COVID-19 vaccine hesitancy threatens to derail war against pandemic in Africa

Vaccine hesitancy in many parts of Africa has emerged as a potent threat to efforts to mitigate COVID-19 and could considerably counteract wider move to contain the pandemic, despite significant gains made to control the disease in the continent.

There is consensus among a cross-section of health experts from the continent that the fight against COVID-19 must address the pockets of apathy and reluctance that now threaten to derail mitigation of the disease.

The World Health Organization (WHO) defines vaccine hesitancy as the delay in acceptance or refusal of vaccines despite availability of vaccine services. Hesitancy is complex and context-specific, varying across time, space and vaccines.

“Early evidence from across Africa shows that many are eager to get the vaccine, despite very limited supplies. Yet battling hesitancy among some older people, as well as managing demand and eagerness among the young has been a challenge in some countries,” states WHO.

Willingness to accept a COVID-19 vaccine varies greatly from one African country to the next, with significant regional differences, as demonstrated in a March 2021 report by the Africa CDC, which sampled 15 African countries.

“Intent to accept a COVID-19 vaccine ranges from higher acceptance reported in Ethiopia and Niger to the lowest willingness reported in Senegal and DRC,” notes the report.

The willingness to receive the vaccine is as high as 92% in Tunisia and as low as 59% in DRC. Across the continent, 1-in-5 (18%) respondents said they would refuse a COVID-19 vaccine.

“When asked why, the most common response is a lack of trust in the vaccine. Some of these respondents do not trust vaccines in general, but others show specific distrust towards a COVID-19 vaccine,” states the report.

“COVID-19 vaccine hesitancy has been there,” said Dr Menelas Nkeshimana, Vice President of Rwanda Medical Association. Dr Nkeshimana is also the leader of a sub-cell in charge of case management in the Rwanda Joint Task force for COVID-19.  “You see people who refuse, people who refuse but aren’t sure if they should refuse, people who accept some vaccines but they delay and refuse other vaccines, and those who accept but are not sure if they have made the right decision.”

A successful vaccination campaign depends on the level of acceptance by the population and the pace of vaccine roll-out and coverage, Dr Nkeshimana told a recent virtual press conference convened by the Africa Science Media Centre.

The continuum of vaccine acceptance, as elucidated in a study, pits people who show varying degrees of reluctance to vaccines against those who willingly accept the vaccines, based on assurances from science and other authority.

“Then you have the people who have been briefed, who have been following what is in the news, and who have been provided with scientific fact. They accept with a smile”, said Dr Nkeshimana.

Various factors have conspired to see Africa lagging behind other parts of the world in COVID-19 vaccination. By end of May, close to 1.5 billion doses of COVID-19 vaccine had been administered globally, of which about 28 million were administered in Africa.

“On average, that gives you around 2 doses per 100 people in Africa,” said Dr Richard Mihigo, WHO Africa’s Immunization and Vaccines Development Programme Coordinator. “That’s compared to 22-23 doses per 100 people globally.”

Sierra Leone has drawn from lessons learned in its previous vaccination drives against Ebola to assure its population of the efficacy and safety of the COVID-19 vaccines.

“One of the challenges we have had with vaccinations is that people are quite concerned that these are new diseases that they’ve never heard of before, and all of a sudden you’re asking them to have vaccinations,” said Sierra Leone’s Minister of Health and Sanitation, Dr Austin Demby. “We had to overcome that.”

Dr Demby added that Sierra Leoneans also pressed for the public vaccination of key government officials to provide further assurance of the vaccines’ safety.

“People were concerned about the vaccines, and they said, ‘If these vaccines are so good, why can’t the president be the first person to be vaccinated?’  So, what we did was that the president and all the cabinet members, all the leaders in government, and all the judiciary had a major event where they were vaccinated in public.”

Other concerns included possible side effects of the vaccine and whether it would leave any health complications on those vaccinated. Questions ranged from “Are we going to be glowing in the dark?” to would people die from the vaccination.

“We reassured them that these were new products, and that the evidence and data that’s available shows that adverse events are very rare, but we’d put in place systems of active pharmacovigilance to monitor and track everyone who has been vaccinated,” said Dr Demby. “And so with the combination of the confidence building by the president and the cabinet, with the pharmacovigilance effort, and the fact that we took time to explain the science in layperson’s terms, we have a situation where people are very interested in being vaccinated now.”

Several African countries paused or stopped their vaccine rollouts due to safety concerns, notes WHO. “Much of this was driven by fears of adverse side effects that were reported in Europe and the United States of America. The suspension of the use of the AstraZeneca vaccine among younger adults in Europe has also affected the uptake of the vaccine in younger health workers in some African countries.”

Concerns regarding the safety and efficacy of COVID-19 vaccines, as well as myths and misinformation, are spreading fast on social media and have added to vaccine hesitancy.

Some common COVID-19 vaccine myths include claims that the vaccines are unsafe, normal safety protocols were circumvented to fast track their authorization for use, vaccines can change a person’s DNA and vaccines are a conspiracy by big businesses to push profits, with government complicity. More outrageous claims have it that the vaccines contain microchips that can be used to track and control an individual, and that the vaccines have the Biblical mark of the Beast – 666. Other fashionable myths in the continent have adversely linked COVID-19 vaccines to infertility and asserted that the vaccines contain aborted fetuses. None of these assertions are accurate.

Pronouncements by political leaders disparaging COVID-19 vaccines have not made things any better. In one of the most notable examples from the continent, Tanzania’s late President John Pombe Magufuli claimed that COVID-19 vaccines could be harmful and urged Tanzanians to use steam inhalation and herbal medicines. His Health Minister Dorothy Gwajima told a press conference in the capital, Dodoma, that “the ministry has no plans to receive vaccines for COVID-19.” The health minister insisted Tanzania is safe, and, in the glare of cameras, she led fellow health officials in chugging a concoction that included ginger, garlic and lemons, and proceeded to inhale steam from herbs, which they endorsed as a natural means of killing the virus. In a stark departure from her predecessor, new President Samia Suluhu Hassan indicated her government will take a science-based approach to dealing with COVID.

In February, Kenya’s health ministry reported a 15% hesitancy level to COVID-19 vaccine, with fears that the figure could increase due to misinformation, rumours, and conspiracy theories. The country is banking on increased engagement with stakeholders, especially religious leaders and immunization champions, as well as a messaging campaign, to reduce vaccine hesitancy and dropout rates.

Neighboring Uganda has also recorded growing interest in COVID-19 vaccines after facing a measure of hesitancy in the early stages of the rollout.

“Initially, it was really bad,” Dr Monica Musenero, one of the key players in Uganda’s response to the COVID-19 pandemic, told a press conference convened by AfriSMC. “People hesitated, so by the time they rushed for vaccination, there wasn’t enough time between the first dose and the second dose and the expiry of the vaccine. To avoid expiry of this precious resource, we had to open up and allow every eligible person to come and take it.

“Towards the end now, we have more demand than we can give. The policy guidance from the president is that we should focus on making sure that those people who qualify have a second dose,” said Dr Musenero, who also chairs Uganda’s Presidential Scientific Initiative on Epidemics and is the Senior Presidential Advisor Epidemics.

“We need to invest a lot of efforts to create trust and confidence of the population in the vaccines once they become available,” said Dr Mihigo.

Dr Nkeshimana cited the endorsement by opinion leaders — from mayors and religious leaders to doctors and others — as a crucial pillar in engendering public confidence in the COVID-19 vaccine rollout across the continent.