COVID-19 vaccine hesitancy in Africa: a call to action
Authors: Polydor Ngoy Mutombo, Mosoka P Fallah, Davison Munodawafa, Ahmed Kabel, David Houeto, Tinashe Goronga, Oliver Mweemba, Gladys Balance, Hans Onya, Roger S Kamba, Miriam Chipimo, Jean-Marie Ntumba Kayembe, Bartholomew Akanmori
Journal: The Lancet Global Health (2021)

In addition to low COVID-19 vaccine coverage in Africa due to vaccine nationalism and vaccine diplomacy, the gradual effort to distribute COVID-19 vaccines to low-income and middle-income countries (LMICs) is threatened by vaccine hesitancy. In Africa in particular, the low vaccine coverage1Makoni M COVID-19 vaccine trials in Africa.Lancet Respir Med. 2020; 8: e79-e80Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar and the ubiquitous vaccine hesitancy in a concerning proportion of the population undermine efforts to fight the COVID-19 pandemic. We advocate for humane, culturally relevant, and rapid public health action to address these issues. Vaccine hesitancy in LMICs is due to a dearth of knowledge about the fact that vaccines are the most effective public health interventions, and have reduced significantly the burden, morbidity, and mortality of communicable diseases. There are also historical, structural, and other systemic dynamics that underpin vaccine hesitancy among people who recognise the public health importance of immunisation.2Callaghan T Moghtaderi A Lueck JA et al.Correlates and disparities of intention to vaccinate against COVID-19.Soc Sci Med. 2021; 272113638Crossref PubMed Scopus (142) Google Scholar A history of colonial medical and vaccine research abuse in Africa diminishes trust in current vaccines. Additionally, an absence of nuanced and culturally informed understandings of vaccine hesitancy and misinformation are major contributing factors. Vaccine hesitancy in Africa is also linked to the duplicity of the global community. Although the global community recognises the need for global vaccine coverage to end the COVID-19 pandemic, it exhibits no firm commitment to expedite vaccine deployment to the African continent, which further reinforces and perpetuates vaccine hesitancy.3Sallam M COVID-19 vaccine hesitancy worldwide: a concise systematic review of vaccine acceptance rates.Vaccines (Basel). 2021; 9: 160Crossref PubMed Scopus (587) Google Scholar, 4Karafillakis E Larson HJ The benefit of the doubt or doubts over benefits? A systematic literature review of perceived risks of vaccines in European populations.Vaccine. 2017; 35: 4840-4850Crossref PubMed Scopus (141) Google Scholar This duplicity is compounded by vaccine diplomacy and donor dependency leading to multiple vaccines, without regulatory approval, making their way into many African countries. The unintended consequences of approaches that bypass continental collective efforts through Africa Centres for Disease Control and Prevention (CDC) include allegations that Africa is a testing ground for vaccines, which further reinforces vaccine hesitancy. Some of these concerns have been exacerbated by sentiments expressed by some people in high-income countries—eg, by two French doctors in early April, 2020—with regard to conducting COVID-19 vaccine trials in Africa.5Karakaya F COVID-19: French doctors recommend trials in Africa to test vaccines.https://www.aa.com.tr/fr/afrique/covid-19-des-m%C3%A9decins-francais-pr%C3%A9conisent-des-essais-en-afrique-pour-tester-des-vaccins/1789838Date accessed: December 9, 2021Google Scholar Bilateral arrangements that bypass continental collective efforts through Africa CDC consolidate the geopolitical influence and economic interests of vaccine providers. The result is that vaccine geopolitics and economics compromise vaccine acceptance, widely amplifying misinformation from social media, religious groups, and other outlets, and filtering confusing messages into communities. Positioning vaccines in a way that demonstrates equitable access and benefits to the population is a powerful tool to address resistance. Evidence from the roll-out of the Ebola vaccines in west Africa suggests that the physical presence of the vaccine drives the involvement of national leadership, which trickles down to local communities. The field deployment of the experimental Ebola vaccines combined with an innovative social mobilisation and community engagement strategy overcame vaccine hesitancy in this instance. A just vaccine landscape will accelerate the promotion of vaccines through a bottom-up health approach. When vaccines are made available, community engagement will become the single most powerful mechanism to successfully combat any vaccine hesitancy and resistance. A commitment to innovative health promotion that is anchored in locally responsive and culturally relevant knowledge, transparency, equity, and access to COVID-19 vaccines will be a strong antidote to vaccine hesitancy in the continent.6Jaklevic MC Researchers strive to recruit hard-hit minorities into COVID-19 vaccine trials.JAMA. 2020; 324: 826-828Crossref PubMed Scopus (23) Google Scholar We issue a call to action in support of global vaccine access and acceptance, and have four recommendations to curtail vaccine hesitancy in Africa: (1) Africa CDC and the WHO Regional Office for Africa should effectively coordinate the continental advocacy drive for COVID-19 vaccines and to minimise vaccine hesitancy through effective community engagement, and contribute to a robust COVID-19 vaccine roll-out strategy; (2) WHO should share experiences and lessons learnt from social mobilisation and communication campaigns for the clinical trials of the Ebola vaccines to effectively overcome hesitancy towards the COVID-19 vaccines; (3) an observatory should be established, under the umbrella of WHO and Africa CDC, in each African country to monitor and combat fake news, rumour mongering, and misinformation about COVID-19; (4) dedicated resources should be mobilised from national and international funders to support the logistics and human resources needed to implement robust health promotion for COVID-19 vaccination that would complement the vigorous advocacy for vaccine procurement and manufacturing on the continent to increase access and equity. Only by owning the response through committed leadership will it be possible to take these actions forward and to achieve the universal immunisation that we need to protect the people of Africa and that of our world, ensuring that no-one is left behind. We declare no competing interests. We received no grants or other financial support. Misunderstanding poor adherence to COVID-19 vaccination in AfricaAlthough I can only applaud the call to action in favour of COVID-19 vaccination in Africa by Polydor Ngoy Mutombo and colleagues (March, 2022),1 their analysis of so-called COVID-19 vaccine hesitancy is questionable. Full-Text PDF Open AccessMisunderstanding poor adherence to COVID-19 vaccination in Africa – Authors' replyWe welcome Bernard Seytre's engagement with our Comment.1 However, his response leaves us more perplexed than enlightened. It is not clear whether Seytre is questioning the sources or disputing the facts. In any event, a careful reader of the US study we cited,2 for example, will find therein explicit treatment of racism, medical abuse, and public trust (page 2 of the study). This finding has direct bearing on vaccine hesitancy and the history of colonial medicine and medical abuse in Africa, as shown by several studies (see Lowes and colleagues for a sample). Full-Text PDF Open Access