African Vaccine Hesitancy Threatens COVID-19 Eradication

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CLEVELAND, Ohio — Hesitancy about the COVID-19 vaccine in the West is now a concern in Africa. Various surveys conducted during the last 12 months show vaccine hesitancy, which has been highly publicized in the United States, also exists in lower and middle-income countries (LMIC) in Africa. There is concern that African vaccine hesitancy about COVID-19 vaccines is worse than that of other vaccines.

In 2019, the World Health Organization (WHO) declared that vaccine hesitancy is one of the top 10 threats to global health. African vaccine hesitancy threatens the eradication of COVID-19 because to defeat the virus, there is an estimated need for a minimum of 70% to 85% of a country being vaccinated to reach “herd immunity,” which is the point when enough people have been vaccinated that the likelihood that the disease will spread is very low.

What is Vaccine Hesitancy?

Vaccine hesitancy, as defined by WHO’s Strategic Advisory Group of Experts on Immunization, is delaying or refusing a vaccine even when there are ample immunization supply and services. On the other hand, vaccine acceptance is one’s willingness to get vaccinated.

As a testament to the importance of understanding vaccine hesitancy, a number of research groups throughout the world have been conducting multi-country surveys about it. The Johns Hopkins Center for Communications Programs (CCP) surveyed 1.5 million people in 67 countries in July and November 2020.  This included 12 African nations surveyed in both months. Of the 12 nations, Cameroon and Algeria remain with around a third of their population willing to be vaccinated, three countries have between 41% to 57% vaccine acceptance, five nations have between 60% and 66% acceptance and Uganda and Kenya have 71% and 72% vaccine acceptance, respectively.

While eight African countries surveyed improved their COVID-19 vaccine acceptance, acceptance rates for four countries actually declined from July to November. WHO underlines that to get COVID-19 vaccine acceptance to a 70% minimum for herd immunity, it is critical that locally trusted sources consistently communicate the safety and importance of the vaccine, its convenience and low cost.

Sources of African Vaccine Hesitancy

The African vaccine hesitancy stems from several sources. Fake news and misinformation have been flooding social media since last spring. For example, in Senegal, someone posted a video on Facebook of children getting a vaccine and said they died afterward. This influenced people in Dakar, Senegal’s capital, to panic in the streets when they mistook door-to-door cosmetic salespeople for vaccinators.

Government officials in some African countries are contributing to the misinformation that is heightening African vaccine hesitancy. John Magufuli, Tanzania’s president declared that the COVID-19 vaccines were “dangerous for our health.” Additionally, Andry Rajoelina, Madagascar’s president, promoted an untested COVID-19 herbal remedy.

Complacency also contributes to African vaccine hesitancy. Since there have not been as many COVID-19 cases in Africa as in the United States, some Africans believe that there is less urgency to vaccinate. Doctors Without Borders vaccine advisor Mamadou Traore shared that some Africans feel that COVID-19 is not “an illness that affects black people.”

Finally, there is a history in Africa of white doctors abusing black Africans through drug testing. It is widely known that during the South African apartheid, Wouter Basson, the head of the apartheid government’s biological warfare program, worked to develop a vaccine to sterilize black Africans. In 1996, 11 Nigerian children died during a Pfizer meningitis vaccine trial.

Reasons for Hope for African Vaccine Acceptance

Despite African vaccine hesitancy, there are reasons for hope for African COVID-19 vaccine acceptance and eventual large-scale vaccination once COVID-19 vaccines become available. Gavi, the Vaccine Alliance, notes that African nations have the infrastructure and experience rolling out large vaccination programs even during the COVID-19 pandemic. Gavi and the United Nations Children’s Fund (UNICEF) vaccinate more than 25 million children annually in Central and West Africa. Last November, Chad had a rare poliovirus outbreak and vaccinated 3.3 million children.

Keys to Overcoming African Vaccine Hesitancy

What do the experts suggest to combat African vaccine hesitancy? The WHO Technical Advisory Group (TAG) on Behavioural Insights and Sciences for Health issued a report in December that makes key recommendations, including:

  • Vaccines must be convenient to get in terms of location and times offered.
  • Trusted community members should promote vaccines and publicize their own vaccinations on social media in order to build confidence.
  • Vaccine communication should be consistent and transparent. It should underline the benefits but not underplay the risks.
  • Dashboards are needed to respond to misinformation and for fact-checking.

Groups Taking the Lead in Combatting African Vaccine Hesitancy

The United Nations recognizes the threat of COVID-19 vaccine hesitancy in Africa and elsewhere and promotes the work of two leading organizations in combatting it. Dr. Heidi J. Larson launched the Vaccine Confidence Project. This project works to guide countries to develop an early warning system of public mistrust of vaccines. Gavi promotes engagement in local communities and respect for their concerns about vaccines. With support from these two groups and others at the forefront of combatting African vaccine hesitancy, more African nations should join Kenya and Uganda in reaching the levels of vaccine acceptance critical for herd immunity.

Shelly Saltzman
Photo: Pixabay

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