Read Part I, II, III , IV , V, VI, VII and VIII of our series 'Global vaccination'.

Philippines

‘Vaccinate yourselves or I'll put you behind bars!’ That was the threat that Philippine President Rodrigo Roa Duterte recently used to try to convince his countrymen to get a coronavirus vaccination. Duterte, who has been criticised by international institutions and human rights organisations for years for his ‘war on drugs’, is well known for such dramatic statements. He has repeatedly called on law enforcement authorities to shoot anyone who defies quarantine measures. Even if this ‘order to shoot’ is not being implemented, the country's crisis strategy is oriented towards police measures and not health education.

At the very outset of the pandemic, the Philippine government enacted one of the world's strictest lockdowns, which is still in place right now. Schools and kindergartens have been closed since March 2020. Until recently, children under the age of 12 and senior citizens over the age of 65 were banned from leaving their homes. Face masks must be worn in public (the government even recommends two of them!) as well as an additional plastic visor.

Sadly, these measures had little effect on the rising number of cases. Ever since the regulations came into force, Duterte has been using the narrative of ‘undisciplined citizens’, which he has been countering with a rigorous approach by the law enforcement authorities. The Philippine National Police recorded more than 1.5 million ‘violations of public health standards’, resulting in arrests, between August 2020 and March 2021.

The pandemic hit the Philippines hard. By July 2021, about 1.5 million of the 110 million inhabitants had been infected and the disease was fatal for about 27,000 of them. Ever since, the economy, which until then had been hardwired for growth, has been in a recession, the unemployment rate has almost doubled and, at times, the intensive care beds in hospitals have been completely full.

Duterte's threat of imprisonment for those refusing vaccination triggered a discussion about the conditions under which compulsory vaccination could be introduced in the country. But even the Duterte-friendly majority in Congress is sceptical. There are considerable reservations about vaccinations in the Philippines. According to a recent survey, more than 60 per cent of citizens reject vaccination. One of the many reasons for this is the quite recent memory of the Dengvaxia scandal in 2017, when several people, including children, allegedly died from a novel vaccine against dengue. Another reason is that the Chinese manufactured Sinovac vaccine has been in use mainly and there are considerable doubts about its effectiveness among the population.

Compared to other south east Asian countries, the vaccination campaign in the Philippines has been sluggish. By July, just four per cent of the population had been fully vaccinated. The fundamental problem remains the insufficient procurement or availability of vaccines. In addition, there is excessive bureaucracy in the distribution of the available vaccines and limited planning capacity due to dependence on international vaccine donations.

Whether Duterte's threats will increase people’s motivation to get vaccinated is questionable. This does not seem to bother him though, especially since he will not be allowed to run again in next year's presidential election. More promising is the initiative of a mayor in the north of the island of Luzon: He has announced that starting in September – when the vaccine is supposed to be available in the village for the first time - a cow will be raffled off every month among the vaccinated villagers.

Dr Vinzenz Huzel, FES Philippines

 

United States of America

Want a joint? A firearm? A hunting licence? A million dollars? States and municipalities in the US are showing creativity in the increasingly desperate attempt to get the sceptics to vaccinate. The list of different incentives is almost endless. Businesses have also jumped on the bandwagon, offering benefits to the vaccinated: a free donut at Krispy Kreme, for example or a free beer with dinner at the local brewery.

By March, the US had already secured such a large number of doses that they could have vaccinated every adult three times. But the initial run on vaccinations has long since died down. By mid-April, an average of 3.3 million doses per day were being put in arms. Since then, the numbers have dropped. Currently, just under 570,000 shots are administered every day. 49 per cent of Americans have been fully vaccinated so far. Joe Biden recently had to grudgingly admit that his goal of vaccinating 70 per cent of the adult population by 4 July has not been met.

When it comes to Americans’ openness to receive the vaccine, there are significant discrepancies across the different states. The front-runner is Vermont, where more than 65 per cent of all residents are fully vaccinated. Mississippi brings up the rear with 34 per cent. ‘We’re drowning in this stuff’, a decision-maker from Arkansas complained, referring to excess vaccines in his state.

A variety of other factors play into the vaccine divide - gender, level of education, insurance status, place of residence - especially when it comes to political orientation: Among Democrats, 86 per cent respond in surveys that they have already received a dose, but only 52 per cent of Republicans. Overall in the US, only three per cent confirm that they still want to be vaccinated as soon as possible. The proportion of those who do not want to be vaccinated remains stubbornly at 20 per cent.

What is driving vaccine sceptics? They are by no means all ideological anti-vaxxers or QAnon conspiracy theorists. Distrust in government recommendations is one frequently cited reason for shying away from vaccines. Given the Trump administration’s wavering pandemic policy, this comes as no surprise. Other arguments include doubts about vaccine safety and bad experiences with the public health system.

Are incentives an effective measure to counter vaccine scepticism? There is no consensus among experts. Surveys show very mixed results depending on the demographic group. Millennials, for example, tend to respond positively to creative freebies. In Ohio, according to Governor DeWine, vaccination rates doubled in some counties after he announced his Vax-a-Million lottery where five vaccinated citizens could each win a million dollars.

Meanwhile, some employers are running out of patience. They are mandating their employees to get vaccinated. While this is legal in the US, it is highly controversial and currently the subject of several lawsuits. Most companies, therefore, resort to incentives for their employees. United Airlines, for example, offers flight attendants three days of additional leave if they get vaccinated.

Mandating vaccines is a very sensitive issue in the US. For many Americans, it is fundamentally at odds with the principles of liberty and self-determination. The Biden administration has long shied away from making a clear statement on the topic. However, now the tide may be turning: On 29 July, President Biden made vaccination mandatory for all federal employees and contractors – with the sole alternative of following strict masking, testing, and social distancing regimen. No more fun and games.

Anja Wehler-Schöck, IPG Journal Berlin

 

Kazakhstan

The largest country in central Asia is in the middle of the third wave of the pandemic and is heading for a new peak: up to 11,000 cases per day are expected for August 2021 and that is with only 18 million inhabitants. Extrapolating this figure to Germany would mean about 50,000 cases per day. The hospitals have once again reached the limit of their capacity and the country is on the verge of another strict lockdown.

The vaccination campaign is proceeding slowly: Kazakhstan is on the list of countries where the population's willingness to be vaccinated is low. So far, only about 17 per cent of the people have been fully vaccinated. Even in the vaccine-critical countries of post-Soviet space, Kazakhstan stands out negatively: Only about a quarter of the Kazakh population is positive about vaccination - less than in Russia or Ukraine. There are many reasons for this: lack of general trust in the government, consumption of critical media, the high number of conspiracy theories being circulated and a late start to the vaccination campaign contributed to the fact that few people have vaccination protection.

Yet the republic had excellent conditions to counteract the pandemic: Kazakhstan brought an independently developed vaccine (QazVac) onto the market, ordered sufficient vaccines (Sputnik-V, Sinopharm and, by the end of the year, also BioNTech/Pfizer) and ensured good availability even in the regions far from the capital Nur-Sultan. The successes of the last few months in the supply of the vaccine and in developing various digital solutions - in terms of arranging appointments, vaccination certificates and access to public buildings - are impressive, and not only in a regional comparison.

Nevertheless, the best vaccination campaigns fail if not enough people are willing to actually get vaccinated. The fact that the delta variant of the coronavirus arrived in Kazakhstan at the time when the vaccination campaign was stagnating explains the now exponentially increasing number of cases.

The government's response is similar to that seen in France, Italy and other countries: increased coercion and de facto vaccination obligations. Since 1 July, a large part of the working population has to show proof of vaccination or weekly tests – which they have to pay for themselves. Public servants are not explicitly exempt from this, but are even required to be vaccinated immediately. Access to public buildings, restaurants, cinemas, theatres, but also malls or even the workplace is increasingly made dependent on one's own vaccination status - checked via the app ‘Ashyq’.

Whether the majority of the population will accept the vaccination offer in view of the increasing restrictions remains to be seen. What is certain, however, is that the Kazakh economy, small and medium-sized enterprises, the tourism sector and the many employees in the informal economy have a considerable self-interest in averting further lockdowns. Kazakhstan could even become primus inter pares in the post-Soviet space - the tools are there.

Christoph Mohr, FES Almaty