Defeating COVID locally means addressing vaccine hesitancy globally

The global health community is investing billions of dollars in making sure COVID-19 vaccines are delivered to inoculate people even in the most resource constrained countries, and rightly so. Equal access to the vaccine is an issue of fairness and justice.

Yet an issue that is just as pressing as putting pallets on airplanes and lining up solar-powered freezers is overcoming vaccine hesitancy. It will be an effort to win the hearts and minds of those whom the world has often overlooked, from the slums of Nairobi to the favelas of Rio and every field and farm in between. 

The issue of vaccine hesitancy is getting a lot of attention in the U.S. A Kaiser Family Foundation analysis warned recently that the number of willing COVID vaccine recipients is rapidly diminishing and supply will exceed demand in the coming weeks. But vaccine hesitancy is a critical international issue as well. If we don’t instill confidence in the vaccines and generate demand, we will not be successful in containing the pandemic.  

Even before the outbreak of COVID-19, the World Health Organization singled out vaccine hesitancy as one of the top 10 global health threats. There are troubling signs that this skepticism could be a hindrance in getting the COVID-19 vaccine into arms around the world. A recent study of African attitudes toward the COVID-19 vaccine in The Lancet revealed cause for both optimism and concern. It found that four out of five respondents would take the vaccine — if they were convinced it was safe and effective. The positive response ranged from a high of 94 percent in Ethiopia to a troubling 59 percent in the Democratic Republic of Congo. Another recent survey found a COVID-19 vaccine acceptance rate of just 28 percent among health care workers in the DRC. Until he died of the virus in March, Tanzanian President John Magufuli refused use of the vaccine outright, a stance his successor, President Samia Suluhu Hassan, appears to be reconsidering. Madagascar had the same stance until it recently reconsidered and joined the WHO-led COVAX initiative, which will administer the AstraZeneca vaccine.

Reluctance to receive one of the COVID-19 vaccines is a growing problem in Latin America as well, according to a recent Florida International University study. “The anti-vaccine movement from Europe and the United States is gaining traction in Latin America,” FIU professor Maria Elena Villar told the Miami Herald.

Some of the reluctance in Africa is being fueled by the negative press in Europe about isolated cases of blood clots related to the AstraZeneca vaccine. Most African countries received AstraZeneca as part of their first COVAX shipments and are struggling with how to instill confidence in the vaccine.  

The Lancet found substantial skepticism about vaccine safety, cited by a quarter of those refusing the jab. Such hostility is rooted in misinformation, a history of medical manipulation on the continent and a lack of trust in science and government. 

“Misinformation circulating in the media was responsible for a lot of mistrust and suspicion around COVID-19 vaccines on the continent” a researcher from Africa CDC told the Lancet. The African CDC survey of residents in 15 countries on the continent “found that many respondents believed that COVID-19 was a planned event by foreign actors, that people in Africa were being used as guinea pigs in vaccine trials and that the spread of COVID-19 was linked to 5G technology.”  

Any herd immunity we can expect from a global vaccine effort would be offset by potentially millions of unvaccinated people who would remain vulnerable to COVID infection and spreading the disease to others. The burden on already fragile health systems will grow even worse, giving the coronavirus a veritable petri dish in which new strains can mutate. These virus mutations could eventually outsmart the vaccines we’ve worked so hard to develop and distribute.   

Our work responding with other public health organizations on multiple outbreaks of the Ebola virus has taught us that our efforts to reach deep into communities, tapping into grassroots, faith and other networks can wage significant influence on public health. Working to address outbreaks in the Democratic Republic of Congo was especially challenging, given widespread community distrust of health workers, misinformation about Ebola itself, and ongoing fighting by militias that resulted in deadly attacks on clinics and health care workers. 

Therefore, our approach emphasized community engagement, building bridges and building trust. We worked closely with local communities, often with the assistance of religious leaders, to help people understand the nature of the disease, what we were doing to ensure their safety and to heal those who were affected. 

Overcoming COVID-19 vaccine hesitancy will require a similar, sustained process of community engagement and education. Given the complexity of barriers to vaccine acceptance and the urgent need for a high level of vaccination globally to contain coronavirus, the humanitarian community, multilateral institutions and governments must unite in supporting campaigns that will help reveal the nature of people’s hesitancy and inform the development of messaging to promote vaccine acceptance.  

It is when communities around the world understand their wellbeing is wrapped up in vaccinating themselves and their neighbors that minds will begin to change and we will finally view COVID-19 in a rearview mirror.  

Audrey Sullivan leads the coronavirus response for Corus International, parent of faith-based international NGOs Lutheran World Relief and IMA World Health.