Behind vaccine doubts in Africa, a deeper legacy of distrust

Ahmad Mansur has made up his mind. Vaccines have not yet arrived in Nigeria, but Mr. Mansur has decided he won’t be getting one, nor will his three young children. 

Word goes around in the northern Kano State that vaccines bring problems, and Mr. Mansur believes those rumors. “Instead of one to be cured of a disease, one will end up getting something else,” says the pedicab driver.      

Nearly 4,000 miles south, pediatric nurse Rich Sicina is treating COVID-19 patients in a hospital near Johannesburg. He grew up in the shadow of one pandemic – HIV/AIDS – and is now fighting on the frontlines of another. But he, too, is suspicious. How can a vaccine developed in such a short time be safe or effective, he wonders – and how can South Africans be sure that Western pharmaceutical companies have their best interests at heart?

For months, many African governments have struggled to secure vaccines in a system where wealthy countries take the lion’s share, shining a spotlight on global inequalities. For most of the region, that challenge continues. But as campaigns finally begin to roll out across the continent, a lingering issue of distrust is coming into sharp focus.

The reasons vary. In South Africa, distrust of the creaking, overburdened public health system and the government that manages it runs deep. So does skepticism that people’s lives here really matter to the foreign companies and countries behind most COVID-19 research – concerns rooted in a long history of inequality. And the continent’s lower number of deaths, compared with many other regions, has given many Africans a false sense of immunity, doctors say.

As recently as December, around a quarter of Africans surveyed felt vaccines will not be safe, according to the Africa Centers for Disease Control and Prevention. A recent Ipsos survey found that only 61% of South Africans would get a vaccine, lower than any of the other 14 countries surveyed, except for France and Russia.

Hesitancy could mean a longer road to herd immunity and slower economic recovery amid a second wave. But community health leaders say there is a window to help address concerns, offer information, and heal distrust. In particular, they argue, strong buy-in from local leaders is crucial to promoting acceptance.

Rumor has it

Across Africa, conspiracy theories about vaccines were popular even before COVID-19. Long-circulating gossip in parts of Nigeria, for example, claims that shots make people infertile, or that they contain surveillance chips. In Ghana, Ebola vaccine trials were halted in 2015 because of rumors that scientists planned to infect people with the disease.

With COVID-19, new conspiracy theories have reared their heads. At the beginning of the outbreak, many WhatsApp users forwarded with dizzying speed allegations that COVID-19 was manufactured in a Chinese lab, or that radiation from 5G internet towers caused the disease.

Some fears “have roots in colonialism, oppression, and exploitation that can easily be stirred up in situations like this, especially when you see the world’s vaccine inequity – where some countries have been able to buy up a disproportionate number of vaccines,” and others are left without, says Indira Govender, a doctor and health activist in South Africa. “That plays on people’s fears of Western colonialism and Western medicine.”

But rumors also have roots in recent trials that, on occasion, have seen African countries on the receiving end of unethical medical practices. In 2009, Pfizer reached an out-of-court settlement over a controversial meningitis drug trial in Kano State in the 1990s. Eleven children died, and others were paralyzed. The company argued the deaths were due to meningitis, not the drug, but parents alleged they had not given informed consent. In South Africa, many recall HIV vaccine trials in the mid-2000s that wrapped up hastily after authorities discovered that not only was the drug powerless against infection, it potentially made those who took it vulnerable.

On the back of the Pfizer episode, rumors prompted a politician-backed polio vaccine boycott in 2003 in parts of northern Nigeria, where low literacy levels and conservative Islamic principles often foster a doubtful eye toward Western interventions. The boycott was lifted more than a year later, but cases shot up, and the virus spread as far as Yemen.

Now with COVID-19, connectivity makes sharing misinformation happen much faster. Top politicians, including a sitting Nigerian governor and a top South African judge, have spread conspiracies, too. In east Africa, Tanzania’s president once declared COVID-19 a scam, and his government has refused vaccines.

Countering fear

Some concerns about vaccine safety stem from its quick development, spooked further by unverified claims of deaths following immunization in Europe.

But those worries can be countered with accurate, targeted information, experts say. For decades, groups like Rotary International worked to overcome polio vaccine rejection in Nigeria by working with local health workers and volunteers, known and trusted by their communities, who helped carry out the door-to-door immunization push across the country. The country was declared polio-free last year. 

“We have the tools. We just need to activate them,” says Tunji Funsho, Rotary International’s polio program lead in Nigeria. “We need to learn to communicate with people in languages they understand,” and figure out where the communications gap is.

It’s the superstitions, long-believed, that could prove harder to fight.

In South Africa, “people are afraid because they need more information. They need help to understand the science – how vaccines work, how they’re tested,” says Narnia Bohler-Muller of South Africa’s Human Sciences Research Council. Professor Bohler-Muller co-wrote an earlier study on South Africans’ vaccine confidence, which found that the most common reasons for doubts were fear of side effects and concerns about effectiveness. “The good news is, that’s a fixable problem. If people have superstitions about a vaccine, it’s hard to counter. If they just need more information, that can be given.”

Targeting people with accurate information is especially important now, she says, after the South African government halted rollout of the AstraZeneca vaccine, following findings that it offered low efficacy against mild and moderate cases caused by a new variant identified in the country. 

“We find that information needs to come from trusted and local sources, like community leaders,” says Tian Johnson, who leads the African Alliance, a group that has done pro-vaccine advocacy in South Africa since the early 2000s. The organization has found that “scientists and researchers shouldn’t be responding to false claims, because for many people they’re seen as the problem,” says Mx. Johnson, who uses gender-neutral titles. Instead, people need to hear from leaders they respect.

Continent-wide, meanwhile, experts warn that information efforts have not been as robust as they need to be. Nigeria’s primary health care agency has launched social media campaigns, but public announcements aren’t yet flooding public radio and TV. In Ghana, where mass vaccinations launched this week, President Nana Akufo-Addo got the first shot to convince skeptics.

Activists argue that vaccine skepticism will decline as more Africans are vaccinated – seeing for themselves a safe and effective procedure that, when more broadly offered, could ease restrictions on movement and help reopen economies.

But many countries face uncertainty about when, and whether, they’ll receive a significant number of doses. Most of the region is depending partially on the World Health Organization-led COVAX program, which promises fair distribution for vulnerable countries. As wealthier countries buy up supplies, that arrangement is leaving others waiting for crumbs. Nigeria, with 200 million people, has had its deliveries shifted back several times and only received its first 3.94 million doses this week. Only a dozen African countries have launched vaccinations, with about 4.5 million doses dispersed. In contrast, more than 150 million vaccines have been administered in the United States, China, and the United Kingdom alone, with millions more doses secured.

“Our challenge right now is [knowing] if the vaccines are coming at a particular time, so we don’t go advocating and the vaccines don’t come,” says Dr. Funsho.