Stamping out COVID-19 vaccine hesitancy in Maguindanao’s last mile communities

MAGUINDANAO --- Ranila Moctal had just given birth to her third child when she contracted the deadly coronavirus disease 2019 (COVID-19) about two years ago.

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A personnel from the rural health unit of Datu Hoffer Ampatuan municipalityin Maguindanao prepares a dose of COVID-19 vaccine. (Photo: Manman Dejeto/Oxfam Pilipinas)

A resident of Barangay Daladap in Mamasapano town, an isolated village that can be accessed through banca (pump boat), Moctal sought medical treatment late in 2021 at a local hospital after her placenta did not come out of her uterus after giving birth.

But before she can be admitted for medical attention, it was standard operating procedure for a patient then to be tested for COVID-19 or severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 since it was still the height of the pandemic.

The result was positive, and for her, it was a horrible nightmare.

The good thing, however, was that the new born, who was left home under the care of relatives, did not contract the disease and is now about two years old.

Moctal was put in isolation for at least six days, giving her separation anxiety from her family, especially her newborn child.

“I was traumatized and I kept on crying. I could not sleep well. I sorely missed my children, especially my baby,” she recalled.

By then she was not vaccinated against COVID-19, and every time a health worker tried to inject her with something to treat her health condition, she was wary and would refuse.

“I had this belief that what would be injected into my body will slowly kill me,” she stressed.

After six days in the COVID-19 isolation center, she tested negative and was allowed to undergo home quarantine. Still, she was terrified to get inoculated against the disease.

Her fears stemmed from fake news and misinformation that spread in her community and among her relatives from neighboring towns in Maguindanao, belonging to the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM).

The misinformation included becoming a zombie after two years, vomiting blood, and instant or slow death after getting injected with the COVID-19 vaccine.

Worst of all, the COVID-19 vaccine is haram, or forbidden in Islam, according to the fake news the residents heard.

“Those things terrified me from getting vaccinated against COVID-19,” Moctal said.

It was only last May that she allowed herself to be injected with the COVID-19 vaccine.

What convinced her and the others who were hesitant in their community to receive the vaccine was the COVID-19 education campaign conducted under the REACH 2 project. REACH stands for “Response to the Unmet Humanitarian Needs of the Most Vulnerable Populations in Mindanao Affected by Conflict, Disasters and the COVID-19 Pandemic.”

With support from the European Civil Protection and Humanitarian Aid Operations (ECHO), the REACH 2 project is implemented by ACCORD Incorporated, Action Against Hunger Philippines, CARE Philippines, Community Organizers Multiversity (COM), Initiatives for Dialogue and Empowerment through Alternative Legal Services (IDEALS), Philippine Business for Social Progress (PBSP), United Youth of the Philippines-Women, and Oxfam Pilipinas.

REACH 2, in collaboration with various local government units in Maguindanao, tapped Muslim religious leaders known as Ustadz in addressing COVID-19 vaccine hesitancy in the Moro communities. An Ustadz(plural Azatids) is a religious scholar who studied Islam and teaches in a madrasah or Islamic school.

The REACH 2 project’s COVID-19 campaign component was implemented from October 2021 until June 2022 and covered the towns of Mamasapano, Ampatuan, Datu Hoffer Ampatuan, Shariff Saydona Mustapha, Datu Salibo and Sultan sa Barongis.

Ustadz Rasid Hakim, who teaches at a madrasah in Barangay Daladap in Mamasapano town, set himself as an example to allay the fears of Moctal and others who were hesitant to receive the COVID-19 vaccine.

“I got myself injected with COVID-19 to show that it does not do any harm or danger to our health,” the 49-year-old Muslim religious leader said.

During the Friday khutba (sermon), which is delivered before the Jumu'ah prayer or Friday midday prayer, Hakim would emphasize to the congregation, over a loudspeaker that can be heard by the surrounding houses, that the Quran, the sacred scripture of Islam, does not prohibit vaccination.

“If one will die, that’s not because of the vaccine but because it’s his or her time to die,” Hakim said, noting the COVID-19 vaccine is halal (acceptable) and not haram, citing also the ruling of the BARMM Darul-Ifta or Islamic advisory council.

He noted that after getting vaccinated against COVID-19, he felt even better and that the pain on his knee joints went away.

In March 2021, the BARMM Darul-Ifta had deemed the Philippine government’s COVID-19 vaccination drive as halal or permissible to Islamic believers.

Grand mufti (Islamic jurist) Abuhuraira Udasan, executive director of the BARMM Darul-Ifta, issued the religious guideline backing the government’s inoculation campaign.

“The vaccine for healing and preventive measure, in general, is lawful (halal),” he said.

During the last Ramadan, or the holy fasting month for Muslims, Udasan issued a fatwa that encouraged the Bangsamoro people to continue receiving the COVID-19 vaccine.

“Vaccination is a preventive and precautionary measure against pandemic diseases, (it is) life-saving and does not invalidate the fasting when taken during Ramadan,” he said.

In May 2020, Udasan approved the Friday Khutba or sermon entitled “COVID-19 and Prevention Against it” to guide Muslim religious leaders in the Bangsamoro region in helping fight the pandemic.

Kamsa Solano, IDEALS Covid-19 response advocacy officer, shared that there was a lack of proper information for the COVID-19 vaccine hesitancy in remote communities in Maguindanao.

To address vaccine hesitancy in Mamasapano and Sultan sa Barongis towns, IDEALS, with support from Oxfam Pilipinas, produced COVID-19 education materials in the form of a brochure and video presentations.

The brochure, written in Maguindanaoan language and titled S’bang Ka Rumor Bulletin, debunked COVID-19 misinformation. The video materials were shown using a big television screen or projector, and in cases when the community has no electricity, the team brought a generator set to power up the devices.

For the video materials presented in Filipino during the COVID-19 information awareness activity, the REACH 2 project team, together with the rural health units (RHU), translated or explained the contents in Maguindanaoan language.

“After the awareness campaign, some would -- right then and there -- like to be vaccinated against COVID-19 as they were enlightened already,” Solano said.

Samrah Manibpel, RHU Mamasapano COVID-19 vaccination manager, thanked the REACH 2 project for choosing the municipality as one of the project areas for its COVID-19 response, despite the town’s security issues.

Manibpel recalled during a COVID-19 vaccination sortie, their team and the REACH 2 project partners were harassed by an individual who wanted to get a vaccination card even without getting the COVID-19 vaccine since there are areas in Maguindanao that restrict mobility for unvaccinated individual. He was later pacified and the team proceeded with the activity.[IP1]

“While the security issues are real, we have the duty to protect our constituents from COVID-19, and that’s what matters,” she said.

Citing the rural health unit's (RHU) data, Manibpel said the COVID-19 vaccination rate was at 18 percent from the start of the inoculation campaign in June 2020 up until December 2021.

But with the REACH 2 project coming in and boosting the RHU's COVID-19 information campaign, the figure shot up to 48 percent from January 2022 up to June 2022, she noted.

Bai Erisha Sinsuat, a public health nurse in Datu Hoffer Ampatuan municipality, described the intervention of the REACH 2 project in the town’s COVID-19 response as a big blessing.

“In the fight against COVID-19, the REACH 2 project helped not only our staff but, more importantly, our constituents in the geographically isolated and disadvantaged areas (GIDA),” she

Of the town’s 11 barangays, six are classified as GIDA areas or last mile communities because of their difficulties in accessing government’s basic health and social services. Some of the GIDA areas in the mountains can only be accessed by foot or by horse due to poor road conditions.

Datu Hoffer Ampatuan, a 5th class municipality assigned under REACH project partner COM, has only six nurses and six midwives for a population of 26,660 (2020 census). The municipality’s residents, 90 percent of whom are living below the poverty line, were also plagued by the spread of vaccine hesitancy. Sinsuat noted that the REACH 2 project helped the LGU in its efforts to increase the rate of COVID-19 vaccination in the area.

Just like in other municipalities covered by its COVID-19 response, REACH 2 provided transportation for the local health workers to reach GIDA areas for house-to-house education awareness sessions in some villages.

With the COM project partner supporting the local health workers, the REACH 2 Project also arranged for the transportation of the vaccines from the provincial health unit to the locality.

“Through the help of REACH 2, our efforts in fighting COVID-19 were given more focus,” Sinsuat stressed.

“During the COVID-19 vaccination schedules, the project provided transportation to fetch senior citizens and persons with disability from their homes to the inoculation hub and vice versa,” she added.

In neighboring Ampatuan town, Teresa Satol, a midwife assigned in Barangay Saniag, noted that even if she was not a barangay health worker, she would still get injected with the COVID-19 vaccine because of the information she has learned.

“I learned from reliable news organizations that each one of us who are qualified to get the vaccine must be inoculated because this will give us protection from the virus,” she said.

Suffering from a kidney ailment, she has been undergoing dialysis every two weeks.

Satol herself had previously tested positive for COVID-19. She was subjected to a 14-day home quarantine. But despite her medical condition, she survived the illness. She thanked the COVID-19 vaccine for saving her life.

Because of what happened, she was among the barangay health workers who gladly participated in the REACH 2 Project to encourage more people in the far-flung areas of their municipality to get inoculated with the COVID-19 vaccine.

“I made myself an example to convince them that the COVID-19 vaccine is safe. I showed that that even while I’m having a dialysis, nothing bad happened to me when I received the COVID-19 vaccine,” she would tell patients.

According to her, many indigenous peoples in their locality fall prey to disinformation or fake news that they read on Facebook or hear from rumors in their communities.

Fatima Puti, the COM project lead for COVID-19 response in Ampatuan and Datu Hoffer Ampatuan towns, said that together with local health workers and Muslim religious leaders, they addressed fake news that caused the residents’ vaccine hesitancy.

“We conducted education awareness even on last mile communities about COVID-19 vaccines, that these were created not to kill but to prevent death,” she added.

Last January following a community education awareness session, at least 80 residents from one barangay queued up for their first doses. It was the first COVID-19 vaccination activity participated in by the REACH 2 team in Datu Hoffer Ampatuan.

“Education is key to their enlightenment. From their faces, we saw they’re excited to get jabbed with the COVID-19 vaccine,” Puti said.

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