidence between Filipino (45.9%)
and Malaysian (49.2%) participants (p = 0.105). Pre- dictors associated with vaccine hesitancy
among Filipino participants included women (OR, 1.50, 95% CI, 1.03–1.83; p = 0.030) and rural
dwellers (OR, 1.44, 95% CI, 1.07–1.94; p = 0.016). Among Malaysian participants, vaccine
hesitancy was associated with women (OR, 1.50, 95% CI, 1.14–1.99; p = 0.004), social media
use (OR, 11.76, 95% CI, 5.71–24.19; p < 0.001), and online information-seeking behaviours
(OR, 2.48, 95% CI, 1.72–3.58; p < 0.001). Predictors associated with vaccine confidence among
Filipino participants included subjective social status (OR, 1.13, 95% CI, 1.54–1.22; p < 0.001),
whereas vaccine confi- dence among Malaysian participants was associated with higher
education (OR, 1.30, 95% CI, 1.03–1.66; p < 0.028) and negatively associated with rural
dwellers (OR, 0.64, 95% CI, 0.47–0.87; p = 0.005) and online information-seeking behaviours
(OR, 0.42, 95% CI, 0.31– 0.57; p < 0.001). Efforts should focus on creating effective
interventions to decrease vaccination hesitancy, increase confidence, and bolster the uptake of
COVID-19 vaccination, particularly in light of the Dengvaxia crisis in the Philippines.

The Philippines and Malaysia are among two of the most populous countries in Southeast Asia
with an estimated population of 110 mil- lion and 32 million people, respectively. To date,
Malaysia has seen over 4.6 million cases with a mortality rate of 0.77%, while approximately 3.7
million cases of COVID-19 were detected in the Philippines with a mortality rate of 1.60% [2].
Malaysia is doing considerably well with their vaccination efforts, with 84.8% of the population
currently considered fully vaccinated as of July 2022. However, vaccination campaigns in the
Philippines have been more difficult, with 65.6% of the population fully vaccinated

Previously, vaccination in Southeast Asia has been associated with mistrust and fear,
particularly in the Philippines, who are still suffering the consequences of the Dengvaxia
(dengue) vaccine controversy in 2017. Studies suggest that this highly political mainstream
event, in which anti-vaccination campaigns linked dengue vaccines with autism spectrum
disorder and with corrupt schemes of pharmaceutical companies, continue to erode the
population’s trust in vaccines. For example, a survey conducted on over 30,000 Filipinos in early
2021 showed that 41% of respondents would refuse the COVID-19 vaccine once it became
available, whereas Malaysia reported 27% hesitancy.

Researchers predict that the controversy sur- rounding Dengvaxia may have prompted severe
medical mistrust and subsequently weakened the public’s attitudes toward vaccines [7, 9].
However, there may be many additional factors that weaken confidence in vaccines. For
example, incompatibility with religious beliefs is one key driver of weakened confidence in
vaccines [10, 11], whereas living in urbanised (vs. rural) areas predicts COVID-19 vaccine
hesitancy in some countries [12–14], possibly due to being more connected to the internet and
social media and being more exposed to COVID- 19-related misinformation.

Other predictors of vaccine hesitancy and confidence may include digital health literacy– one’s
ability to seek, find, understand, and appraise health information from digital resources– and
social media use. Research has shown that beliefs in available information is integral to
perceptions of the vaccine safety and effectiveness. Previous studies for example have
associated higher vaccine hesitancy with misinformation about the virus and vaccines,
particularly if they relied on social media as a key source of information

A total of 2558 participants completed the online survey. shows descriptive statistics of
participants from the Philippines (N = 1002) vs. Malaysia (N = 1556). Filipino (vs. Malaysian)
participants indicated higher rates of education (p < 0.001), but were more likely to be
unemployed (p < 0.001). Further, Filipino (vs. Malaysian) participants were also more likely to
indicate lower income (p < 0.001) and rate themselves lower on subjective social status
(p < 0.001). Malaysian (vs. Filipino) participants were more likely to live in urban areas
(p < 0.001). Most notably, Filipino participants (56.6%) indicated higher prevalence of COVID-19
vaccine hesitancy compared to Malaysian participants (22.9%; p < 0.001). How- ever, there
were no significant differences between Filipino (45.9%) and Malaysian (49.2%) participants in
ratings of vaccine confidence (p = 0.105). Malaysian (vs. Filipino) participants were also more
likely to report using social media (96.6 vs. 89.8%; < 0.001)

Significant predictors of vaccine hesitancy in both Filipino and Malaysian samples.

Among Filipino participants, multivariate logistic regression analyses revealed that factors
associated with higher vaccine hesitancy included women (OR, 1.51, 95% CI, 1.14– 2.00; p =
0.004), residing in a rural community (OR, 1.45, 95% CI, 1.07–1.95; p = 0.015), and having
lower income (OR, 1.62, 95% CI, 1.20–2.19; p = 0.001). Among Malaysian participants, women
(OR, 1.51, 95% CI, 1.14–2.00; p = 0.004), being aged 25–34 (vs. 18–24; OR, 1.52, 95% CI,
1.48–2.21; p = 0.027), Christians (OR, 2.45, 95% CI, 1.66–3.62; p < 0.001), completing ter- tiary
education (OR, 2.17, 95% CI, 1.63–2.88; p < 0.001), social media use (OR, 11.59, 95% CI,
5.63–23.84; p < 0.001), and information-seeking behaviours (OR, 2.50, 95% CI, 1.74–3.61; p <
0.001) were predictors of higher vaccine hesitancy, whereas having a health impairment (OR,
0.49, 95% CI, 0.30–0.78; p = 0.003) and higher self-reported ratings on subjective social status
(OR, 0.82, 95% CI, 0.75–0.89; p < 0.001) were associated with lower vaccine hesitancy.

shows significant predictors of vaccine confidence in both Filipino and Malaysian samples.
Factors positively associated with higher vaccine confidence among Filipino partici- pants
included higher self-reported ratings on subjective social status (OR, 1.16, 95% CI, 1.07– 1.25;
p < 0.001), whereas factors associated with lower vaccine confidence included women (OR,
0.72, 95% CI, 0.54–0.96; p = 0.026) and information-seeking behaviours (OR, 0.63, 95% CI,
0.49–0.81; p < 0.001). Among Malaysian participants, factors positively associated with higher
vaccine confidence included women (OR, 1.27, 95% CI, 1.18–1.60; p = 0.035), complet- ing
tertiary education (OR, 1.31, 95% CI, 1.03–1.66; p = 0.026), and higher self-reported ratings on
subjective social status (OR, 1.08, 95% CI, 1.00–1.16; p = 0.036). Factors negatively associated
with lower vaccine confidence included residing in a rural community (OR, 0.63, 95%
CI,0.47–0.87; p = 0.004), Christians (OR, 0.50, 95% CI, 1.20–2.24; p < 0.001), Buddhists (OR,
0.15., 95% CI, 0.10–0.22; p < 0.001), Hindus (OR, 0.24., 95% CI, 0.17–0.34; p = 0.004), infor-
mation-seeking behaviours (OR, 0.42, 95% CI, 0.31–0.58; p < 0.001), and determining rele-
vance of online information (OR, 0.68, 95% CI, 0.51–0.92; p = 0.013)

Discussion
Malaysia and the Philippines are among the most populous countries in Southeast Asia. While
the economic impact of the COVID-19 pandemic has been permanent in the Philippines, it
has been shown thus far to be temporary in Malaysia [26]. Between January and October 2020,
around 30,000 Malaysians had been infected by the virus with a mortality rate of 0.79%, while
approximately 380,000 cases of COVID-19 were detected in the Philippines with a mortality
rate of 1.9%

Further, 61.8% of Malaysians had completed their vaccination up until September 2021, while
the percentage of completed vaccinations during the same period in the Philippines was only
19.2%. Vaccine uptake is likely to be a key determining factor in the outcome of a pandemic.
Knowledge around factors which predict vaccine hesitancy and confidence is of the utmost
important in order to improve vaccination rates. Thus, the core aims of this research were to
determine levels of hesitancy and confidence in COVID-19 vaccines among general adults in
the Philippines and Malaysia, and to identify behavioural or environmental predictors that are
significantly associated with these outcomes.

First, while there were no significant differences in ratings of confidence in the COVID-19
vaccine between Filipino and Malaysian participants, Filipino (compared to Malaysian)
participants expressed greater vaccine hesitancy. This may be a consequence of previous
vaccine scares in the years leading up to the pandemic, including the Dengvaxia controversy in
2016. Systematic reviews demonstrated that, by the end of 2020, the highest vaccine
acceptance was in China, Malaysia, and Indonesia. The authors postulated that this elevated
awareness was due to being among the first countries affected by the virus, hence resulting in
greater confidence in vaccines

Next, this study shows that women expressed greater vaccine hesitancy in both countries. The
evidence base shows mixed findings, with other studies reporting higher hesitancy in women or
in men. There are clear differences in predictors of vaccine hesitancy in the Philippines and
Malaysia. However, when results for both countries were combined, women, urban dwellers,
those of Christian faith, those with higher educational attainment, higher self-reported social
class, social media use, and information-seeking tendencies remained as predictors of
hesitancy. Urban-dwellers and individuals with more years of education have previously been
demonstrated as predictors for vaccine hesitancy [35], but contradictory results have also
previously been shown. Urban residents are typically more connected to the internet and social
media and, thus, may be more exposed to vaccine-related misinformation than rural inhabitants
who have fewer sources of information available to them.
Frequent social media use is the only strong predictor for vaccine hesitancy in this study,
followed by information-seeking behaviours. Research has identified that the safety and
effectiveness of the vaccine is the primary concern that people have, including beliefs in
available information [15–17]. Unfortunately, high internet literacy is a double-edged sword,
since participants in this study preferred to seek information through social media, and thus may
have been exposed to inaccurate information regarding COVID-19 vaccine. Previous studies
have associated higher vaccine hesitancy with misinformation about the virus and vaccines
particularly if they relied heavily on social media as a key source of vaccine-related information.

A 2022 systematic review discovered that high social media use is the main driver of vaccine
hesitancy across all countries around the globe, and is especially prominent in Asia [39].
Furthermore, vaccine acceptance and uptake improved among those who obtained their
information from healthcare providers compared to relatives or the internet.

These findings have important implications for health authorities and governments in areas
focusing on improving vaccination uptake. Misinformation about vaccination greatly hampers
vaccination efforts. Thus, not only is it important to understand how specific population groups
are influenced by digital platforms such as social media, but it is imperative to provide the right
information driven by governmental and non-governmental organisations [39]. This could be
achieved by having community-specific public education and role modelling from local health
and public officials, which has been shown to increase public trust [44]. Since the primary
reason for hesitancy is concern about the safety of vaccines, it is crucial that education
programmes stress the effectiveness and importance of COVID-19 vaccinations [45].
Participants in this study coped with the pandemic by seeking out new information, but they
sought information from social media when information from the authorities was lacking or were
viewed as untrustworthy, which may have contained erroneous information. One way to deter
this is to empower information-technology companies to monitor vaccine-related materials on
social media, remove false information, and create correct and responsible content

2. Caple A, Dimaano A, Sagolili MM, Uy AA, Aguirre PM, Alano DL, Camaya GS, Ciriaco BJ,
Clavo PJM, Cuyugan D, Fermo CFG, Lanete PJ, La Torre AJ, Loteyro T, Lua RM, Manansala
NG, Mosquito RW, Octaviano A, Orfanel AE, Pascual GM, Sale AJ, Tendenilla SL, Trinidad
MSL, Trinidad NJ, Verano DL, Austriaco N. Interrogating COVID-19 vaccine intent in the
Philippines with a nationwide open-access online survey. PeerJ. 2022 Feb 16;10:e12887. doi:
10.7717/peerj.12887. PMID: 35190785; PMCID: PMC8857903.

file:///C:/Users/HP/Downloads/peerj-12887.pdf

Interrogating COVID-19 vaccine intent in the Philippines with a nationwide openaccess

online survey

To mitigate the unprecedented health, social, and economic damage of COVID-19, the
Philippines is undertaking a nationwide vaccination program to mitigate the effects of the global
pandemic. In this study, we interrogated COVID-19 vaccine intent in the country by deploying a
nationwide open-access online survey, two months before the rollout of the national vaccination
program. The Health Belief Model (HBM) posits that people are likely to adopt disease
prevention behaviors and to accept medical interventions like vaccines if there is sufficient
motivation and cues to action. A majority of our 7,193 respondents (62.5%) indicated that they
were willing to be vaccinated against COVID-19. Moreover, multivariable analysis revealed that
HBM constructs were associated with vaccination intention in the Philippines.
Large majorities of our respondents would only receive the COVID-19 vaccines after many
others had received it (72.8%) or after politicians had received it (68.2%). Finally, our study
revealed that most (21%) were willing to pay an amount of PHP 1,000 (USD20) for the
COVID-19 vaccines with an average willing-to-pay amount of PHP1,892 (USD38)

Though immunization rates had been relatively high in the Philippines for many decades, the
controversial 2016 rollout of the dengue vaccine, Dengvaxia, triggered significant drops in the
rates of immunization as Filipino parents refused to have their children routinely vaccinated
against polio, chicken pox, and tetanus (Fatima & Syed, 2018; Smith, 2018)

The Health Belief Model (HBM) posits that people are likely to adopt disease prevention
behaviors and to accept medical interventions like vaccines if there is sufficient motivation and
cues to action (Rosenstock, Strecher & Becker, 1988). Motivational factors include perceived
susceptibility to and severity of the disease and perceived benefits of the vaccine. Cues to
action include information, people, and events that nudge the individual towards vaccination.
The HBM has been adopted as a conceptual framework that has been used to evaluate the
beliefs and attitudes toward a diversity of vaccines including the influenza, human
papillomavirus, and hepatitis B vaccines.

During the COVID-19 pandemic, the HBM was used to assess the root causes of COVID-19
vaccine hesitancy in the Asia-Pacific region and beyond. In this study, we interrogated
COVID-19 vaccine intent in the Philippines by deploying a nationwide open-access online
survey, two months before the rollout of the national vaccination program. Based on the HBM
framework, we hypothesized that acceptance of a COVID-19 vaccine depends upon beliefs
about susceptibility to and severity of COVID-19, and beliefs about the perceived benefits of the
vaccine. We also wanted to assess possible cues to vaccination for our Filipino respondents.

A majority of our 7,193 respondents (62.5%) indicated that they were willing to be vaccinated
against COVID-19. Moreover, multivariable analysis revealed that HBM constructs were
associated with vaccination intention in the Philippines. Perceptions of high susceptibility, high
severity, and significant benefits were all good predictors for vaccination intent. We also found
that external cues to action were important. Large majorities of our respondents would only
receive the COVID-19 vaccines after many others had received it (72.8%) or after politicians
had received it (68.2%). Finally, our study revealed that most (21%) were willing to pay an
amount of PHP1,000 (USD20) for the COVID-19 vaccines with an average willing-to-pay
amount of PHP1,892 (USD38)
Health beliefs

The respondents in the survey reported significant perceived benefits for the COVID-19
vaccines. A large portion of participants noted that they believed that a COVID-19 vaccine
would decrease the chances of getting COVID-19 (88.1%) and that the vaccine would alleviate
their anxieties about catching the virus (84.5%). Notably, significant majorities of our
respondents reported that they had worries about possible side-effects (89.6%), effectiveness
(87.1%), safety (88.8%), and high cost (78%) of the vaccines. Nearly all were concerned about
the possibility of fake jabs (97.4%). Many participants noted they would only receive the
COVID-19 vaccines after many others had received it (72.8%) or after politicians had received it
(68.2%)

COVID-19 vaccination intent

A total of 4,497 of the participants (62.5%) responded either ‘probably yes’ or ‘definitely yes’ to
COVID-19 vaccine intent—demonstrating that they were not vaccine hesitant—while 2,696
(37.4%) displayed vaccine hesitancy (responses included ‘definitely no’, ‘probably no’, and
‘unsure’). More specifically, the majority of responses were ‘probably yes’ (32.8%, n = 2,358),
followed by ‘definitely yes’ (29.7%, n = 2,139), ‘unsure’ (28%, n = 2,017), ‘probably no’ (6.4%, n
= 461), and ‘definitely no’ (3%, n = 318). Demographics of respondents who intend (not vaccine
hesitant) and do not intend (vaccine hesitant) to take a COVID-19 vaccine.

Univariate analyses showed a significantly higher proportion of participants who were single
(63.6%) expressed an intention to take a COVID-19 vaccine (not vaccine hesitant) than married
participants (60.4%). However, the association was not significant in the binary analysis. By
occupational category, a significantly higher proportion of respondents that were not vaccine
hesitant included those who identified as students (65.5%) and professional/white collar workers
(62%). Significant differences were noted in vaccine hesitancy for COVID-19 by location,
whereby individuals in an urban location (65%) reported a higher proportion of an intention to
vaccinate compared to respondents in rural locations (53.1%). By demographics, binary
analyses revealed that males have greater odds of an intention to take a COVID-19 vaccine
(OR = 1.222, 95% CI [1.078–1.386]) than females.

Willingness to pay

most participants were willing to pay PHP1,000 (USD20.38) (21%) followed by PHP500
(USD10.18) (18.8%) for two doses of a COVID-19 vaccine. The median (interquartile range
[IQR]) of WTP for two doses of a COVID19 vaccine was PHP2,000 (USD40.73).

The results of the multinomial logistic regression (PHP1,500/2,000/2,500 vs. PHP500/1,000 and
PHP3,000/3,500/4,000 vs. PHP500/1,000) revealed that individuals aged 31 to 40 displayed a
higher WTP: PHP3,000/3,500/4,000 (USD61.09/71.28/81.46) over PHP500/1,000
(USD10.18/20.36). Compared to married participants, single respondents had the highest WTP:
PHP3,000/3,500/4,000 (USD61.09/71.28/81.46) over PHP500/1,000 (USD10.18/20.36).
Students had the highest WTP: PHP3,000/3,500/4,000 (USD61.09/71.28/81.46) over
PHP500/1,000 (USD10.18/20.36).

Vaccine brand preference

The vast majority of participants were ‘confident’ (59.7%) or ‘completely confident’ (23.1%) in a
COVID-19 vaccine made in the USA or Europe. In contrast, a majority of participants indicated
they were either ‘completely not confident’ (38.2%, 16.5%) or ‘not confident’ (46.8%, 49.2%) in a
vaccine developed in China and Russia respectively. Findings on the preference of where a
COVID-19 vaccine is made revealed respondents reported a preference for a vaccine made in
the USA or Europe (53.4%) while 44.6% of participants indicated no preference of where a
COVID-19 vaccine is made as long as it is safe and effective.

Discussion
In this study, we sought to interrogate the extent of COVID-19 vaccine hesitancy in the
Philippines and to determine whether the Health Belief Model (HBM) could be used to explain
this hesitancy among Filipinos. We deployed our nationwide open-access online survey for a
two week period (January 15–29, 2021), a month before the first COVID-19 vaccines were
administered in the archipelago on March 1, 2021. We received nearly 7,200 completed surveys
from around the country. The majority of responses (5,348; 74%) were from the three
geographical and administrative regions, National Capital Region (NCR), Region III, and Region
IVA, that encompass and surround the capital city of Manila. Together, these three regions,
which have 38% of the population, have weathered the worst of the COVID-19 pandemic in the
Philippines with about 60% of the total nationwide reported cases
(https://doh.gov.ph/covid19tracker). A majority of our respondents (62.5%) indicated that they
were willing to be vaccinated by responding either ‘probably yes’ or ‘definitely yes’ to COVID-19
vaccine intent. As a point of comparison, a survey conducted by Pulse Asia from February 22,
2021, to March 3, 2021, which was a month after our survey period, reported that only 16% of
the 2,400 Filipinos they interviewed face-to-face indicated that they would have themselves
vaccinated, while 23% said that they ‘‘cannot say’’ if they would have themselves vaccinated
(Pulse Asia, 2021). There are many possible reasons for this difference in reported vaccine
confidence but three immediately come to mind. First, our survey was an open access online
survey while the Pulse Asia survey involved face-to-face interviews of Filipinos throughout the
country.

It is likely that this pandemic experience would have heightened their desire to be vaccinated as
compared to those Filipinos who live in the countryside where viral transmission was sporadic
and pandemic restrictions were relatively innocuous. Notably, our bivariate analysis confirms
that individuals in an urban location (65%) reported a higher proportion of an intention to
vaccinate compared to respondents in rural locations (53.1%). Finally, the intervening month
between the two surveys witnessed several political events prior to the vaccine rollout that could
have changed the public’s views on the COVID-19 vaccines.
Multivariable analysis revealed that HBM constructs were associated with vaccination intention
in the Philippines, which is in accordance with other studies from the AsiaPacific region (Wong
et al., 2020; Wong et al., 2021; Lin et al., 2020; Yu et al., 2021; Kabir et al., 2021; Huynh et al.,
2021; Tao, Wang & Liu, 2021) Perceptions of high susceptibility, high severity, and significant
benefits were all good predictors for vaccination intent. A study to interrogate vaccine hesitancy
among Filipinos in two urban communities in Manila before the COVID-19 pandemic also found
that respondents who believed in the protective nature of vaccines were less likely to report
vaccine hesitancy and were nine times less likely to refuse vaccination for their children
because of negative media exposure (Migriño et al., 2020)

Perceived barriers against COVID-19 immunization reported by our respondents including

worries about the side-effects, effectiveness, and safety of the vaccines have also been
reported by these other HBM studies. These are triggers for hesitancy that can be eradicated
with scientific explanation. Public health authorities in the Philippines should address these
issues. In response to the findings of this survey, we have initiated a public awareness
campaign in the Philippines to directly respond to these concerns by generating infographics
and other publication materials to alleviate these worries

Interestingly, we discovered that our Filipino respondents were overwhelmingly worried about
fake COVID-19 vaccines (97.4%). This is not surprising given the prevalence of counterfeit
items in Philippine society (Calunsod, 2013). Similar concerns have been raised in India
(Choudhary et al., 2021) though this was not observed in China (Lin et al., 2020). This suggests
that the national governments of developing countries should ensure the integrity of the vaccine
rollout to reassure their citizens that they are not receiving ‘‘dud’’ doses.

Next, we found that external cues to action were important. Large majorities of our respondents
would only receive the COVID-19 vaccines after many others had received it (72.8%) or after
politicians had received it (68.2%). We observed that disagreement with the statement that the
individual would receive the COVID-19 vaccine only after many others had received it was the
strongest predictor for an intent to vaccinate among our Filipino respondents. This segment of
the population could represent citizens who so want to be vaccinated that they are willing to put
aside the collectivist mindset that is strongly rooted in Filipino culture (Grimm et al., 1999).
However, given the high numbers of respondents who indicated that they were waiting for
others to first receive the vaccine, our UST-CoVAX public awareness program began sharing
the personal vaccination testimonies of Filipinos around the world on social media platforms to
show Filipinos in the Philippines that others like them had already received the COVID-19
vaccines.

Our study revealed that most (21%) were willing to pay an amount of PHP1,000 [USD20] for two
doses of the COVID-19 vaccines with an average willing-to-pay amount of PHP1,892 (USD38).
Multinomial logistic regression showed that individuals aged 31 to 40, single respondents, and
students had the highest WTP in their demographic categories respectively. Since the minimum
daily wage in the Philippines in 2021 is PHP537 [USD10.54], the average WTP amount of
PHP1,892 (USD38) remains a significant investment in the health of the individual, equivalent to
nearly four days of wages. This suggests that the COVID-19 vaccines should be provided free
of charge to ensure population-wide access among all Filipinos across the economic classes.
Finally, our analysis revealed significant vaccine brand preference among our Filipino
respondents. The vast majority of participants were ‘confident’ (59.7%) or ‘completely confident’
(23.1%) in a COVID-19 vaccine made in the USA or Europe. In contrast, a majority of
participants indicated they were either ‘completely not confident’ (38.2%, 16.5%) or ‘not
confident’ (46.8%, 49.2%) in a vaccine developed in China and Russia respectively. These
findings mirror those reported by the Pulse Asia survey already described above that showed
that a majority (52%) of Filipinos who were opting to get vaccinated preferred the Pfizer vaccine
(Pulse Asia, 2021). The roots of this brand preference are not clear. One possibility could be the
political controversy in the Philippine Senate where senators deemed the Chinese vaccine
brands ‘‘unacceptable’’ because of their low efficacy (Romero, 2020). Anecdotally, Filipino social
media influencers have also reminded Filipinos of the contaminated Chinese milk products that
had been banned in the Philippines over a decade ago (Crisostomo, 2012). Regardless of the
reasons, this vaccine preference has to be managed by the national government to prevent
Filipinos from unnecessarily delaying immunization to obtain their preferred vaccine brand. Our
study has several limitations. As we already noted above, the use of an openaccess online
survey may result in sampling bias so we cannot generalize our findings to the entire Filipino
population (Wyatt, 2000; Eysenbach & Wyatt, 2002). It is notable that young people aged 18–30
years, who make up around 28% of the population of the Philippines
(https://www.populationpyramid.net/philippines/), constitute 52.4% of our respondents.
Unexpectedly, however, senior citizens aged 61–89 years of age, who constitute 8% of the
country’s population are also over-represented with 11.8% of the respondents. Furthermore, the
responses were based on self-report and may be subject to self-reporting bias and a tendency
to report socially desirable responses especially in a strongly collectivist society like the
Philippines. One final limitation of our study is the bias associated with the assessment of
acceptance and WTP for a hypothetical COVID-19 vaccine before any concrete vaccines
actually exist (Schmidt & Bijmolt, 2019).

3. Jabar, Melvin and Torneo, Ador and Luis, Razon and Felices, John Benedict and Duya,
Hazel Ann Marie, Predictors of Intention To Vaccinate for COVID-19 in the Philippines: Do Trust
in Government and Trust in Vaccines Really Matter? (August 16, 2021). Jabar, M.A., Torneo,
A.R., Razon, L.F., Felices, J.B.E., & Duya, H.M.R., Predictors of intention to vaccinate for
COVID-19 in the Philippines: Do trust in government and trust in vaccines really matter?
Asia-Pacific Social Science Review, Forthcoming, Available at SSRN:
https://ssrn.com/abstract=3905783 or http://dx.doi.org/10.2139/ssrn.3905783

PREDICTORS OF INTENTION TO VACCINATE FOR COVID-19 IN THE PHILIPPINES: DO

TRUST IN GOVERNMENT AND TRUST IN VACCINES REALLY MATTER?

Vaccine Hesitancy as a Continuum

Several studies have highlighted the changing degree or extent of vaccine hesitancy or
acceptance. Gualano et al. (2019), in their systematic literature review, showed the varying
attitudes toward vaccination among parents, healthcare workers, and the general populace over
time. This means that some individuals may at one point desire to vaccinate, while at other
times, they may opt not to vaccinate. The work of Piltch-Loeb and DiClemente (2020) noted that
five important factors might shape and reshape vaccine uptake. According to them, decisions to
vaccinate are influenced by awareness of the health threat, availability of the vaccine,
accessibility of the vaccine, affordability of the vaccine, and acceptability of the vaccine. The
varying levels of hesitancy have also been observed across different disease-specific vaccines
(Yaqub et al., 2014). Such a phenomenon poses challenges in studying people’s attitudes
towards vaccines, but at the same time, reveals different entry points for policy interventions.
The work of MacDonald et al. (2018), for example, identified specific measures in addressing
hesitancy, such as targeting health communication, education of children, and the use of
language and framing (MacDonald et al., 2018). To get vaccinated or not is a decision that is not
fixed or static. Various factors come into play that shape and reshape one’s acceptance or
otherwise of a vaccine. For instance, in the Philippines, a study under the Vaccine Confidence
Project revealed a substantial drop in people’s trust in vaccine safety and effectiveness in the
Philippines - with the majority (93%) “strongly agreeing” that vaccines were important in 2015 to
only 32% in 2018 (Larson et al., 2019). Despite vaccination campaigns and immunization drives
of DOH, childhood immunization has also declined from 79.5% in 2008 to 69.9% in 2017 (PSA,
2020). As such, the nationwide delivery of the Expanded Program on Immunization has
suffered, causing an outbreak of polio and measles in different regions in 2019 (Department of
Health, 2019). The rapid increase in the cases of vaccine-preventable diseases indicates that
the existing approaches on rebuilding trust in vaccines at the macro and micro level need to be
revisited in order to prevent future outbreaks and contain future diseases. The diversity of
attitudes towards vaccines is a function of various individual and social factors. In particular, the
SAGE Working Group on Vaccine Hesitancy of the World Health Organization identifies a
plethora of influences encapsulated in three categories: contextual, individual, and group and
vaccine-specific influences (MacDonald, 2015). Interestingly, studies do not see the strong
influence of socioeconomic status on vaccine hesitancy (NoniMacDonald, 2015; Peretti-Watel et
al., 2015), which is a slight departure from traditional studies concerning attitudes and
perceptions. Also apparent in most definitions and frameworks of vaccine hesitancy are the
features of trust and legitimacy of institutions involved in vaccination programs such as the
government (Yaqub et al., 2014), which are the main variables of interest in this study.

Trust in Government and in Vaccines in the Philippines and Overseas

In the Philippines, trust in vaccines has been synonymous with trust in government, most
especially in the aftermath of the Dengvaxia controversy. How the government handled the
issue and the propagation of unfounded narratives about its adverse effects significantly altered
people’s awareness and trust in vaccines and resulted in the unprecedented resurgence of
prominent infectious diseases such as polio and measles (Tomacruz, 2018). And it is
recognized that media has played a vital role in this controversy, and it is only through the same
avenue that trust in vaccines can be rebuilt among the general population (Fatima & Syed,
2018). This atmosphere of mistrust has unfortunately dominated the sentiments of the Filipino
population even until the pandemic. A recent survey about COVID-19 vaccines in the
Philippines showed that 47% of Filipino adults are unwilling to take a vaccine owing to safety
concerns (Pulse Asia Research, Inc., 2020). Moreover, the current political situation, the close
ties between the Philippines and China, and the highly militarized approach in handling the
pandemic might have reinforced what Vergara (2021) calls “social traumas.” Such context might
have further aggravated the problem of hesitancy. In this case, restoring trust in vaccines also
necessitates simultaneous and constant rebuilding of trust in the government. In other countries,
anti-vaccine sentiments borne out of mistrust are almost as old as vaccination itself, as the first
organized groups dedicated to it were established as early as the 19th century (Blume, 2006).
Anti-vaccination sentiments usually are grounded on some population’s low levels of trust in
vaccines, partnered by the weak reinforcement of health institutions (Yaqub et al., 2014). These
sentiments eventually have paved the way for the development of organized movements, which
are often reinforced by deep-seated philosophical and religious beliefs (Blume, 2006). Its
continuous growth has been observed in recent years, with perceived risks of vaccines as one
of the prominent reasons (Yaqub et al., 2014), and as it is still making an impact on the delivery
of the Covid19 vaccine (Burki, 2020). Trust was also crucial in forging vaccine confidence in the
context of previous epidemics. In the U.S., where partisan politics is more defined, it was found
out that trust in government and vaccines is relatively high among Democrats than among
Republicans, which is likely influenced by the fact that the epidemic was happening under a
Democrat-led US government when the study was conducted (Mesch & Schwirian, 2015). This
demonstrates how political contexts should also be considered in how vaccine trust is forged
(Larson, 2018), most especially now that it is salient in how the government responds to the
Covid-19 crisis. Initial studies at the onset of the pandemic showed that there is still a great deal
of uncertainty regarding the sentiments towards Covid-19 vaccines. Studies found that vaccine
acceptance rates vary among different population groups. Most of the respondents of a recent
global survey conducted among 19 countries showed significant willingness to take a Covid-19
vaccine, provided that it is safe (Lazarus et al., 2020). On the side of the healthcare workers,
those who are directly administering Covid-19 patients reported high rates of acceptance
compared to those who are handling non-Covid19 cases (Dror et al., 2020). Higher levels of
acceptance have also been associated with higher trust levels in government information
(Lazarus et al., 2020). This shows how the integrity and performance of governments play a
vital role in the implementation of an efficient vaccination program. A number of studies have
examined the role of trust (e.g., Freimuth et al., 2017) in people’s willingness to vaccinate
(vaccine propensity) in other countries. The study of Justwan et al. (2019) found that
respondents who strongly trust the Centre for Disease Control (CDC) in the U.S. exhibited
positive views about vaccination (in this case, for measles). The critical review of Yaqub et al.
(2014) identified trust issues (in health care providers/health system [also in Ozawa and Stack,
2013], government sources, and pharmaceutical companies) more than lack of information and
misinformation as the primary reason for vaccine hesitancy. The study of Palamenghi et al.
(2020), meanwhile, concluded that willingness to avail of a Covid-19 vaccine is associated with
trust in research and in vaccines (also in Ozawa and Stack, 2013). Their study opined that a low
level of trust might negatively impact Covid-19 vaccine intentions. Vaccine decisions may also
be influenced by the source of the vaccine.

The Role of Risk Communication in Vaccine Acceptance

Public perception of risks associated with vaccines and immunization are varying and complex.
Negative public risk perception on vaccines can lead to long-term impacts such as a low level of
vaccination coverage and recurrence of diseases and infections (Larson et al., 2012). Moreover,
poor communication and information dissemination can shape the attitudes and behaviors of
individuals towards vaccination in a negative way (Goldstein, 2015). With the emergence of new
epidemic diseases and the changing public perception of vaccines, scholars and experts
emphasized the importance of risk communication at the individual and societal levels. Learning
from previous experiences and cases, studies on pandemic and vaccination perceptions
suggest different models of risk communication. For instance, the U.K. Risk and Regulation
Advisory Council (as cited in Bouder, 2015) focused on “five As”: assembling the evidence,
acknowledgment of public perspectives, analysis of options, authority in charge, and interacting
with the audience. This approach highlights the need to “test for trust” by taking public
perspectives into account when devising a communication strategy. Alternatively, a three-step
model on vaccine risk communication shows that risk assessment, risk communication, and risk
mitigation are inextricably linked. Risk communication should be integrated into the whole
process of managing risks related to vaccines. Operational and policy strategies employed
through communication are essential in building trust in vaccines and mitigating existing and
potential risks (Larson et al., 2012). While governments and institutions have utilized various
approaches to communicate the benefits and risks of vaccines, efforts to improve vaccine risk
communication must be sustained and intensified. An assessment of the current situation, risks,
and measures on promoting vaccination must be done to reinforce strategic communication at
all levels. Furthermore, information to be shared with the public should be true, complete,
balanced, and easily understood (Bozzola et al., 2020; Dittmann, 2001; Goldstein, 2015).
Overall, vaccine-related communication strategies can be used to relay and clarify information,
reduce risks, manage public concerns, and maintain trust in vaccines (Bozzola et al., 2020;
Larson et al., 2012). Amid a global pandemic such as Covid-19, having an integrated
communication strategy plays a crucial role in potentially increasing vaccine acceptance and
ensuring vaccine safety.

Understanding Vaccine Hesitancy using the Health Belief Model

There are different models to explain vaccine hesitancy or acceptance. The most common of
which is the health belief model (HBM). The health belief model, developed by Hochbaum and
Rosenstock in the 1950s, maintains that the likelihood of occurrence of a behavioral action (e.g.,
to vaccinate) is influenced by a confluence of factors including socio-demographic
characteristics (e.g., education, age, sex, race, ethnicity), perceptions (perceived susceptibility
and perceived severity), expectations (perceived benefits, perceived barriers to actions,
perceived self-efficacy to perform the action), and cues to action (e.g., media, personal
influence, and reminders) (Rosenstock, Stretcher, & Becker, 1988). The study of Wong et al.
(2020), for instance, examined intention to receive and willingness to pay for a Covid-19 vaccine
using such a model. In their operationalization, they defined perceived susceptibility as one’s
belief or assessment of the likelihood of contracting the disease. This was defined as being
anxious or worried about getting the virus, the perceived likelihood of being infected, and the
perception of the possibility of acquiring the virus. These authors examined perceived severity
as the understanding of the negative effects of the diseases on one’s mental and physical
health. These included the perception of the possible complications once infected, fear of
getting the disease, and perception that one will be very sick if infected with the virus. Perceived
benefits refer to the advantages of getting vaccinated, while perceived barriers refer to the
psychosocial, physical, and financial factors that inhibit a person from performing the expected
behavior. In the study of Wong et al. (2020), perceived benefits were measured in terms of the
likelihood of reducing the chance of being infected and of being worried. Perceived barriers,
meanwhile, were examined in terms of doubts and concerns regarding efficacy, safety,
affordability, side effects, and halal certification compliance. For cues to action, the authors
included variables, namely, information (adequate information about the vaccine are acquired),
people and events (many people are receiving the vaccine), which can influence an individual to
receive the vaccine. There are mixed results as regard what factors within the model
significantly explain vaccine acceptance or hesitancy. The results of the study of Wong et al.
(2020) pointed out that the intention to take a COVID-19 vaccine among their respondents
(n=1,159) was highly influenced by perceived benefits (decrease chance of infection and
reduction of being worried). The study of Walker et al. (2021) revealed that mothers were
somewhat skeptical in getting the Covid-19 vaccine due to their past vaccine hesitancy attitudes
and behavior. However, their perceptions of threats or risks shaped their protected behaviors
such as “handwashing, mask-wearing, and [physical] distancing.” Their skepticism in getting the
vaccine is due to issues of safety, efficacy, and conflicting information. A multi-country study was
conducted by Kebede et al. (2021) in Bangladesh, India, Kenya, Myanmar, Tanzania, and the
Democratic Republic of Congo. Their analysis revealed that Covid-19 vaccine acceptance was
significantly associated with “perceived social norms, perceived positive and negative
consequences, perceived risk, perceived severity, trust in Covid -19 vaccines, perceived safety
of Covid -19 vaccines, and expected access to vaccines” in Bangladesh, Kenya, Tanzania, and
the Democratic Republic of Congo. However, in India and Myanmar, apart from the factors
already mentioned, “self-efficacy, trust in Covid -19 information from leaders, perceived divine
will, perceived action efficacy of the Covid-19 vaccine” were likewise found to be significantly
associated with vaccine acceptance. Variations in the results of studies using the health belief
model to understand vaccine acceptance or hesitancy can be due to several factors, but most
notably, the personal background of the individuals and the time or period in which these studies
have been conducted. Although this review is not exhaustive, one can surmise that among
health care workers, the factor that seems to drive them to accept vaccination is its perceived
benefits (Wong et al., 2020; Youssef et al., 2020) more than the other HBM factors, including the
perception of susceptibility and severity. This may be due to the fact that health care workers
are more or less familiar with the pathology of the disease. Among the general population,
however, quite a number of the HBM factors seem to explain their willingness or otherwise to
accept or receive the vaccine. These included perceived barriers (Wong et al., 2021; Walker et
al., 2021a; Walker et al., 2021b), susceptibility, severity (Shmueli, 2021), cues to action (Wong
et al., 2021; Shmueli, 2021), and benefits (Shmueli, 2021; Walker et al., 2021a; Walker et al.,
2021b). However, as more and more people are becoming aware of the nature of Covid-19
(including transmission, prevention, and health effects), the decision to receive the vaccine is
now more focused on benefits, barriers, and cues to action. Despite its usefulness in
understanding behavioral intention/action, the health belief model (HBM) has its limitations. This
model, however, is very much appropriate to vaccination acceptance since this refers to a
behavior that is not habitually expected. This model is highly criticized, though, because of the
very reason that it cannot explain habitual behavior. Kirscht (1988) even suggested that the
model may be best applied in less repetitive behavior that requires specific actions that are
deemed as solutions to health predicaments (e.g., prevention of breast cancer through annual
breast examinations; immunizations). The other limitation of the HBM in examining behavioral
intention is “trust” related variables. Given this limitation, the authors of this present paper made
reference to the work of Dubé et al. (2013). Their framework, to the minds of the authors, is
somewhat informed by the HBM, such as the use of the concepts like perceived importance
(benefits), knowledge and information (cues to action), risk perception and trust (perceived
risks). However, the framework of Dubé et al. (2013) included other contexts to include past
experiences, subjective norms, religious and moral convictions, and trust in public health and
vaccine policies, trust in health professional’s recommendations, and trust in communication
and media (i.e., traditional and social media and anti-vaccination activists). Informed by the
HBM and the work of Dubé et al. (2013), this study, however, made some adjustments. First, the
trust variable is related to trust in vaccines and trust in government. At the individual level, it
looks into the influence of personal demographics, risk exposure perception, perceived current
health status, and access to vaccine-related information. Additionally, this study also looks into
the family members’ past experience with any type of vaccination.

Other Factors Influencing Vaccine Hesitancy

Understanding of individuals towards the risk of getting a vaccine varies differently depending
on different factors and circumstances. Larson et al. (2014), in their global analysis on vaccine
hesitancy, revealed that despite several studies on vaccine confidence and refusal, some
potentially relevant determinants on vaccine hesitancy still need to be identified and examined.
Further studies now consider factors such as socioeconomic status, educational attainment,
cost of vaccines, knowledge about the vaccines, familiarity with the disease, perceived
consequences and social, communication, and media environment as part of analyzing attitudes
towards vaccines (Bond & Nolan, 2011; Larson et al., 2014). In some cases, psychological,
sociocultural, and political factors such as religious and philosophical beliefs, unsuccessful
immunization programs, inadequate health programs and infrastructures, negative publicity, and
counter propagandas can also affect the acceptance and trust of people in vaccines (Barrelet et
al., 2013; Dittmann, 2001; Larson et al., 2012). A closer look in the existing case studies on
immunization programs indicates that sociodemographic profile (gender, age, household
composition, socioeconomic status) and family members’ experience of getting a vaccine can
also be associated with the change of public attitudes on vaccines. For instance, it is suggested
that campaigns on Covid-19 vaccines should target women as decisions regarding the health
and safety of their families often depend on them (Lazarus et al., 2020). Interestingly, studies do
not see the strong influence of socioeconomic status on vaccine hesitancy (MacDonald, 2015;
Peretti-Watel et al., 2015), which is a slight departure from traditional studies concerning
attitudes and perception. Instead, studies have shown the varying extent of vaccine hesitancy
differentiated by population, namely parents, healthcare professionals, and the general
populace, as well as by disease-specific vaccines (Gualano et al., 2019; Yaqub et al., 2014).
Information related to vaccination is also crucial in determining the public’s decision on
vaccines. At the onset of the Covid-19 pandemic, the World Health Organization have raised its
concern on the possible effects of a “global epidemic of misinformation” as the internet and
social media enable borderless and seamless sharing of information and misinformation on
vaccine safety and other health interventions (Zarocostas, 2020). However, it is essential to note
that the credibility of the source, accuracy of the information, and delivery and content of the
message should also be considered in understanding vaccine attitudes (Yaqub et al., 2014).
Ultimately, identifying factors that contribute to vaccine hesitancy is necessary to ascertain its
possible implications on vaccination rollout programs and to create further trust-building
interventions through health and risk

Conceptual Framework
As earlier mentioned, this paper is informed by the Health Belief Model (HBM) and the work of
Dubé et al. (2013). The paper’s focus is to establish the link between trust in government and
trust in vaccines to the intention to vaccinate for Covid-19. The choice of trust as a variable was
guided by the work of Dubé et al. (2013). Meanwhile, there are concepts in the HBM that this
paper adopted, namely, perceived risk exposure (perceived susceptibility), demographics, and
access to vaccine-related information (cues to action). Although not present in HBM and the
work of Dubé et al. (2013), this paper included family members’ past experience with any type
of vaccination and perceived current health status as factors that would likely influence intention
to vaccinate Covid-19.

Method
This paper is based on an online survey involving 1,953 respondents (general population who
own a Facebook or Instagram accounts). The said online survey was conducted from July 28 to
August 2020. Recruitment of participants was done through paid online advertisement. The
respondents were asked to read the informed consent and to confirm that they agree with the
conditions for participation. Once they have indicated their agreement, the respondents were
then directed to the online survey. This study underwent an ethics review by the De La Salle
University Ethics Review Board with the number FAF.012.2019-2020.T2.SDRC. The survey,
which this paper is based on, covered the following variables, namely, information related to
personal demographics, intention to vaccinate, trust in government, trust in vaccines, access to
vaccine-related information from different sources, family members’ past experience in receiving
a vaccine, perceived risk exposure, and perceived current health status were analyzed.
Statistical tests (chi-square test) were conducted to see the association between personal
demographics and intention to vaccinate, namely, sex (male or female), marital status (married,
single, separated, or widowed), level of education (high school or lower and college level or
higher) and monthly household income from all sources (Below 30,000 pesos or 30,000 pesos
and above. In the study context, respondents were asked to convey their intention to vaccinate
(yes, no, or maybe). Likewise, using the chi-square test of association, perceived risk (high,
moderate, or low) and perceived current health status (very healthy, healthy, not so healthy, very
unhealthy) were tested vis-à-vis intention to vaccinate. For the perceived risk exposure, the
respondents were asked, “ In your opinion, which of the following best describes your risk for
COVID-19.” To guide the respondents with their assessment of risk exposure, the authors
provided an operational definition. High-risk exposure means the respondents had many
encounters or interactions with people suspected or confirmed to have COVID-19. Moderate
risk exposure, meanwhile, pertains to few encounters. Low-risk exposure means no interaction
with people suspected of having or confirmed to have COVID-19. The respondents were asked
to indicate whether they think they are very healthy, healthy, not so healthy, and very unhealthy
for the perceived current health status. The authors designed a scale for the trust in
government. The said scale covers the following items: a) satisfaction with the way the local
government handles the COVID-19 pandemic in the respondent’s locality, b) trust that the
government can decide effectively regarding which vaccine should be made available to the
public, c) trust that the government will be able to manage COVID 19 pandemic in the country
effectively, d) confident that the government can make decisions that are in the best interest of
the public when it comes to what health remedies/intervention to offer for Covid-19 patients, and
e) satisfaction with the way the government has handled the COVID-19 pandemic in the country.
The Cronbach’s α for this scale is .780 (sd=.921). In this scale, the respondents were asked to
indicate their response to each item by choosing either strongly agree, agree, neutral, disagree,
or strongly disagree. In the analysis, the mean score of all the items for each respondent was
used in the statistical treatment. Another scale specifically made for this study is the trust in
vaccines in scale (Cronbach’s α=.704, sd=.733). This scale measures the following, a) belief in
the importance of vaccine as a preventive measure, b) disagreement with some groups of
people who are against any kind of vaccine, c) belief that vaccine will stop the spread of
Covid-19, d) willingness to have oneself vaccinated once the vaccine is available, e) willingness
to participate in clinical trials and f) conviction that all vaccines are safe. Like the scale for trust
in government, this scale also asked the respondents to indicate their level of agreement or
disagreement in each of the items. Like the previous scale, the data used in the statistical
analysis was the mean scores of the respondents for all the items of the scale. Meanwhile,
access to vaccine-related information questions pertain to access to information related to risks
and benefits, access to vaccine-related information a month ago, access to vaccinerelated
information from a family member, a friend, a college, and from social media. In these items,
respondents were asked to indicate either yes or no. Similarly, the respondents were also asked
whether or not (yes or no) any family member has been vaccinated in the past five years, has
been vaccinated for Dengue in the past five years, and has been vaccinated with Dengvaxia in
the past five years. In terms of the normality tests results, all data have values suggesting that
data is not normally distributed. All but two items have kurtosis beyond the acceptable value
(i.e., read vaccine-related information from social media a month ago and family member who
have availed of Dengvaxia). In terms of skewness, all the data or measures are not normally
distributed. Despite this limitation, the number of respondents and the performance of
chi-square test associations will hopefully guide the readers in ascertaining the robustness of
the multinomial regression results

RESULTS
Of the 1,953 respondents, 39% said that they are willing to vaccinate for Covid -19 while 37%
are not sure. About a quarter (24%) of the respondents claimed to be unwilling to
vaccinate.Furthermore, when asked if they would be willing to vaccinate for free, only 654
(33.49%) respondents said yes. Among those who want to push through despite the possibility
of the vaccine not being free, the median price they are willing to pay for a Covid -19 vaccine is
Php 1000 (roughly 20 USD)
As earlier mentioned, the respondents were asked if they had read or heard any vaccine-related
information from their significant others or from social media. Results suggest that the
respondents have the practice of reading vaccine information related to risks and benefits (95%
of them responded yes to the item, n=1,858). Many of them (88%) have read vaccine-related
information through social media platforms. Less than 50% of the respondents had heard of
vaccine-related information from a friend (49%, n=962), family member (4%, n=876), and a
colleague (43%, n=849) a month prior to the survey.

4. Amit, A. M. L., Pepito, V. C. F., Sumpaico-Tanchanco, L., & Dayrit, M. M. (2022).

COVID-19 vaccine brand hesitancy and other challenges to vaccination in the
Philippines. PLOS global public health, 2(1), e0000165.
https://doi.org/10.1371/journal.pgph.0000165

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021706/pdf/pgph.0000165.p
df

Determinants of COVID-19 vaccination decision among Filipino adults

5. Tejero, L.M.S., Seva, R., Petelo Ilagan, B. et al. Determinants of COVID-19 vaccination
decision among Filipino adults. BMC Public Health 23, 851 (2023).
https://doi.org/10.1186/s12889-023-15712-w

file:///C:/Users/HP/Downloads/s12889-023-15712-w.pdf

COVID-19 vaccine brand hesitancy and other challenges to vaccination in the

Philippines
 Study Study Populatio Sample Acceptance Predictors of hesitance
period n size rate

Pagador, P., et.al April 11, General 1,011 79.5% The majority of responders who were
2021 to reluctant to receive the vaccine voiced
May 5, their mistrust of the shot (56.5%) and their
2021. uncertainty about its safety (59.7%).

Cross
sectional
study

Hartigan-Go, K., et.al July 7, General 40,367 44% Early research on COVID-19 vaccine
2020 and reluctance revealed varying levels of
March 29, hesitancy in different nations, which was
2021, related to a number of variables including
socioeconomic circumstances, information
Longitudin sources, and concerns with trusting the
al study government, scientific community, and the
health sector.

Roldan-Gan, R., et.al August 18 Unvaccinated 438 72.23% Regarding the truth about COVID-19 and
2023 to w/ COVID-19 its vaccines, there are many
August 27 vaccine misconceptions among Filipinos. Based on
2023 their expressed confidence in the various
vaccine brands given, Filipinos are also
cross-secti demonstrated to be brand conscientious.
onal mixed Many of the responders are concerned
method about the efficacy and safety of the
study vaccine, but the majority of them are
persuaded that everyone should get
vaccinated in order for us to stop the
pandemic.

Migriño, J., et.al April 2022- 20-39 year 119 88% Exposure to unfavorable media coverage
June 2022 old mothers and worries about vaccination safety were
the main causes of vaccine reluctance.
Cross The primary unfavorable media coverage
sectional noted by the respondents concerned the
study dengue vaccine, Dengvaxia®.

Yanto, Theo., et.al June 2020- General 12 61% Age, sex, education, past COVID-19
June 2021 datasets infections, smoking and marital status,
health insurance, living together, chronic
Systematic conditions, and healthcare workers were
review & the only ten factors that did not
Meta substantially predict acceptance.
analysis

Saito, K., et.al June General 609 75.7% In addition to sociodemographic

2020-June characteristics, risk perception and beliefs,
2021 which in turn were influenced by societal
factors including infection trends and
Comparati vaccine regulations, also had an impact on
ve study vaccination willingness.

Amit, AML., et. al July - General and 35 Individual barriers include perceptions;
August health attitudes; and beliefs about science, about
 2022 workforce vaccines, about the health system and
government. Interpersonal barriers are the
Descriptive networks and social capital that influence
research health beliefs and decisions. Vaccine
procurement, supply, and logistics,
together with media- and policy-related
issues, comprise the structural barriers.

Ong, AKS., et. al General Purposive Efficacy of COVID-19 vaccines, perceived

cross-secti sampling; side effects, its benefits, and barriers
onal study 865

Frias, A., et. al March 23 - PHINMA 274 99.3% Trust in a strong immune system, Efficacy
March 30, Saint Jude of the vaccines, social media influence,
2022 College Comorbidities, adverse effects, Access to
Students vaccines

Cleofas, J., & July 2021 18-24 y/o, 1692 48.97% High life satisfaction, high pandemic
Oducado R unvaccinated fatigue, Perception of self-health, no
exposure to persons with COVID-19

Wee, M, K., et. al September Parents with 400 62.8% Most common factor determined was the
2020 - April children aged risk/benefit of vaccine and introduction to
2021 1-17 y/o new vaccines

non-experi
mental
quantitativ
e
descriptive
research
study

Bautista, A. et. al January 19 General 137 71% Vaccine safety and effectiveness was
- February noted to be the most important factor in
4 2021 vaccine hesitancy. Majority of those
quantitativ unwilling, do not think the vaccines are
e safe
cross-secti
onal study

Marzo et al. February - Genera; 311 84% Living in rural areas, lower education,
May 2021 illiterate, family economic status.
descriptive
cross-secti
onal study

Brackstone, K. et al. May-Septe General 1002 45.9% May be a consequence of previous

mber 2021 vaccine scares in the years leading up to
cross-secti the pandemic, including the Dengvaxia
onal study controversy in 2016
Survey results showed that the trend for vaccine hesitancy has increased for women in the
Philippines. More investigation is needed to determine the root causes for distrust among
women. However, there is a possible connection through women’s networks — and possibly
among mothers— as the growing global online anti-vaccine movement has been found to be
composed mostly of women. Other significant determinants also highlight the
influence of effective communication and accurate news in decreasing vaccine hesitancy. With
increased trust in the WHO while government health authorities were linked to decreased
vaccine hesitancy, it is imperative to reinforce trust in these sources among the population to
increase vaccine acceptance. Since more exposure to COVID-19 information was also linked to
decreased vaccine hesitancy, it would be beneficial to expand the reach and increase the
frequency of exposure to these trusted sources. The content of COVID-19 vaccination
communication campaigns can also be streamlined around messages that have been linked to
decreased vaccine hesitancy. For instance, in this study, it appears that communications
campaigns to promote mask wearing was effective in promoting positive attitudes towards
vaccination. Knowing a positive case has also been linked to decreased hesitancy, which may
be attributed to an increased perceived risk of COVID-19 when a close contact has been
infected. Perceived risk has been found to be a significant predictor of COVID-19 vaccination
intention.20-22 Accordingly, communicating the risk of COVID-19 can be helpful in vaccination
communication efforts. In localized communication campaigns that may use social media
platforms, testimonies by community members who have recovered from COVID-19 or have
already been vaccinated may be helpful in convincing more vaccinations.