PAGBABAGO Dr. Florangel Rosario Braid We thought that the main hurdle in the current mass vaccination program, the most ambitious health project we’ve ever undertaken,  was the slow pace in the administration of the vaccine. It was at the beginning,  but  the low rate of acceptance of COVID-19 vaccination where only three out of 10 adults had expressed willingness, is indeed worrisome. This is what prompted Senator Joel Villanueva to suggest that it might be a good idea to have both the President and the Vice-President come together and appeal to the public to cooperate in order to achieve herd immunity. Studies on adoption of innovations that present some kind of risk, such as  immunization. have shown varying degrees of resistance. Costs in adoption or non–adoption - material, social or psychological,  provide useful learnings and should be a part of the communication strategy  that should be carried out  before and after the rollout of an innovation. I remember my doctoral dissertation some 53 years ago, on the diffusion and adoption of family planning practices, where I analyzed case studies of family planning as compared to innovations in health, agriculture, industry, etc. Factors such as economic and social-psychological costs, perceived benefits and risks, environmental costs, trust and empathy, opinion leaders, social networks and religious values, rumor and disinformation, accessibility, among others, were shown to be critical variables in predicting early adopters and laggards, and in identifying facilitators and barriers in the adoption  of an innovation. These and similar factors were identified in similar studies including an October 2020  report by the World Health Organization on “Behavioral Considerations for Acceptance and Uptake of COVID-19 Vaccines. But because the pandemic came on so suddenly, there was not much time to build the necessary infrastructure and prerequisites – trust in the vaccines and the system, establishing an “enabling environment” through community engagement, communication,  building transparency, and other facilitating factors. The WHO Report provides another explanation for the low level of acceptance, and it is the impression that the vaccine was rushed and not tested thoroughly. People may have low level of confidence in the system including the motives of other actors including the pharmaceutical companies, and the politicization of vaccination as well. Here, and I am sure elsewhere too, there are conspiracy theories spreading around, many of which have been debunked. But because of forthcoming elections in 2022, some are wary that the mass vaccination may be used for political considerations. We can learn from the experience of other countries as well. An example is Jordan where a study showed that the acceptability of COVID-19 was fairly low at 37.4 percent and the importance of building trust about safety and efficacy of the vaccine including the technology utilized in its production. Employed males were shown to be less likely to accept the vaccine. It also demonstratedthe importance of vaccination convenience or relative ease of access,  as well as  economic costs. Early this year, the Octa Research Group carried out a face-to-face interview with 1200 respondents with 46 percent saying, “I will not have myself vaccinated; 19 percent said yes, and 35 percent, can’t say for now.  The survey found class D (74 percent) and E (73 percent) concerned with safety of vaccines compared to class ABC (46 percent). The survey further indicated that 1 in 10 or 15 percent Filipinos trusted vaccines from China while 4 in 10 or 41 percent trusted those coming from the U.S. In between, 25 percent say they trusted vaccines coming from the UK, 20 percent, Russia and 19 percent,  India. But a Social Weather Stations (SWS) face-to-face survey held for two months starting March this year showed these  preferences – 39 percent preferred vaccines developed by Sinovac Biotech, while 32 percent preferred Pfizer and BioNTech and 22 percent, AstraZeneca. Since studies have shown that the low adopters belong to Class D and E, it may not yet be too late to undertake an intensive community engagement in  thosefar-flung areas, mostly in Mindanao. Besides the apparent need to address motivation concerns – lessening fears about safety of vaccine  and assuring them of the  benefits of inoculation, health policy makers must  address how they can deliver the vaccines to places where health clinics are not easily accessible to a large percentage of our population. Finally, we appeal to all who have gone through the process to do their civic duty by providing testimonials on channels that are available. We must all be single-minded about achieving herd immunity by the end of the year. If we don’t achieve it, at least we can say, we gave our very best shot. My email, [email protected]