Turning doubters into defenders to fight a measles outbreak in the Philippines

Information and immunization campaigns aim to reverse plummeting vaccine coverage rates

Maria Mutya Frio
A health worker vaccinates a child while being held by his mother at a health center
UNICEF Philippines/2019/Shehzad Noorani
24 April 2019

MANILA, Philippines – Shirly Mendez, a 41-year-old grandmother from Bicutan in Metro Manila, never missed a vaccine for her five children when they were young. When her oldest daughter had children of her own, she followed her mother’s example and made sure they were vaccinated. Both mothers believed that vaccines would keep their babies safe from diseases.
But three years ago, the routine trips to the health centre stopped. Shirly was once again a mother to a one-year-old, and a grandmother to three more infants. But she was apprehensive.

Rumors and misinformation

“I became worried because of rumors spreading that children who were getting vaccinated in schools were getting headaches and stomach aches. I never took my children or grandchildren to the health center to be vaccinated again,” she said. 

Shirly’s scepticism was part of a larger trend in the Philippines – a decline in public confidence in vaccines. One survey found that in 2015, 93 per cent of people “strongly agreed” that vaccines are important, and that rate fell to 32 per cent in 2018. 

Three women carry their children outside a health centre
UNICEF Philippines/2019/Shehzad Noorani
Holding their children in their arms, women wait outside Lower Bicutan Health Centre to vaccinate their children in Taguig City, Philippines.

Cause and effect

Over the past few years, the Philippines has experienced chronically low rates of immunization. According to World Health Organization (WHO) estimates, 2.6 million Filipino children under the age of 5 years are not protected from measles.

This decline in vaccine coverage ultimately led to a recent measles outbreak in the country, with 28,362 reported cases and 389 deaths from measles from January to 5 April this year.

This is a staggering 369 percent increase in reported cases within the same period last year, exceeding the entire caseload of 2018. Around 53 per cent of this year’s cases were children under five years old. 

Misconceptions and misinformation about vaccines were only part of the problem. Supply and demand challenges, problems with vaccine management and forecasting, an inadequate number of health workers, and poverty all contributed to a health crisis that shows no signs of abating.

Many children from urban poor families, ethnic minorities, transient and highly mobile populations, as well as children living in remote and conflict-affected areas usually miss out on immunization. 

Helath workers carry vaccines in temperature-controlled containers
UNICEF Philippines/2019/Shehzad Noorani
Health workers from the Lower Bicutan Health Centre visit communities in Taguig City, Philippines, to check on the immunization status of children in the area and vaccinate those who are scheduled to receive routine vaccines.

Containing an outbreak

In response to the outbreak, the Philippine government intensified its mass immunization campaign against measles, concentrating on areas with the highest reported cases, including metro Manila. At the Lower Bicutan Health Center where Shirly goes, health workers saw a 60 per cent surge in the number of clients — more than 200 daily — who came to inquire or get their children vaccinated against measles.

“We were surprised by the rapid rise in number of parents who started believing in vaccines again,” said Marites Diaz, rural health midwife at the center.

“Our clients who hadn’t shown up at the centre for a long time were coming back to continue with follow-up shots to complete the required shots,” she shared.

Rural health workers are also going door to door in areas that are farthest from the health center, working inwards to households that are closer. They give out brochures in Tagalog, the local language, and have one-on-one conversations with parents to explain how immunization protects children from diseases. 

The information campaign is empowering mothers like Shirly to vaccinate their children.  

“I saw on TV that there had been many measles cases and many had died,” said Shirly. “After the outbreak, I was afraid that my children would also get measles. That’s when I decided to take my children and grandchildren back to the health centre,” she said.

A woman feeds two young girls inside their home
UNICEF Philippines/2019/Shehzad Noorani
Sherly Mandez, 41 years old, feeds her youngest daughter Anika (left) and granddaughter (right) in her house in Taguig City, Philippines. Because of misinformation about vaccines, she was reluctant to get Anika vaccinated. However when she saw several children get sick during the recent measles outbreak, she decided to seek counselling and get Anika immunized against measles.

Health partners in action 

UNICEF is supporting the Department of Health to respond to the outbreak and make sure that all parents and caregivers are informed about how important vaccines are. We’re working through multiple partners and channels, including:

  • Engaging local executives, youth groups and the private sector to collaborate on improving the country’s immunization coverage.
  • Using social media to shape positive public opinion on the safety and effectiveness of vaccines.
  • Expediting the procurement of six million doses of measles vaccine and five million doses of polio vaccine to supplement stocks in priority areas.
  • Providing tents to hospitals to accommodate the sudden surge in measles cases.
  • Developing and optimizing tools to help monitor immunization rates in the most at-risk regions of the country. 

UNICEF Philippines’ immunization programme is supported by Al Waleed Foundation and by individual donors to the Champions for Children programme.