By Betha Igbinosun
This blog post was submitted as a contribution to the Tabula project, an international and comparative research collaboration carried out over the summer of 2021.
Although vaccination programs in Africa have made giant strides over the last four decades, vaccine hesitancy, which has been named one of the ten major threats to global health by the World Health Organization, remains a blight there. Vaccine hesitancy refers to delays in the acceptance of vaccines or the outright refusal of vaccines, despite the availability of vaccination services.
Vaccine hesitancy in Africa has been amplified by false rumors and conspiracy theories, making communities vulnerable to infectious diseases and culminating in multiple disease outbreaks. For example, in 2003, five states within northern Nigeria boycotted the oral polio vaccine due to allegations by political and religious leaders within the region that the vaccine had potentially been contaminated with “anti-fertility” agents to stem the growing population of developing countries. This boycott lasted from February 2003 to July 2004 and had devastating consequences for the spread of polio, with Nigeria alone accounting for 86% of all polio cases within the African continent by 2008. Consequently, it was not until 2020 that Nigeria achieved official polio-free status, becoming the last African country to do so. Ebola virus vaccine trials were also halted in Ghana in 2015 due to widespread rumors that scientists were intentionally infecting Ghanaians with the virus in order to test the efficacy of the vaccine, and that trial participants were at risk of being infected with the virus as a side effect of the vaccine.
This state of affairs has been largely unchanged in the case of the COVID-19 vaccines, with conspiracy theories alleging the use of the vaccine as a means to introduce the disease and kill vaccine recipients. Results of a survey carried out by the Africa Centres for Disease Control and Prevention in 15 African countries revealed some of the prevalent myths contributing to vaccine hesitancy within the continent. For example, more than half of the survey respondents expressed belief that the threat posed by COVID-19 was grossly exaggerated, and almost half expressed belief that COVID-19 was an event planned by foreign actors. The low number of deaths from the virus within the African continent compared with other regions also appears to have created a false sense of immunity.
As of June 10, 2021, only 32 million vaccine doses had been administered in Africa, accounting for less than 1 percent of the more than 2.1 billion doses administered worldwide. Just 2 percent of nearly the 1.3 billion people on the continent had received one dose of the vaccine, and only 9.4 million Africans were indicated to be fully vaccinated. Although the low figures could be attributed in part to the relative scarcity of vaccines within the continent, as well as the lack of adequate health infrastructure and workforce, vaccine hesitancy is also a major driver, with thousands of vaccines in Africa needing to be destroyed due to expiration from non-use. Common reasons given for the reluctance to take the COVID-19 vaccine include concerns about side effects and long-term impacts, as well as the absence of sufficient information about the vaccines to make an informed decision.
It is apparent that African countries need to develop thoughtful communication strategies to allay their citizens’ fears about the COVID-19 vaccines. In this regard, community mobilization and participation might be a better tactic than a traditional “top-down” approach. For example, in reversing the false rumors within northern Nigeria about the use of the polio vaccine as a birth control mechanism, “Polio Eradication Ambassadors” were appointed to engage with traditional and religious leaders on the importance of the vaccine, including educating them about the safe use of the vaccine in other parts of the world to debunk their misconceptions. A similar approach can be taken on behalf of the COVID-19 vaccines, particularly as religious leaders have been at the forefront of claims about the supposed dangers of the vaccines; having them champion the safety of the vaccines following proper enlightenment would undoubtedly yield positive results.
Other measures utilized as part of the polio eradication initiative included going directly to parents in their homes to speak to them about the importance of the vaccine for their children, and relying on certain parents as “community influencers” to talk with other parents. Relatedly, the BRAC Manoshi approach to reducing maternal and neonatal mortality rates in urban slums within Bangladesh involved using trained community health workers to disseminate health messages, accompany mothers in labor to delivery centers, and offer essential newborn care, among other strategies. The result was a 73% reduction in the percentage of women who gave birth at home, a 56% reduction in the maternal mortality ratio, and a 60% reduction in neonatal mortality rates.
In the COVID-19 context, community health workers can be trained to administer vaccines and respond to any questions or concerns that may be raised by community members. Vaccine administration points can also be sited in community-wide acceptable areas, and community health centers can be used to monitor and investigate any adverse vaccination side effects, in order to prevent the formation of unfounded rumors that might link unrelated illness or death in people who have been vaccinated to the vaccine.
Unless public confidence were built, it is doubtful that mandatory vaccination regulations would be effective. In fact, it is more probable that making vaccination a condition for participation in essential activities, without making reasonable accommodations for those who either choose not to or are unable to get vaccinated, would most likely undermine public trust. There is also a risk of counterfeit vaccination cards being used as evidence of compliance, much as counterfeit COVID-19 test results have been used to enable travel.
The success of vaccination programs has been linked to trust and solidarity, and in this regard, it is imperative to emphasize the social impact of vaccination and the role of herd immunity in protecting vulnerable groups. The concept of social solidarity is, for the most part, firmly entrenched in many African countries, where people share a concern for the common welfare and the well-being of others. This can be leveraged by encouraging people to be vaccinated not only to protect themselves, but also to protect members of their broader communities. Moreover, though the lower death rates from COVID-19 on the African continent might offer some comfort, vaccines remain an important preventive measure, making it suboptimal to wait until a surge to increase uptake.
Overall, it is undoubtedly important to consider ease of access to the COVID-19 vaccines in developing countries, especially within the sub-Saharan African continent. As vaccines become more widely available, however, there is perhaps even greater need to consider the general acceptability of the vaccines to the community. Where there is hesitancy, then, there is a need to implement measures geared toward providing accurate information, and to enable people to be vaccinated safely, without fear.