To the Editor,With great enthusiasm, I find the recent article published in this journal “impeccable” when
the authors rightfully highlighted that the “spread of mistrust” worldwide has impacted
negatively primary care practice and public health in general during this COVID-19 pandemic.
They based this conclusion claiming that even the most advanced countries have had a difficult
time grappling with the disease due to nonadherence to the International Health Regulations
(IHR) and world leaders undermining the science of managing COVID-19. This undermining from
world leaders led to increased deaths due to a lack of testing, contact tracing, vaccine
hesitancy, and adherence to public health recommendations.[1] With this, I would like to enflesh and validate this claim by
exploring what had happened in the public health system of the Philippines. In this way, the
country can learn more and be more prepared for a future health crisis.As of this writing, the World Health Organization (WHO) reports that there were already
3,668,268 cumulative COVID-19 cases and 57,066 deaths in the country.[2] As of 7 March 2022, a total of 63.1 million
are fully vaccinated and that is only 57.6% of the country’s estimated total
population.[3] What do these data
imply? The country has not achieved yet the longed herd immunity and one of the significant
reasons for this is due to the “mistrust” behaviour of the different institutions involved in
the public health system. First, there has been a huge demand for COVID-19 self-testing amid a
rise in cases from the start of January. The government does not have full confidence in these
self-testing kits and has yet to approve a self-administered rapid test. Manufacturers in the
country have only recently filed for the registration of self-administered rapid test kits,
and 11 are currently undergoing review. Reverse transcription-polymerase chain reaction, or
RT-PCR, tests remain the accepted testing kit in the country[4] but even an average-earning Filipino cannot afford it because
of its high cost. Second, another “mistrust” attitude is manifested in terms of contact
tracing. A year into the COVID-19 pandemic, contact tracing in the Philippines is
“deteriorating” in various regions. For each COVID-19 case detected, the close contacts who
were traced decreased from 7 to 3 within a month.[5] This means that some locals do not put their factual information in the
mandatory health declaration forms every time they are asked to after going to public
establishments. Third, the unending problem of vaccine hesitancy also seems to be unending.
There are still Filipinos who do not trust the essentiality and even the efficacy of the
vaccines. There are those in the far-flung areas or remote provinces who think that these
vaccines are unsafe and even deadly or the life span of those who are vaccinated is shortened
and they only have 2–3 years to live. Vaccines were also viewed as unnecessary to those in
older age groups who are not allowed to go out while there are those in the younger groups who
felt that others needed the vaccine more than them.[6] Lastly, the lack of trust also emanates from the relationship between the
government and the public. Some Filipinos are already traumatized by the corrupt practices of
some government officials. The country borrowed a record P2.74 trillion in 2020 to fight the
health and socioeconomic crises inflicted by the pandemic. Senator Panfilo Lacson had exposed
an attempt by some people to pocket $350 million or P16.8 billion in public funds in the form
of kickbacks during a Senate hearing on the government’s mass immunization
programme.[7] On the other hand, some
government officials also mistrusted those locals who simply wanted to help their needy
fellows by organizing community food pantries during the pandemic. The pantry’s principle was
from a popular slogan, “from each according to his ability, to each according to his needs.” A
week after the initiative began, over 300 similar donation-driven efforts have popped up
across the country. Other variations of the programme were also organized such as community
libraries, pharmacies, and even essential needs of pets. However, these initiatives were seen
negatively by the government by red-tagging, profiling, or closely monitoring every move of
its organizers. Red-tagging is the act of labelling, branding, naming, and accusing
individuals and/or organizations of being left-leaning, subversives, communists, or terrorists
used as a strategy by state agents, particularly law enforcement agencies and the military,
against those perceived to be “threats” or “enemies of the state.”[8] Uniformed and armed personnel were seen roaming around
various locations and trying to investigate possible rebellion against the state.With all these elements of “mistrust” coming from both the government and the public, it will
indeed be difficult to achieve overall wellness for every family and the whole country in
general. The ill attitude influences to a greater extent the proper actuation of every person
who is involved in the management of the healthcare system. How can these negative attitude be
at least reduced? The government officials should serve as role models in terms of getting
inoculated first so that there will be high confidence in the vaccine; practice transparency
to the public in all its financial transactions; and instead of maliciously doubting the
charitable acts of the locals, why not help them in organizing these initiatives by offering
support like maintaining peace and order or simply assuring that health protocols are observed
during the operation. In addition, the public is also expected to have a cooperative, honest,
and considerate attitude in treating any government official. They must realize that everybody
is capable of mistakes and getting tired. These qualities can motivate these officials to
perform their duties well and minimize if not eradicate corruption or abuse of
authority.[9] The next important
question that needs to be addressed is how can Filipinos engage more in the practice of an
improved primary care systems? First, both the government and the public should prioritize the
improvement and promotion of health literacy. Health literacy is the degree to which
individuals and organizations can find, understand, and use information and services to inform
health-related decisions and actions for themselves and others.[10] Better health literacy has the potential to improve
community trust, alleviate health disparities, and improve the results of the immediate
response required in the early stages of a pandemic.[11] With this, the public will have full confidence in the vaccines and
drugs, realize the importance of contact tracing, regard the essentiality of health protocols
as campaigned by the government, etc. Second, the government should also focus on addressing
the inequalities in primary care. This unfair condition is evident in the health programmes,
facilities, human health resources, finances, and training.[12] The huge fund of the Department of Health (DOH) must be well
spent and allocated in procuring the much-needed drugs and effective vaccines for the
treatment and containment of diseases, improving the facilities especially in the remote
health centres, and most of all, making the necessary intervention to attend to the plight of
healthcare workers. This can be done by holding regular training programmes, an increase and
timely release of their wages/allowances, and proper recognition of their great efforts. The
COVID-19 pandemic is not over yet. The experience of Filipinos with this health crisis brought
a lot of learning and hope which can be a tool for a better healthcare system in the
future.