Editor’s Note: Jason Tan Liwag is an early-career scientist taking his MS in Molecular Biology and Biotechnology at the University of the Philippines Diliman. He is also an actor, a writer, and the founder of Queer Scientists PH. The opinions expressed in this story are the author’s.
Dagupan City (CNN Philippines Life, January 29) — When the lockdown began, medical frontline workers were left in limbo without public transportation. Photos and stories of frontliners from different parts of the country walking to work, some still in their PPEs, quickly populated local news sites and social media. Better mobility was crucial to the pandemic response and, as they discovered a few months later, the key to it was simple: broadening the existing mobility movements and coalitions to involve the doctors and medical frontliners in the lobbying.
Doctors are able to withstand political pressure and business interests (as evidenced by the success of the sin tax law) because people trust them. Everyone has a doctor or knows a doctor or knows what doctors look like. So whether it’s denouncing incorrect health-related claims by government officials on vaccines or simply messaging their community through self-organized COVID-19 messaging groups on Telegram, doctors wield some form of political power in society because of this trust.
Though immensely complex and difficult to measure, trust is the foundation of society. It is a driver for compliance to regulations, determines policy design and effectiveness, and is the cornerstone of modern-day democracies. Trust in governments is dependent upon the confidence of the public in their leaders and breaks in trust can scar the nation for good. The Dengvaxia death toll and the recent PhilHealth corruption allegations alone have sowed seeds of doubt not only in the political landscape, but also in the science that informs it. Anti-vaccine sentiments and health policy skepticism impact the country’s COVID-19 response and the relationship of individuals to scientists and medical experts.
How then do we move towards a community that trusts researchers enough to listen to them in the same way politicians listen to doctors?
It’s not as if Filipinos don’t value science itself. In the 2018 Wellcome Global Monitor, the Philippines had one of the highest likelihoods of "high" trust in science despite being one of the lowest ranking in STEM education. We see this in the country’s high mask-wearing compliance, as opposed to anti-mask rallies in other countries with higher levels of scientific distrust.
However, high scientific trust does not always mean behavior is easily modified by new information. A study in the US shows that there is larger trust in practitioners than in researchers. The everyday Filipino listens to scientific advice, as long as it is within their means of living.
Proximity and visibility contribute to building reputations of trustworthiness for doctors and these contribute, in part, to the absence of the same confidence in researchers. “The limitation that most scientists feel is that they are only comfortable talking about their expertise,” says Dr. Giovanni Tapang, Professor at the Institute of Physics and Dean of the College of Science at UP Diliman. He explains that, unlike doctors, which can be encountered by dozens in communities, it’s rare to see scientists.
In the 2019 Meeting of the National Academy of Science and Technology, they revealed that the Philippines needed to double the number of scientists if it were to achieve the minimum average globally. Simply put: you can’t trust scientists if there are no scientists to trust.
I recall a friend who messaged me about the recent deaths in Norway linked to the immunization of the elderly and those with pre-existing medical conditions such as allergies. She expressed her worry that her elderly mother would suffer the same fate if the vaccine rollout started here. I dropped whatever I was doing, read the article, and calmly told her what I understood. She confessed that, given the medical terms, she didn’t understand the article and thanked me for my time.
This doesn’t seem like much, but then I thought of the population: millions of individuals who have to go through the process of making sense of this information alone. Everyday, seeing news that provides incomplete pictures and poorly communicated science, leveraging entertainment at the cost of accuracy, from a government more concerned with shutting down news sources that could be a source of public health information or discrediting scientists as “bayaran.”
To have a scientist to run to is comforting, to say the least. But not everyone has that luxury. To make that a reality comes with investment because forests have to start somewhere. "What enables you to have the low hanging fruit is that you need to plant the tree. Investing in science is planting the seed," says Tapang.
Scientific trust significantly improves with transparency. Doctors have Hippocratic oaths that hold them to prioritize life, whereas scientists’ allegiance is to data and what truths it reveals. The distance that is thought of as necessary to maintain some form of scientific objectivity is also one of the reasons why scientists are perceived to be detached. Not to say that research is apolitical, but the relative proximity and visibility of doctors allow them to be pulled into rooms and communities for policy-making, compared to researchers.
To create scientists more actively involved in policy-making and engaged with communities, universities and other institutions must improve incentives for these efforts. Ken Abante — former chief of staff of the Strategy, Economics, and Results Group of the Department of Finance and a current policy researcher for the Interdisciplinary Studies Department of the Ateneo de Manila University — explains that upward mobility for researchers is often confined to promotion through publication, discouraging researchers from participating in other efforts that are equally necessary. Abante says, "Universities and research institutions can come up with other ways to incentivize researchers to engage in community work where ideas coming out of their research can be applied... like a faculty position (or load) for math community outreach, or a faculty position (or load) to do community organizing for better national policies for the broader community of researchers and scientists in the Philippines."
Abante explains that the culture wherein scientists exist still have gaps that need to be addressed by creating better environments for the public to access secure and quality data (as he elaborated, in part, here and here). According to the COVID-19 Citizen’s Budget Tracker, which Abante began with friends and volunteers as a way to make sense of where the money was going, over half of the Philippine COVID-19 budget has already been spent. However, 99% of the budget in the second Bayanihan Act is still largely unknown to the public as of the Nov. 3 President's report [or as of the time of the interview]. Research and development is crucial to policy-making because it allows for public scrutiny and independent assessment by both local and foreign researchers. The absence of access to data prevents proper checks-and-balances necessary for verifying the science backing up political decisions.
Similar problems exist for health-related data, highlighted by the pandemic. Independent researchers managing the UP COVID-19 Pandemic Response Team and the COVID-19 Citizen’s Budget Tracker are doing their best with whatever data is dropped by the government. "Anyone who has ever worked in the health sector will tell you how hard it is to access data for research and policy," says Jason Haw, a PhD Epidemiology student at the Johns Hopkins University and an instructor at the Ateneo de Manila University.
Working as a consultant for the Department of Health, Haw assisted in setting up what we now know to be the COVID-19 epidemiological surveillance system. "I got called in around the start of lockdowns in March. At the time, DOH released a PDF version of a linelist of cases with limited data — I think it was age, sex and a few address variables."
Based on his experience in health policy and systems research, Haw started by recommending a process by which more detailed data could be collected from all the hospitals, including daily number of individuals tested, cumulative positivity rate, and the number of testing labs that successfully submit their results. These were then presented to the public through a dashboard he co-developed with the big data group Thinking Machines.
The dashboard required that data be deidentified to protect data privacy without losing epidemiologically-relevant data such as exposure history. It also included the state of nationwide health facilities such as bed occupancy and availability of mechanical ventilators. These enable outsiders — including modelers and statisticians — to monitor the public health system, create epidemiological and economic projections, and to compute independently the reproductive number (R0, an indicator of how contagious a virus is) and the transmission rates across time throughout the country (visible through endcov.ph).
This boosted transparency with the public, but also provided an opportunity to have difficult but important discussions with decision makers about mass testing, implementing, and lifting community quarantines. Mass "recoveries," or a large number of recovered COVID-19 patients, are actually the result of backlogs in the data management and delays in the adoption of the COVID-19 patient discharge criteria set by the World Health Organization.
Building an ecosystem
With doctors, you could maintain your relationship and your health progress through regular checkups. But for science, maintaining transparency and trust relies a lot on track record and building momentum. “I am obsessed moving forward with keeping most of those gains, because the next stage is building institutional memory,” says Haw, who explains most of his work now is training local government epidemiology surveillance units to not only understand the epidemiology of COVID-19 but to also learn how to communicate these stories to their higher ups and, more importantly, to the public.
Epidemiological surveillance is a tool to estimate the health status and behavior of populations served by a particular government: measuring both the need for and the effect of health interventions. It is necessary for rapid detection of cases and for knowing which members of the population need public health and clinical interventions the most. Data gathered on not only the spread of the COVID-19 pandemic but also the effectiveness of interventions used to mitigate it will determine changes in public health policies and also infrastructure that will support these changes.
Most news outlets have attributed the successful pandemic response of other countries to women leaders. While this is true to an extent, countries such as New Zealand and Taiwan also have had formal, institutionalized science advisory groups backing up their decision-making process. Haw tells the story of Taiwan and Egypt — two countries who carried over institutional reforms from prior experience with coronavirus outbreaks. The former benefits from a vice president who is a trained epidemiologist who served as health minister during the SARS outbreak while the latter improved their government-induced upscaling of pharmaceutical manufacturing following the H1N1 outbreak in the Middle East.
In addition to doctors creating de facto science advisory systems through Telegram and Viber groups — small digital pockets that provided crucial knowledge, fact-checked government statements, and relieved budding anxieties with only a few texts — researchers started to use social media to communicate with the public more directly as well. Edson Guido, a PhD Candidate at the UP School of Economics and the head of ABS-CBN’s Data Analytics Team, uses Twitter to contextualize the dangers of the new, more transmissible variant, explaining the reasons why the public needs to maintain strict social distancing rules over the holidays especially when dining outdoors, and even the effectiveness of vaccines when politicians were unclear or incorrect.
That said, formal science advisory systems already exist through the National Academy of Science and Technology (NAST), which is the science advisor to the President. However, this has been far from a straightforward system. "We [researchers] are already sitting on policy-making and advisory boards," says Tapang. "But sometimes, participation is just a token.”
Institutional memory is valuable because it functions like adaptive immunity that protects us from future pandemics. Prior public health scares such as the 2003 SARS crisis and the 1960s cholera outbreak have resulted in the formation of pre-existing infrastructure used to respond to the COVID-19 pandemic, such as the Bureau of Quarantine and the different networks of epidemiological surveillance from the national to the local government units.
Institutionalizing science advisory groups in a similar way to medical health associations will be necessary moving forward, as most of the science advisory is informal or limited by bureaucratic structures. To move forward is to also understand the role of social scientists and science communication — which are both necessary to mobilizing scientific experts and in making sure that messages are understood by the different subcultures in the archipelago. Support must also be given to existing community led-efforts at educating and promoting scientific and political coalitions that have slowly been forwarding concerns to the national level.
"We [researchers] are already sitting on policy-making and advisory boards," says Tapang. "But sometimes, participation is just a token.”
Even within the systems of anchors of national integrity such as the Commission on Audit (CoA), there exist some oversights that affect the continuity of research and development. In an interview with Professor Nelson Querijero and Assistant Professor Rhea Ledesma-Gumasing of the UP Los Banos College of Public Affairs, they narrate briefly how even the simple reshuffling of officials and employees, initially meant to preserve and protect CoA’s independence, results in lapses in established procurement practices that decrease research output and make it hard to pay researchers and purchase materials. “National agencies should provide enabling environments to allow for a more relaxed but accountable system,” says Querijero.
Weeding out the distrust
But apart from identifying major lapses, these are symptoms of bigger issues: the lack of scientists and health-allied professionals in public office. There are plenty of examples of trustworthy doctors who are visible in the public sphere as they do their part in the pandemic response: Dr. Anna Ong Lim (who sits on the DOH Technical Advisory Group), Dr. Kathy Villegas (who is Associate Dean for Research in UP’s College of Public Health), Dr. Antonio Dans (who is the face of the health worker alliance who called for a strike), just to name a few.
But where are the faces of the scientists? Science and the scientists have always been trustworthy despite the uncertainty. Early calls to action were rapidly responded to and, within the first few months, researchers developed low-cost sanitation and testing tents, 3D printing of personal protective equipment (PPEs), prototypes for production of hypochlorite — the chemical compound used for disinfection — in hospitals, volunteer testing groups, and mathematical models for the spread of SARS-COV-2 per province. The media can always hold more space for these stories and it can be a strong ally in directing the public’s attention to what endeavors should be supported, serving as scaffolds for trust-building efforts.
More importantly, where are these individuals in public office? The individuals who are tasked to spearhead the COVID-19 response — the Inter-Agency Task Force for Emerging Infectious Diseases (IATF-EID) — are military men or the policemen, even in the regional task groups. Congress is no different, with the exception of some added celebrities in the mix. The stark lack of diversity in the educational backgrounds and minimal representation of science in politics results in similar frameworks of responses: patriarchal, militarized actions and policies.
As of this writing, the Department of Justice junked the complaint against Koko Pimentel for violating the quarantine breach. This is one of many instances when the science seems misaligned with, even suppressed by, the same government which should be upholding it, due to competing interests and priorities: the Supreme Court junking the call for free mass testing in the country, the delay in putting price caps on COVID-19 testing, and even the Balik Probinsya program becoming a way to spread COVID-19 to the provinces, just to name a few.
With almost a year in lockdown, science has been in the backseat and not because we are incapable or because the numbers are too few. Government action and policy in the past has been driven by political and business interests, seen in the number of misplaced priorities not only in funding but also legislature. This is not the last pandemic that the Philippines will ever face and if we are to survive this and all future pandemics, we must learn to value science and what it offers as a community.
The only way out of this Sisyphean nightmare is to have a government that puts science at the forefront of response, a public that places trust and support in these initiatives, and a community of scientists, however many we have left, to continuously be vocal and critical in their journey towards upholding the truth; no matter how tiring it can be.
Cover illustration and design by THE PUBLIC SCHOOL MANILA
Produced by ANNA CANLAS and DON JAUCIAN
Update: The article has been edited to reflect the correct former designation of Ken Abante in the Department of Finance and to clarify that the spending of 99% the budget that is still unknown to the public is from the budget in the second Bayanihan act. We apologize for these oversights.