CHAPTER 1 - Draft
CHAPTER 1 - Draft
CHAPTER 1 - Draft
2021-2022
2nd Semester
Chapter 1
INTRODUCTION
Following this phenomenon, months after the confirmation of a triumphant and effective
production, the initiation of vaccination was immediately enforced shortly after the approval of
WHO and the Food and Drug Administration (FDA). In the Philippines, almost 51% of the
population has become fully vaccinated, as of January (Our World in Data, 2022). Because of
the distribution and inoculation of vaccines, getting infected was reduced. However, despite the
months that have passed since the availability of these COVID-19 shots, there are still those
who are reluctant to vaccinate. While some worry because of their health conditions, others who
do not suffer from any choose to remain unvaccinated. Their reasons for vaccine hesitancy are
yet to be discussed, more so to be accepted by society. Hence, the unvaccinated people by
choice becomes subjects of criticization, judgement, and discrimination.
The history of COVID-19 can be traced back to Wuhan City, Hubei Province of China
before it subsequently spread worldwide. During the months of November and December, 2019,
an outbreak of similar cases of acute respiratory illnesses in the area was reported to the
Chinese Center for Disease Control (CDC). The diseases found were caused by the etiological
agent behind COVID-19, a newly identified novel coronavirus named Severe Acute Respiratory
Syndrome Coronavirus 2 or SARS-CoV-2 (initially was called 2019-nCoV) (Mohan & Nambiar,
2020). SARS-CoV-2, like any other viruses, evolves as time goes by. As a result, its properties
may or may not change, depending on the level of modification. Since January of 2020, WHO,
alongside different academic researchers, have been analyzing the mutation of SARS-CoV-2 to
examine the possible variants that may appear. Later in the same year, specific Variants of
Interest (VOIs) and Variants of Concern (VOCs) were identified and categorized such as VOCs’
Omicron and Delta variant (WHO, 2022). Omicron being the most recent discovery imposed a
greater threat to global health. First appearing in South Africa, this variant is more dangerous
because of its rapid transmission than Delta. Because of the minimal number of cases
originating from this mutation, its association to the severity of the disease and death rates is
still unknown (Centers for Disease Control and Prevention, 2021).
Vaccines are vital weapons for combat against the virus. Successful immunization and
production of vaccines are the world’s only hope to alleviate society's current situation, more so
to eliminate further severe infections. Late December of 2020 to early 2021, there were already
three vaccines that have been granted with Emergency Use Authorization (EUA) by the FDA,
namely: Pfizer-BioNTech, Moderna, and Johnson & Johnson’s Janssen. Following this was the
approval to initiate an early vaccination process to prioritize the public’s welfare from the
growing number of COVID-19 cases. FDA collaborated with vaccine manufacturers, research
centers, and other organizations in the same field to study, interpret and assess the data of
these vaccines through conducting a series of tests. As a result, findings report that all three
were successful in achieving two of FDA’s major standards for vaccination: (1) preventing
severe COVID-19 infections, and (2) having extremely low risks of serious side effects (Kelen &
Maragakis, 2021). However, with the presence of new variants such as the Omicron, late 2021
to early 2022, booster shots were immediately effectuated afterward when studies from the
Centers for Disease Control and Prevention (CDC) reported how booster shots for COVID-19
vaccines "reduces a person's odds of hospitalization from the Omicron variant" (as cited in the
published article of Edwards, 2022).
A study conducted by the CDC (2021) shows that a rough estimation of 85% of adults
ages 18 and above in the United States have already received at least one dose of COVID-19
immunization as of December 14. However, the remaining 15% are reported to be the exact
opposite. In a survey carried out by the U.S. Census Bureau’s Household Pulse Survey (HPS),
it was presented that there were multiple reasons why many have not received any. Among the
responses, about half of the respondents revealed that they were "concerned" with the possible
side effects of the vaccines. 42% were saying they “don’t trust the COVID-19 vaccine; less than
10% were because of their doctor’s recommendations; and about 2% of the respondents
showed that they were experiencing difficulties in accessing to COVID-19 vaccines (Monte,
2021). The same behavior was also seen in a community-based survey about the attitude
towards COVID-19 vaccines in Tamil Nadu, India where about 19.5% percent denied vaccines
while 40.7% were hesitant. The most garnered reason was their “mistrust in the health systems
and the vaccines” (Danabal, Gopichandran, Magesh, & Saravanan, 2021).
In the Philippines, similar cases were also reported regarding the behavior and
acceptance of Filipinos all around the country towards COVID-19 vaccines. In the study of Amit,
Dayrit, Pepito, and Tanchanco (2022) about vaccine hesitancy and other challenges of
vaccination in the country, findings reveal some factors that greatly influence the opposition of
attaining a successful immunization such as the having vaccine brand hesitancy. With rumors
circulating about producing a specific vaccine, respondents expressed their concern over its
efficacy and safety; therefore, they preferred specific brands that were recognized and fully
approved in other countries. Others also view the vaccination process as unsafe and deadly,
while some deem it unnecessary. Other aspects include: negative experiences as a source of
vaccine hesitancy and/or anti-vaccination; skepticism towards incentives; low health literacy;
and many more reasons as to why people have poor and negative attitudes towards COVID-19
vaccines. In Davao City, around 30% of its people are still not vaccinated despite the continuous
turnout of the three-day Bakunahan from November 29 to December 1, 2021, and other
strategies imposed by the Local Government Unit (LGU) like house-to-house and barangay
mobile vaccinations. Aside from local residents, vaccine hesitancy was also prevailing
among indigenous people (IP) communities in the city (City Government of Davao City,
2021).
With that being stated, successful immunization still remains unclear as 3 billion people
worldwide are still unvaccinated since February (Our World in Data, 2022). Early this year, the
Philippines was at high alert level for COVID-19 infection when the new mutation, Omicron, was
found in the capital city. Taking matters further, the Inter-Agency Task Force for the
Management of Emerging Infectious Diseases’ (IATF) imposed specific guidelines, limiting the
movements of civilians; two of which are restricting unvaccinated people’s access to public
transport and requiring employees to be vaccinated (Coventus Law, 2022). Their guidelines
garnered mixed reactions from citizens. While some projected positive feedback, others
expressed their displeasure, with the Kilusang Magbubukid ng Pilipinas commenting, “Dividing
the population into vaccinated and unvaccinated is anti-people and inhumane.” (Cervantes,
2022).
The significance of this study is to present a new outlook and perspective on the attitude
of how Filipinos acknowledge the presence of COVID-19 immunization. In this research, the
students gathered the necessary information to address the different factors that influence the
hesitancy of the involved citizens towards COVID-19 vaccines, subsequently leading to their
decisiveness to remain unvaccinated even after the appearance of variants such as Omicron
and Delta. This study served as a platform for unvaccinated citizens to share and express their
sentiments as to why they are hesitant to vaccinate. In line with this, because of restricted
actions caused by the pandemic and limited studies focusing on the residents of Davao City,
this research took the initiative to explore and interview only Davaoeños for their reasons and
opinions. Furthermore, the researchers also wanted to promote a respectful community despite
the differences in perspectives. As people who are not yet vaccinated are unfortunately
criticized and discriminated against in the country for their “selfish” and “risky” decisions, the
researchers aim to eliminate any form of judgment and mistreatment towards unvaccinated
people. Not only are they heard, but they are also protected.
The study's limitations are those that fall outside its scope, which are the vaccinated,
people living outside of Davao City, and those who have not yet reached the age of legality.
Given the circumstances that follow with the prevalence of COVID-19 pandemic and its
restrictions, the researchers were unable to conduct actual face-to-face in-depth interviews with
the respondents due to the risks that may be encountered during physical meetings and
engagements. Moreover, since the study only focuses on Davao City residents as responders,
those that do not live within the location were not included. A limited number of people residing
in certain areas of the city was only covered during the entire process of researching since
COVID-19 outbreak is still alarming, and with an insufficient amount of time, the study can no
longer cater to a much larger sample size. Therefore, the study's sample size may become
insufficient to collect the general and necessary information for the findings.
Hence, all interviews and discussions between the researchers and respondents were
conducted online via virtual meeting platforms such as Google Meet and Zoom to ensure the
safety and welfare of both parties. In line with this, the researchers sent a letter of permission,
supplied with a consent form to the chosen respondents of the study. The respondents were
free to accept or decline the researchers’ invitation, and no sense of disrespect or displeasure
from the investigators was portrayed if they were to be rejected. Furthermore, the respondents
were given the freedom to talk about their reasons and share their lived experiences about the
topic of COVID-19 vaccinations, and their hesitancy and/or refusal towards it. It did not,
however, involve any discussions that diverted away from the topic, and contexts that generated
any form of insolence towards the respondents.
In line with their goal, issues have arised, contradicting the plans of the government.
Around 39% of Filipinos are unwilling to be vaccinated because they feel that vaccines may hurt
them. Moreover, the Dengvaxia Controversy years ago caused many Filipinos vaccine trauma,
and from then on, caused their loss of trust in immunizations, more so with those generated in
less than a year. Other reasons include their suspiciousness. They are wary of the vaccines in
effectively protecting and securing their health and welfare. During the first years, the majority of
the dosages that have arrived in the Philippines are from China, and they are not as effective as
those from Pfizer or Moderna. For this very reason alone, many Filipinos claim that they do not
want to be vaccinated since the country supplies insufficient vaccinations for everyone to be
properly immunized. Because of these issues, the government is having difficulty persuading
Filipinos to get vaccinated (Westerman, 2021).
In order to deal with the problem of vaccine hesitancy, there is a need to know about the
“C’s”. The World Health Organization (WHO) has outlined three “C’s” that contribute to
vaccinating hesitancy: complacency, convenience, and confidence. Confidence in the safety of
vaccines exposes the main reason for vaccine hesitancy, the fear of unforeseeable secondary
effects. In addition, people are afraid to try and trust once again because of the past
controversies about vaccines. Thus, it can be seen that Filipinos are harder to convince. Many
factors hinder them from listening to implemented government protocols against COVID-19.
Therefore, the government must make a great effort to gain the trust of the majority. The
government and leading organizations can use the data that will be gathered in this study to
develop more excellent strategies in persuading the unvaccinated people to change their minds
about not getting their immunizations, like eliminating the false information about the vaccine
through informative videos or an infographic. As a result, the unvaccinated citizens might be
encouraged and convinced to have their immunizations.
This proposed research aspired to explore and better understand the reasons and lived
experiences on why some Filipinos choose to be unvaccinated, and eradicate any form of
discrimination between the vaccinated and unvaccinated. In doing so, the Local Government
Units (LGUs) or any leading organization may use this study to identify needed improvement,
share better and truthful information about vaccines, and strategize much more effective
methods to encourage people to get vaccinated. To do this, the researchers gathered
information about their opinions, reasons, stories, and sentiments of delaying their immunization
to achieve its purpose.
As previously mentioned, this research did not aim to discriminate or differentiate people
by their stand on vaccines. In contrast, it was to identify why other people choose to be
unvaccinated despite the ongoing COVID-19 outbreak, and the emerging mutations or variants
of the virus. It sought to eliminate discrimination and mistreatment between vaccinated and
unvaccinated citizens of the country, and give the unvaccinated people a chance to present
their reasons; thus, it will help the government and other people to further understand their
perspectives.
The beneficiaries of this study were the unvaccinated people by choice. Consequently,
this study will give us a thorough grasp of why these people choose to be unvaccinated;
allowing the other civilians or citizens to be enlightened of their perspectives. Therefore, both
the unvaccinated and vaccinated benefited since the former was heard, and the latter had
learned their reasons, and developed a sense of respect and understanding towards their
decision. From then on, any form of discrimination and criticization between the two parties was
completely eliminated. Other beneficiaries of this study include the Department of Health, the
Local Government Unit, specifically that focused in Davao, and the researchers. The DOH,
LGU, and the Davao City Health Office will be more aware of the different factors that cause
vaccine hesitancy. Thus, they can remodify their methods and develop more effective and
persuasive strategies when it comes to COVID-19 immunizations. On the other hand,
researchers and other investigators from and outside of this study benefited as well because
their objectives were attained, and a new knowledge to solve a prevailing issue was discovered,
leading to more exploration to be done by succeeding researchers, in order to generate new
ideas and concepts.
Research Questions
This research was intended to explore, identify, and better understand the reasons and
lived experiences of several five (5) Filipinos who chose to be unvaccinated, and eradicate any
form of discrimination between the vaccinated and unvaccinated. This study answered the
following specific questions:
Theoretical Lens
Rational Choice Theory
Professor Renata Salecl presented the Rational Choice Theory, a theory originally created
by Philosopher Adam Smith, as to how different people perceive the idea of getting COVID-19
shots. The theory suggests the concept of making rational decisions relying on rational
projections that people think will suit and serve them best (Olivia, 2021). In the original ideology
of Smith (1776), written in his work entitled “An Inquiry into the Nature and Causes of the
Wealth of Nations”, was a proposition that “human nature has a tendency toward[s] self-interest,
and this self-interest results in prosperity through the control of the so-called ‘invisible hand’ —
the collective actions of the self-interested human race.” (cited in the publication of Nickerson,
2021). In line with this, the theory suggests that decision-making is solely in the hands of every
individual. As humans are drawn towards the thought of “self-gain”, this leads to making choices
derived from personal experiences for self-benefits. Even so, the theory still believes that behind
every behavior is a rational justification that supports certain decisions being made.
With this being said, Professor Salecl used the theory to describe the issue of vaccine
hesitancy among certain people. While some countries are dealing with a scarcity of vaccines,
people of other nations, mostly from rich countries, fight for their rights to not be vaccinated
because of personal preferences. These kinds of citizens think vaccination is a matter of
individual choice. The idea of producing vaccinations in less than a year started people’s
suspicions. As a result, despite the high efficacy rate for specific leading brands, it was
overlooked because minimal side effects were discovered. Thus, as cons outweigh pros, this
leads to certain people’s decisiveness to not get immunized because it is deemed to be the
more rational and self-beneficial choice for an individual.
Furthermore, the Philippines is a democratic country. Therefore, the public has complete
authority to deliberate and participate in decision-making; all the more reason why a portion of
the country’s population believe that they have the right and validation to not get their shots
because they were never inoculated as “mandatory”. Although recent news reports show
President Rodrigo Roa Duterte threatening his countrymen with an order of arrest for
unvaccinated people (Parrocha, 2022), it remains a harmless threat because no law or bill was
filed, passed and implemented to permit such actions.
In accordance with Smith's theory, the Availability Heuristic Theory by Tersky and
Kahneman is another theory with the same proponents as Rational Choice. The Availability
Heuristic Theory is a type of cognitive bias in which one makes a decision based on an
example, information, or recent experiences (Gleason, 2021). In a similar manner, the
Availability Heuristic causes people to incorrectly assess the likelihood of events. For instance,
individuals who believe that vaccines cause COVID-19 after getting vaccinated, based on
isolated media reports (Macareg, 2021). Stories and experiences have great impacts on
decision-making. With fake news, rumors and false conspiracy theories about vaccines, it is no
surprise that people would believe such misinformation with supporting evidence driven out from
stories and experiences seen, read or heard. Therefore, the theory of Availability Heuristic can
be applied, suggesting that misleading information and assumptions about the COVID-19 shots
may contribute to vaccine refusal or hesitancy.
Psychologist Cornelia Betscha and colleagues created a scale called “5C’s”, which
shows the five factors behind the reason for vaccine hesitancy. The following five C’s are:
Confidence in the Safety of Vaccines; Complacency; Constraints; Calculation; and Collective
Responsibility. Confidence in the Safety of Vaccines exposes fear for unforeseeable secondary
effects as the main reason for vaccine denial. Complacency is how people perceive their own
risk of contracting the disease (Garcia & Gordon, 2021). While COVID-19 shots are proven as
effective, the results after vaccination remain unknown. This heightens people’s fear and
anxiety, subsequently pushing them to delay or refuse immunization as they may consider the
possibility of risks acquired through getting vaccinated. Third, Constraints are how easy or
difficult it is for people to be vaccinated, considering the accessibility of vaccination sites and
restraints in time for school, work, childcare, etc. Calculation is how people engage in searching
for information to weigh the pros and cons. And finally, Collective Responsibility is the
willingness to protect others through one’s own vaccination (Garcia & Gordon, 2021).
Choice plays an important role in immunization. Since the beginning, prioritizing health
and welfare has already been recognized as a matter of personal choice and/or preferences.
Thus, unvaccinated people are in full control over their decisions to not vaccinate.
Consequently, the Rational Choice Theory, as the main theory, can be applied to the study as
it implies people’s thinking before they act, and make decisions pursuing to maximize their
benefits and reduce losses. Meanwhile, the Availability Heuristic Theory, The Dunning-Kruger
Effect, and the Five C’s scale serve as subtheories that further support the main theory and
suggest possible agents that may influence the decision-making of unvaccinated people.
Definition of Terms
❖ WHO - World Health Organization
❖ FDA - Food and Drug Administration
❖ IATF - Inter-Agency Task Force
❖ CDC - Center for Disease Control
❖ HPS - Household Pulse Survey
❖ VOIs - Variants of Interest
❖ VOCs - Variants of Concern
❖ CDCP - Centers for Disease Control and Prevention
❖ EUA - Emergency Use Authorization
❖ Vaccine Hesitancy - Is a delay in acceptance, or refusal of vaccines despite the availability
of vaccine services.
❖ SARS-CoV-2 - Severe Acute Respiratory Syndrome Coronavirus 2
❖ Regimens - A prescribed course of medical treatment, way of life, or diet for the promotion
or restoration of health.
❖ IATF-EID - Inter-Agency Task Force for the Management of Emerging Infectious Diseases.
❖ Non- mandatory - not required by law or mandate.
❖ One-on-one interview - the most common interview where only the interviewer and the
interviewee is present.
❖ Focus group - a group interview involving a small number of demographically similar
people or participants who have other common traits/experiences.
❖ Immunization - the process by which an individual's immune system becomes fortified
against an infectious agent.
❖ Rational choice theory - this refers to a set of guidelines that help understand economic
and social behavior.
❖ Foundation of Democracy - refers to freedom from unwanted governmental deprivation of
the right to life and liberty, and minority rights.
❖ “Five C’s”- Confidence in the Safety of Vaccines, Complacency, Constraints, Calculation,
and Collective Responsibility.
❖ Dunning Kruger Effect Theory - Also known as “double curse”
❖ Availability Heuristic - It describes our tendency to use information that comes to mind
quickly and easily when making decisions about the future.
❖ Complacency - a feeling of smug or uncritical satisfaction with oneself or one's
achievements.
❖ DOH - Department of Health
❖ LGU - Local Government Units
❖ Phenomenon - is an observable fact or event
❖ Inoculation - is a set of methods of artificially inducing immunity against various infectious
diseases.
❖ Etiological - causing or contributing to the development of a disease or condition.
❖ Mitigation- the reduction of something harmful or the reduction of its harmful effects.
❖ Hesitancy - the quality or state of being hesitant.
❖ Mutation - is a change in a DNA sequence
❖ Apprehension - anxiety or fear that something bad or unpleasant will happen.
❖ Modification - a change or alteration, usually to make something work better.
❖ Queries - a question, especially one addressed to an official or organization
❖ Enforced - the proper execution of the process of ensuring compliance with laws,
regulations, rules, standards, and social norms.
❖ Inconsolably - incapable of being consoled.
❖ Statistics - the discipline that concerns the collection, organization, analysis, interpretation,
and presentation of data.
❖ Respiratory Diseases - any of the diseases and disorders of the airways and the lungs that
affect human respiration. bronchioles of the lungs.
❖ Psychological - related to the mental and emotional state of a person.
❖ Inoculated - to implant a disease agent or antigen in a person, animal, or plant to produce a
disease for study or to stimulate disease resistance.
❖ Complacency - a feeling of smug or uncritical satisfaction with oneself or one's
achievements.
❖ Omicron Variant- likely will spread more easily than the original SARS-CoV-2 virus and
how easily Omicron spreads compared to Delta remains unknown.
❖ Skepticism - the attitude of doubting knowledge claims set forth in various areas.
❖ Incentives - a thing that motivates or encourages one to do something.
❖ Delta Variant - Is a variant of the COVID-19 virus.
❖ Booster - that boosts: such as ; a : an enthusiastic supporter.
❖ Emergence - the process of coming into view or becoming exposed after being concealed.
❖ Conspiracy theories - An explanation for an event or situation that invokes a conspiracy by
sinister and powerful groups, often political in motivation, when other explanations are more
probable
❖ Infectious Diseases - are disorders caused by organisms.
❖ Sentiments - a view of or attitude toward a situation or event; an opinion.
❖ Heuristic Theory - A mental shortcuts that can facilitate problem-solving and probability
judgments.
❖ Inadequate - lacking the quality or quantity required; insufficient for a purpose.
❖ Scarcity - The state of being scarce or in short supply; shortage.
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