Five TWC2 volunteers conducted a smallish study among male migrant workers, focussing on their awareness of, and attiudes towards Covid-19 vaccination. Reaching workers proved to be a little harder than expected because just as fieldwork was commencing, Singapore experienced a second wave of infections. Although the second wave was located in the general community, the worker dormitories were all locked down again and we could not continue interviewing men in the nearby recreation centres.
The study was conducted by Neo Rui Yi, Ng Qian Qian, Drishtant Chakraboty, Andy Nathaniel Sung and Sharon Tan. This is their report.
Many of us in Singapore are bombarded with information on vaccination. From news to fake news, official messages from MOH to Whatsapp messages from friends and family, there is no shortage of information at our fingertips.
But unlike us, our migrant workers get little to no information. Through interviews with male migrant workers residing in dorms and workers who are out of jobs, we found that almost all of them have no line of communication with the Singapore ministries, not even one-way transmission.
What’s surprising, though, is that nearly all the workers we spoke to displayed no vaccine hesitancy. What worried them was whether and how they can get the vaccine.
By the time of writing this report, workers can now sign up for vaccines. The promise that all persons in Singapore regardless of citizenship and pass will eventually be vaccinated is being kept.
Nevertheless, those most left out continue to lag behind. Workers who have lost their jobs find that the path to registration for vaccines is not straightforward, and workers with jobs can only rely on the ad-hoc updates from their employers.
Inadequate channels of information, unequal levels of anxiety
We found that very few migrant workers receive information directly from MOM and MOH. This behaviour is in spite of the many newsletters, disseminated in both Tamil and Bengali.
The conclusion is not to blame workers for their poor uptake, but to probe the factors that continue to deter access to the government’s announcements, and conversely, what other channels of information they defer to.
From what we’ve found, workers tend to get their information from social media such as Facebook, as well as their friends and family, be it through whatsapp messages or face-to-face. Workers with jobs do get their information from their bosses or upper management. Important information such as swab test dates is disseminated by employers, though information such as when they’ll be vaccinated, possible side effects, and which vaccine will be administered hardly reaches the men. Other information that would help to quell some uncertainty include whether being fully vaccinated will allow them to safely visit their families back home and return to work, and when masks can be removed in Singapore.
At this point, workers with jobs hold out on the blind faith in the Singapore government, that somehow, one day, their turn to be vaccinated will come, and their employers will send them for it.
But workers without jobs have no employers and lack that crucial channel of information. They deal with the most uncertainty, anxiety, and so quiet rage: “Singaporeans all get vaccines, but I no job how I get vaccine?”
They share similar concerns about not dying from Covid-19 and not knowing where and how to get vaccinated. The lack of information about vaccines would probably have compounded feelings of abandonment special pass holders feel. A few workers who come from higher and more educated classes in Bangladesh pointed out that their families had already been vaccinated, and that they would be too had they been home. But majority of special pass holders are not treated well at home either, and feel their chances of getting vaccinated in Singapore are higher. The conflict for many of these special passes holders and who do not come from higher, more educated classes in Bangladesh, is the faith that the government or MOM will eventually get to them with vaccination, and general inability to clarify their doubts.
Across both samples – with or without jobs – the men know they’re at the bottom of the priority barrel, even if it’s a pretty safe barrel they are currently in. But those with jobs allow themselves to feel more ease in the “automatic” way vaccines will eventually be administered for them. As usual, special pass holders lose out in this information asymmetry and have to deal with higher levels of anxiety.
Almost no vaccine hesitancy
While some local residents are worried about the side effects of getting vaccinated, it helps to keep things in perspective when we consider how our migrant workers are worried about not getting vaccinated. 82.5% (n=33) responded with a definite “yes” when asked if they were willing to take the vaccine. Generally, workers felt that the vaccine would make themselves and their community safer, that the vaccine was efficacious, and that they would have better access to vaccination in Singapore as opposed to their home countries (Bangladesh/India). When asked if they have any worries about the vaccines, the usual reply goes: “Not scared, as it will help me. I am not worried about side effects.”
Despite having little recourse to clarifying about the side effects – and some are worried about it – workers nevertheless remain eager to be vaccinated: “Won’t die!” Their cost-benefit calculus works out in favour of Singapore’s quest to achieve herd immunity. Furthermore, workers tend to be confused when asked if they are aware they can refuse the vaccine. “No no, I want.”
Some men who do not know about how the vaccine works nor the possible side effects, have nevertheless made up their minds about wanting the vaccine: “I don’t know about side effects, but not important to me.”
There are at least 4 reasons for the lack of vaccine hesitancy. Firstly, most workers have had first-hand experience with themselves or their peers being infected with Covid-19 as well as receiving the vaccine. They are thus aware of the consequences of a Covid-19 infection and the relatively mild side effects of vaccination. Secondly, several workers stated that they trusted the Singapore government in their vaccination drive. Thirdly, we feel that it is precisely this lack of information channels that has allowed the workers to not be exposed to falsehoods and fear-mongering about covid vaccination. Fourth and lastly, the families of these men, such as their wives, mothers and siblings, are usually supportive of their getting vaccinated.
To be clear, we are not saying that more information leads to more vaccine hesitancy. Further, we do not endorse depriving workers or any other person of information so as to promote vaccine take-up rates.
In fact, we recommend the opposite: increase access to information for workers, employed or not. And for workers without employers, more hand holding might need to be done to aid them in the vaccine registration process.
Needed: Equitable access to vaccination information & registration
Our current system of information dissemination and vaccine roll-out overtly relies on the employer, and that’s a problem of 1) unequal access to information between those employed and those who aren’t, and 2) unequal power that makes even those employed fearful of clarifying any doubts they have about the vaccine.
Let’s first focus on the first issue of unequal access. Those currently employed likely face no hitches in getting vaccinated, and they are generally assured of it too, that their bosses will somehow make it happen. But special pass holders are left out in the cold. The question is: how will information about the vaccine and registration be adequately conveyed to them?
Unequal access to information, with resulting anxiety, is echoed by the unequal vaccination rates. One worrying observation from their lack of information on how to get vaccinated is the lack of vaccination uptake amongst workers who do not have employers to rely on. In the study period, 100% of the unemployed male migrant workers (Figure 2) have not received their vaccination, compared to the approximately 70% of the employed male migrant workers (Figure 1). Of note, a greater percentage of the unemployed workers have not been previously infected with COVID-19 (84.2% vs 57.1%).
Figure 1: Vaccination status amongst 21 employed male migrant workers. One of the respondents had an upcoming appointment for his first dose a few days later (in end June), but for the purposes of this study, his reply is classified as a “no”.
Figure 2: Vaccination status of 19 male migrant workers who were unemployed (i.e. on Special Passes).
As mentioned earlier, more thought needs to be given to how more guidance can be rendered to our special pass holders. One obvious indicator of success would be whether these men know how to register for vaccines on their own, and for those who can’t, to consider what can be done to help them.
And as we rectify the second problem of men’s inability to clarify their doubts, one consideration that ought to be borne in mind is this: Would it be a violation of their rights if workers continue to be unaware of their right to refuse the vaccine? Of course, this concern might be a theoretical one. After all, the men seem to be caught in a virtuous information cycle that encourages them to take up the vaccine across a spectrum of information available to them.
Our bottomline: vaccinate everyone in an equitable manner. And truly equitable access to vaccines does not just stop at making the opportunity to be vaccinated available in theory. We have to consider the user experience of all men, including our special pass holders who seem to be systematically left out, even now.
Huge problem getting vaccination slots for Special Pass holders
TWC2 volunteers began helping Special Pass holders try to get vaccination appointments through the government’s portals since the beginning of July 2021. Special Pass holders are migrant workers who have filed salary or injury claims and have had their employment (and Work Permits) terminated. They typically stay on in Singapore for months and months while their cases wend their way slowly through the case resolution system, before going home or transferring to new jobs.
For unknown reasons, about 75% of the time when we try to book slots for them, the vaccination portals do not recognise their identification details that we are asked to key in. The portals do not reply; the system gives us nothing but silence. It’s as if the system does not believe they are real people or that they are in Singapore. Despite trying several times, we get the same non-response from the app. For the other quarter, the system works flawlessly and we manage to book slots for them within a minute. As yet, TWC2 is unable to understand why the majority of Special Pass holders cannot get through whilst a minority can.
We first conducted a pilot study, speaking to about 10 workers in Penjuru dormitory and 5 workers at the Cuff Road Project, 4 of whom were special pass holders. We then conducted open-ended surveys, first as guided interviews and later over-the-phone interviews, with 40 male migrant workers to find out regarding some of the prevailing attitudes towards the COVID-19 vaccination from May 2021 till mid June 2021. Twenty-one of the workers were employed, whereas 19 of these workers were currently unemployed. Face-to-face interviews were initially conducted at the Recreation Centres and our in-house Cuff Road Project. Subsequently phone interviews were employed, in accordance with the heightened alert restrictions that were in force. Majority of these workers were from Bangladesh (70%) whereas the rest were from India (30%). Twelve of the workers had previously been infected with COVID-19.
Compared to local residents, we found the workers we interviewed to have little information about the vaccination process. None of the workers had been briefed by MOH / MOM, and instead received information from their employers. Workers who were out of work were ill informed, as they no longer had employers, and those who had previously been infected with Covid-19 were also not briefed by their employers since they were not due to be vaccinated. Alarmingly, we also found that majority of the workers we questioned did not know that they had a right to refuse the vaccine.
82.5% (n=33) responded with a definite “yes” when asked if they were willing to take the vaccine. Generally, workers felt that the vaccine would make themselves and their community safer, felt that the vaccine was efficacious, and that they would have better access to vaccination in Singapore as opposed to their home countries (bangladesh/india). Three workers were reluctant to take the COVID-19 vaccination. One believed he did not require it, the other had no thoughts of taking it as his employer had yet to inform him, and the third was worried regarding side effects his friends had experienced and that his special pass renewal process could be hampered should he swab positive due to the vaccine.