In a personal decision that will have far-ranging public implications, President Rodrigo Duterte will have himself inoculated, of course, but he will do so in private according to presidential spokesperson Harry Roque.
Roque said it's because the president wants to have the vaccine through his buttocks, instead of having it through the usual arm or deltoid muscle.
"Sabi nga niya sa puwet siya magpapasaksak (ng vaccine) so hindi pupuwedeng public," Roque said in a press briefing.
Roque did not explain why the president wanted to have it through his butt.
In an earlier press conference, Roque said that getting vaccinated in private is the president’s “personal decision. I don’t think he has to explain.”
On Jan. 27, the Department of Health made statements that tried to give sense to the president's seemingly odd decision, especially as the default choice for most patients is to have it through the arm.
Health Secretary Francisco Duque said that, newsflash, the effect will be the same if the vaccine is injected through the arm or buttocks.
We will continue to have a challenging situation when the public does not see our president getting vaccinated publicly because we need the people to see that vaccination is key to dealing with COVID.
For some reason, Duque even cited that the Queen of England also chose to be vaccinated privately.
Health Undersecretary Rosario Vergeire said butt shots are preferred if the arm is emaciated, which the president, last we checked, does not have.
“Ang common practice po sa atin kapagka ang isang tao ay hindi puwede halimbawa ang deltoid (upper arm) area masyadong emaciated payat na payat na, binibigay natin sa ibang bahagi ng katawan katulad ng ibang parte na muscular po tinatawag,” she said.
The long and winding road
A number of studies have discussed why the deltoid muscle is a better point of entry for vaccines, like this study about the hepatitis B vaccine.
This separate study basically says the same thing. It says that if not the arm, then the thigh should be the next option.
“Traditionally the buttocks were thought to be an appropriate site for vaccination, but the layers of fat do not contain the appropriate cells that are necessary to initiate the immune response (phagocytic or antigen-presenting cells). The antigen may also take longer to reach the circulation after being deposited in fat, leading to a delay in processing by macrophages and eventually presentation to the T and B cells that are involved in the immune response,” noted the study from a lecturer from the UCL Medical School in London, which seems like a long-winded way of saying that the vaccine may take a long-winded way if injected through the butt and may even get lost along the way.
Dr. Tony Leachon, who was a former adviser to the National Task Force against COVID-19, said that most of his patients get vaccines through the deltoid muscle.
"Bibihira lang nagpapa-bakuna (sa buttocks). 95% of my patients sa deltoid nagpapabakuna," Leachon told PhilSTAR L!fe.
Besides the usual patient preference, Leachon said it is also advisable from a medical perspective to have the vaccine through the arm due to a possible risk when a needle goes through the buttocks.
"Sa buttocks kasi you might hit the sciatic nerve, which might actually cause injury to the muscles in the buttock area," Leachon said. "But sa deltoid, it enhances the immune capability of the vaccine."
The positive symbolic nature of a president having his jab in public is also not lost on Leachon.
Having an extremely popular president na nagpapabakuna in public, malaking bagay 'yun.
"Having an extremely popular president na nagpapabakuna in public, malaking bagay yan," said Leachon. "What could be a faster way of educating the public about vaccines than that?"
According to a Pulse Asia survey early this January, almost half or 47% of Filipinos said they do not want to be inoculated with the COVID-19 vaccine. When you think about it, this level of distrust among Filipinos is not surprising given the recent Dengvaxia controversy that severely dented public confidence in vaccines and hamstrung government efforts to expand vaccination rates.
This "Dengvaxia effect" was detailed in this study called the Vaccine Confidence Project, which saw a “dramatic drop” in vaccine confidence in the country from 93% in 2015 to a measly 32% in 2018. In fact, in 2019, the DOH tagged “vaccine hesitancy” as the culprit for the measles outbreak that time.
In addition, the country also has very few lawyers doctors, with a doctor-to-patient ratio of 1:33,000, way higher than the global average of 1:6,600. One visit to one's folks in the countryside and one could see that the resident albularyo or manghihilot is still very much in business and are both in the speed dial of a family member.
The rise of the nutty hardline anti-vaxxers and some not-so-flattering stories about the low efficacy rates of the Sinovac vaccine further muddy the waters, driving vaccine confidence down.
A shot in the arm
Seemingly in inverse proportion to the unpopularity of the vaccines, however, is the popularity of the president.
A Pulse Asia survey in October last year showed a 91% approval rating for the chief executive.
"We will continue to have a challenging situation when the public does not see our president getting vaccinated publicly because we need the people to see that vaccination is key to dealing with COVID," Dindo Manhit, a political consultant who is the founder of the policy think-tank Stratbase Group, told PhilSTAR L!fe.
Vice President Leni Robredo also prodded Duterte to take the vaccine in public.
“Iyong sinasabi lang natin, mahalaga kasing pangulo iyong mauna,” Robredo said in her radio show on Jan. 24. “Ginawa ito sa lahat ng bansa para ma-boost iyong confidence ng tao sa bakuna kasi marami ngayong pagamba sa safety nito.”
The importance of such a public gesture, which has already been done by countless other heads of state, is not lost on other government officials who are still holding their breath for the president to change his mind.
“We will try out best to convince the president to perhaps publicly allow himself to be vaccinated but we will respect his ultimate decision,” said Duque.
Even vaccine czar Carlito Galvez himself sounded off on the importance of a public presidential vaccination in a meeting with the president himself.
Speculations notwithstanding regarding the reasons behind a private inoculation, the weight and meaning of a public vaccination is inarguably compelling. For a body politic whose confidence in vaccination has been flagging at best and almost hostile at worst, such a display from a highly popular president would be a much-needed shot in the arm.