Manila, Philippines – Last week, after ignoring her brother’s advice for months, Fannie Taladro Pestaño hurried to a school campus near her home in Las Piñas City, a suburb of the Philippines’ capital Manila, to line up for her first dose of a COVID-19 vaccine.
Her brother, Johnny Rey Taladro, had been urging her to sign up for the immunisation drive.
It was free, and they needed the protection because, as menial labourers, they did not have the luxury of working from home.
“Think of your family,” he told her.
But Pestaño worried about side effects. She said she had heard news of people in other countries fainting, having a heart attack, and even dying after getting the jab. All her neighbours were talking about it.
So while she was aware of the immunisation campaign, she felt strongly against it, and not even her brother could convince her.
Then Las Piñas City’s congresswoman began a raffle offering huge prizes, but only for those who registered for COVID-19 vaccination.
“I heard a house-and-lot was at stake. I want that, of course,” Pestaño told Al Jazeera. She still feared the vaccine’s side effects, but she reassured herself by remembering her brother’s advice.
“Whatever happens, happens. It’s all up to God,” said Pestaño.
“We need it,” she said, referring to the house she now stands a chance of winning.
Vaccine hesitancy among Filipinos is a major concern in the country’s COVID-19 immunisation drive, already hampered by the slow arrival of vaccine shipments. Only 4 percent of the Philippines’ roughly 110 million people have received at least one dose of a COVID-19 vaccine as of June 6, and only 1.4 percent have received a second dose.
In May, the local pollster Social Weather Stations (SWS) found that only one-third of 1,200 Filipinos it surveyed were willing to be vaccinated against COVID-19 even though the country is enduring one of the worst outbreaks in Southeast Asia. Another third were unwilling to be vaccinated, and a little more than a third were uncertain about it.
Mostly, people said they were concerned about the vaccines’ side effects, followed by doubts about the drugs’ efficacy, the survey showed. Social media posts discrediting vaccines are also a major cause of hesitation, according to the health department.
Congresswoman Villar, whose family owns one of the country’s largest property conglomerates, donated the prizes for Las Piñas’ raffles. The house-and-lot, estimated to be worth about one million pesos ($20,000), is a project of a company owned by her father, former senator Manny Villar.
Aside from boosting vaccination sign-ups, Villar said the raffle was designed to “spread awareness about the benefits of the COVID-19 immunisation programme of the national government”.
“A lot of Filipinos have reservations about getting vaccinated due, in part, to fears about the side effects, as a result of lack of proper knowledge and information about the benefits of vaccination,” she told Al Jazeera.
Every month starting from July, 10 immunised residents will win a livelihood starter package each worth more than $100, a small fortune for the extremely poor. The kits include food and other grocery items enough to start a hole-in-the-wall convenience store, a common household business in the country.
The house-and-lot will be given away in a grand draw in December, along with two motorcycles.
Las Piñas is not the only place trying to entice residents to get vaccinated. Local governments in cities and towns across the Philippines are resorting to raffles.
Mostly the prizes include sacks of rice – the country’s staple food – and bags of grocery items but in San Luis town in Pampanga province near Manila, the municipal government will raffle a cow every month for immunised residents. Worth about $628 each, the animals will be supplied by local donors.
“Winning a cow might not mean much in other places but here in San Luis, we’re agricultural, so it’s the ideal incentive,” Ardee Taruc, the town’s disaster mitigation officer, told Al Jazeera.
A cow can offer its owner a way out of extreme poverty. It feeds on grass that grows abundantly on the plain. With it, a farmer can start a herd, use it as a beast of burden and, if it is female, sell its milk.
“It’s up to the winners if they want to slaughter the cows,” said Taruc.
Filipinos’ confidence in vaccines took a severe hit in late 2017, when legislators investigated the government’s 2016 rollout of a vaccine against the mosquito-borne dengue virus.
State lawyers – not doctors – linked Sanofi-Pasteur’s Dengvaxia vaccine to a number of deaths in children who had been inoculated. Although the results of the investigation were inconclusive, the public’s vaccine confidence declined dramatically from 93 percent in 2015 to just 32 percent in 2018, according to The Vaccine Confidence Project.
Besides the Dengvaxia scare, the novelty of COVID-19 vaccines adds to the hesitation, said Lulu Bravo, a doctor and executive director of the Philippine Foundation for Vaccination.
“With the pandemic, we’re walking on uncharted territory. It’s actually fear of the unknown,” Bravo told Al Jazeera.
The Philippines’ priority list for COVID-19 immunisation includes medical workers, the elderly and people with co-morbidities – medical conditions that make them more susceptible to infection and severe disease.
Since the country only started public vaccination drives in the mid-1970s, many of the elderly grew up without having been immunised at all, which might also explain their reluctance to be vaccinated against COVID-19, Bravo added.
Education is a factor, too, she said.
‘I don’t trust the government’
Driven out of a job by the pandemic, Leandro Atienza and his wife live in his mother-in-law’s house in Las Piñas. Like many poor Filipinos, he only finished high school.
Despite the scale of the coronavirus outbreak in the Philippines, Atienza says he does not personally know anyone who has contracted the disease. As a result, he does not believe COVID-19 is real, and refuses to be vaccinated.
“People have been talking about COVID for more than a year. I should have gotten it by now because I’m always out looking for a way to feed myself and my wife. I should have gotten COVID already, but I haven’t,” Atienza told Al Jazeera.
The negative news about COVID-19 vaccines has also given Atienza the impression that the drugs are dangerous, despite government assurances that they are safe and effective.
“See, I don’t trust the government,” Atienza said.
Senator Risa Hontiveros, a public health advocate, welcomed any effort to boost the immunisation drive, including incentives. However, she says there is also a need to “address barriers” in people’s attitudes towards the vaccines.
“The mere fact that local government units need to resort to raffles, or that private companies have to offer vaccine benefits, reflects failure and inadequacy on the part of our national government to build public confidence in our vaccination programme,” Hontiveros told Al Jazeera.
Bravo added that the central government’s inconsistent messaging on the pandemic has also undermined the vaccination drive.
President Rodrigo Duterte has often downplayed the severity of the pandemic and has been coy about getting a vaccine.
He received his first dose only on May 3, months after the public rollout began. He chose the vaccine made by the Chinese state-owned pharmaceutical Sinopharm, which had no emergency use approval in the Philippines at the time, and was not available to the wider population.
By taking a vaccine brand other than one of those available to Filipinos, Duterte has fuelled the public’s hesitancy, critics said. Duterte, whose foreign policy favours China, later apologised.
“Messengers who are highly politicised have harmed the country’s immunisation drive,” Bravo said.
She said it should be made clear to everyone that their risk of getting sick from COVID-19 is about 2,000 times greater than that of suffering from a vaccine’s side effects, a message the health department already has on repeat.
“You can only be convinced if you trust the messenger. If you don’t trust the messenger, you also will not trust the message,” she added.
Did it work?
But the race towards herd immunity cannot wait until every citizen is properly convinced, and the offer of incentives – raffle prizes in particular – has encouraged vaccination sign-ups.
“The cows have made a huge impact,” said Taruc of San Luis town. Since the raffle was announced in late May, registrations for vaccination increased by about 50 percent.
“Now, our problem is everyone wants to be vaccinated, and there aren’t enough vaccines on hand,” Taruc added.
Local governments’ social media notices about the vaccine-linked raffles have been flooded with enquiries from residents wanting to register for vaccination so they can join the contests, and Duterte’s cabinet, including vaccination chief Carlito Galvez Jr, has been generally supportive of the unconventional approach.
The central government itself may soon offer incentives for the immunised, such as fewer restrictions in public places and shorter quarantine times for travellers, Galvez told local news outlets.
Las Piñas announced its raffle on May 28, and has seen “a rapid increase in sign-ups and interest in vaccination,” Villar said. More than 100,000 residents had been inoculated by June 8.
The raffle helped Taladro convince his wife, Nilrene, who has heart disease, to get the jab.
For Nilrene, it was worth the risk to increase the family’s chances of winning the house-and-lot. Her husband had joined it, too.
Relieved that his wife finally agreed to be vaccinated, Taladro now also fantasises about winning the house. If they win, it would change their lives.
“I barely make enough to put food on the table. More than half of what I earn goes to the rent,” Taladro, a construction worker who earns 537 pesos ($11) a day, told Al Jazeera.
The Philippines is reeling from its worst economic recession in the post-war era. Its economy shrank by 9.5 percent in 2020, and as of April, more than four million Filipinos were unemployed.
A week ago, it opened the immunisation drive to “economic front-liners” – citizens involved in the kind of work that is not possible to do from home.
As an itinerant labourer, Atienza might qualify but he has still refused to sign up and he disagreed with his city’s raffle programme too, observing that only one person can win.
Atienza, who rarely ever sees a doctor and whose infant son died of meningitis last year, would rather hear the government commit to pay the hospital bill of anyone who might get sick from the vaccines.
As it stands, the government’s health insurance policy offers only conditional subsidies, including for vaccine side effects.
“They should be responsible for whatever happens, right?” Atienza said.