Vaccination in Africa must overcome skepticism

JOHANNESBURG – Detection of the omicron variant In Africa, it marked the beginning of the next stage in the battle against COVID-19: getting many more people inoculated in the poorest nations, where vaccines have been rarest, to prevent new mutations from developing.

However, while world leaders sometimes speak of this as if it were just shipping doses overseas, South Africa’s experience at least hints at a much more complex set of challenges.

Like many poor countries, South Africa was forced to wait months for vaccines as the richer countries monopolized them. Many countries still do not have nearly enough doses to inoculate their populations.

The problems have not ended despite the fact that vaccines began to arrive in greater numbers.

A neglected and underfunded public health infrastructure has slowed its delivery, especially in rural areas, where storage and staffing problems are common.

Now, there are growing signs that in some parts of Africa, as well as South Asia, skepticism or outright hostility towards COVID-19 vaccines may run deeper than expected, even as it is spreading. the new and perhaps more dangerous omicron variant. In Africa, at least three countries have already reported cases of infections with the omicron variant: South Africa, Botswana and, on Wednesday, Nigeria.

Deep mistrust of governments and medical authorities, especially among rural and marginalized communities, could be delaying vaccination campaigns. The legacy of Western exploitation and medical abuse during and after colonialism also weighs heavily.

Disinformation circulating on social media often fills the void, partly from the United States and Europe, where vaccine rejection has also been a problem.

“There is no doubt that uncertainties about vaccines are a factor in their deployment,” said Matshidiso Moeti, director of the World Health Organization (WHO) in Africa. News or rumors about possible side effects, he said, “are picked up and talked about, and some people freak out.”

A few days before the omicron variant was first detected, South African health authorities they refused shipments of doses from Pfizer-BioNTech and Johnson & Johnson, concerned that their stocks of 16 million vaccines could be spoiled by insufficient demand.

Although only 36 percent of South African adults have the full vaccination schedule, daily vaccinations have already decreased, according to government statistics.

And that doesn’t just happen in South Africa.

Namibia, Zimbabwe, Mozambique and Malawi have also asked vaccine manufacturers and donors to delay shipping more vaccines because they cannot use the supplies they have, according to several health officials involved in the vaccine distribution effort for women. developing nations.

Research has consistently revealed that factors such as population mistrust and uneven distribution of vaccines can increase doubts about these drugs in any country, but during the pandemic these problems have occurred frequently in the poorest countries. , and have had a more profound effect, he commented Saad Omer, a public health researcher at Yale University.

Public information campaigns and carefully planned vaccine deliveries can counter mistrust, but they are rare.

“Essentially, there has been no investment in vaccine education or promotion in low-income countries,” Omer noted. “Why do we think that all you have to do is leave the vaccines at an airport, take the photo and people will come running to collect the vaccine?”

Only one in four health workers in Africa is vaccinated, according to officials of the WHO. In several countries, less than half say they intend to get vaccinated.

It is not a problem unique to Africa.

In India, health workers have found a sometimes violent resistance in rural communities. Indices of indecision when getting vaccinated are approaching 50 percent among people who have not finished high school. In some parts of the country, more than a third of doses are spoiled due to low demand.

However, many are eager to get vaccinated. Earlier this year, when doses were first available in South Africa, a third of adults in the country were immediately vaccinated – a pattern that is repeating elsewhere.

Experts insist that even partial acceptance will slow the spread of new or existing variants, but that may not be enough to achieve the high vaccination rates necessary for the world to overcome the pandemic.

In South Africa, distrust of government and medical authorities predates COVID-19, but a series of setbacks with the deployment of the vaccine, as well as widespread allegations of corruption amid the shutdown of activities last year, have increased. the discomfort of the population.

“There is a lot of mistrust in the capabilities of the public health system to deliver vaccines,” said Chris Vick, founder of Covid Comms, a South African nonprofit group.

The group has held information sessions on vaccines, but overcoming skepticism is not easy. After a session in Atteridgeville Township in Pretoria, a 20-year-old who attended said she had not been convinced.

“I think COVID-19 is not real,” said the young woman, Tidibatso Rakabe. “They are playing with us, with politicians and with everyone.”

Many say they fear side effects.

Earlier this year, reports of extremely rare blood clots led the United States to suspend for a short period Johnson & Johnson’s supply of the vaccine, prompting South Africa to delay its distribution to healthcare workers. Both countries decided to resume the injections after concluding that they were safe.

The South African government held regular briefings, but these were conducted on television and in English, when radio is still the most powerful medium and the mother tongue of most South Africans is not English.

Online registration systems also excluded millions of people who do not have regular access to the internet.

Actions to mitigate the effects of the lockdown were clouded by corruption scandals, in which the president’s spokeswoman was forced to resign. Later, the Health Minister also resigned after it was discovered that his office fraudulently awarded a $ 9 million communication contract.

The racial divide is another important factor.

White South Africans are significantly more likely to express skepticism about vaccines, revealed a recent study. In part, this is due to mistrust in the black-led government, but also because the message of the American conspirators has had a huge impact among white South Africans on social media, according to Vick of Covid Comms.

Although black South Africans express greater openness to inoculation, they are vaccinated at lower rates, often citing difficulties in reaching vaccination sites. Some also express doubts about receiving a second injection.

Vaccine concerns have long hampered vaccination campaigns globally, which health experts say indicates that some of the elements that make immunization difficult predate the pandemic.

In poor rural areas, health resources are often scarce. Doctors from the capital or abroad often supervise vaccinations. But stories of neglect and exploitation make communities wary of outsiders who arrive with mystery drugs.

The first modern global campaign, launched in 1959 against smallpox, generated deep skepticism in various regions of Africa and Asia, where it was seen as a continuation of colonial-era medical abuses. Some WHO officials they used physical force to vaccinate people, which deepened mistrust. The campaign lasted 28 years.

The effort to eradicate polio, which finally escalated in poor countries during the 1980s and is continuing, has met similar resistance. A study in the scientific journal Nature found that the decision to avoid vaccination it was higher among poor or marginalized groups, who believed that health authorities, and especially Western governments, would never voluntarily help them.

In Nigeria in the early 2000s, amid rising religious tensions, unfounded rumors circulated that foreign health workers were using polio vaccines as a cover to sterilize the country’s Muslim population. Boycotts and local bans sparked a resurgence of polio, and the cases spread to 15 other countries, as far as Southeast Asia.

Similar rumors emerged among the Muslim minority in India, and polio cases increased six-fold in one year.

Health authorities may be paying the price for the long years of exploitation, before and after colonialism, which instilled deep mistrust in Western medical authorities. A poll of 15 countries conducted by the African Center for Disease Control revealed that 43 percent of respondents believe that Africans are used as guinea pigs in vaccine trials, a acting legacy of Western pharmaceutical companies in the 1990s.

Even within their own borders, Western governments struggle to overcome vaccine resistance. Therefore, it is hard to imagine that they do better in distant societies where local populations do not understand the importance of immunization.

Any strategy by officials of Western powers that go so far as to administer unwanted vaccines in African or Asian communities runs the risk of aggravating mistrust.

“If the goal is to keep the United States, and the rest of the world, safe, it should be obvious that the success of the national program depends on what happens internationally,” said Omer.

Declan Walsh contributed to this report from Nairobi, Kenya.

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