The Sinovac conundrum

To be or not to be vaccinated with Sinovac: That is the question health care workers all over the country are facing today.

On a personal level, most health care workers believe in vaccination and seek protection from a virus that has claimed many lives, including those of their colleagues. Although doctors are now much better in managing COVID-19 with the benefit of a year’s worth of experience, it continues to be a threat especially in light of new variants and the rising number of new cases. Thus, any vaccine with proven safety and efficacy would be most welcome.

On a professional level, moreover, health care workers are aware that their stances on vaccination can influence the public, which, based on surveys, seems to be very skeptical of vaccines. In my own field visits to rural communities in Luzon, people’s sentiments overwhelmingly mirror these surveys, citing “Dengvaxia,” “made in China,” and government mistrust as reasons for vaccine avoidance. “We would rather hide in the mountains,” one Aeta man in Zambales told me.

However, many health professionals have questions about the efficacy of Coronavac (the vaccine’s official name). While there is willingness to accept a 50.4 percent efficacy in preventing mild disease in the absence of alternatives, some take issue with the absence of peer-reviewed Phase III clinical data. Indeed, while many of our experts are vouching for Sinovac, and while company-released Phase III and peer-reviewed Phase II data (Zhang et al. 2020; Wu et al. 2021) indicate that the vaccine is very effective in preventing severe COVID-19, doctors who have been trained to look for evidence naturally want to see the findings go through validation by other experts (hence, peer review), and appraise such findings for themselves.

It has not helped that health care workers, at least those in the Philippine General Hospital, were told that they would be getting the Pfizer vaccines, and that last week, AstraZeneca vaccines were supposed to arrive, only for them to be “delayed” (as of this writing, I don’t know if they have arrived as announced). Such glitches and switches, coupled with President Duterte’s vaccine messianism and unapologetic preference for Chinese vaccines, have led to fears that the decision behind rolling out Sinovac first was driven by politics, not science. Moreover, some feel that by accepting the vaccines, they are legitimizing the administration’s policies, potentially paving the way for Sinovac to be the country’s vaccine of choice.

On the other hand, supporters feel that, despite the less-than-spectacular efficacy, relative lack of transparency (as compared to other vaccines), and questions about the decision-making processes, some protection—or even just some likelihood of protection—is better than no protection at all (12 other countries have authorized Sinovac’s use, including Indonesia and Thailand). Some also posit that Coronavac’s being an inactivated vaccine may make it more resilient against viral variants and suitable for distinct populations like the elderly.

They further feel that there’s no way to raise criticism in a way that will not exacerbate public fear, so it’s important to rally behind the Inter-Agency Task Force for the Management of Emerging Infectious Diseases on this matter. Thus, notwithstanding their misgivings, some have gone ahead with receiving, or signing up for, their first dose of the vaccine.

Regardless of where our medical professionals stand on Sinovac, I hope it will not divide the health care sector, and that we can all join hands in calling for more vaccines and rolling them out en masse as soon as possible, mindful that Filipinos deserve better than “better than nothing.” Indeed, while the oft-quoted “the best vaccine is the one that is available” makes sense if you have no choice, we have to question why we have no choice in the first place, and why those responsible for making the best vaccines available have not lived up thus far to their mandate. (Note that we were the last in the region to have a vaccine rollout.)

Another unifying point is vaccine communications: Surely, we can all support efforts to persuade the public to get vaccinated—including leading (and being vaccinated) by example. But must health care workers assume a responsibility that some of our top officials seem to have abdicated from? To raise people’s trust in our vaccination program, our leaders need to ensure our health care workers’ confidence in it, by addressing their concerns and avoiding inconsistent messaging and decision-making.

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