Dealing with Vaccine Hesitancy in Africa: The Prospective COVID-19 Vaccine Context

"Myriads of experiences with infectious diseases and the weak health system on the African continent makes VH [vaccine hesitancy] worth investigating, especially in the COVID-19 context."

COVID-19 Vaccines Global Access (COVAX) has the potential to bridge the inequality gap in many African countries by ensuring the COVID-19 vaccine is available to all persons, including the marginalised. In spite of the potential of the vaccine to help control the COVID-19 pandemic through such efforts, anecdotal evidence has reported the reluctance of many Africans to accept the proposed COVID-19 vaccine. Vaccine hesitancy (VH) threatens to hinder the success that could be achieved through the COVID-19 vaccine and the entire COVID-19 outbreak response. In that light, this essay explores reasons behind, and potential strategies for addressing, COVID-19 VH in Africa.

As outlined here, many experiences and rumours have challenged the success and effectiveness of vaccination programmes in Africa. For example, the 2003-2004 polio vaccine boycott, prompted by distrust and fallacies, resulted in a five-fold increase in the polio incidence in Nigeria between 2002 and 2006 and led to polio outbreaks on three non-African continents. Such examples suggest that VH poses a threat to individual, personal, and global health, as it delays the attainment of herd immunity for specific illnesses.

The authors examine possible causes of COVID-19 VH in Africa, including lack of trust in the pharmaceutical industry, the identification of the vaccine as the "mark of the beast" among some religious folk, and the belief the COVID-19 vaccine is political in nature. To look more specifically at factors related to the latter, public distrust in the COVID-19 outbreak response on the African continent has been attributed to delayed response activities by the government of many African countries and public health experts. The authors explain that Africans reportedly did not appreciate the actions of political moguls across Africa who ensured the exit of their relatives from COVID-19 high-risk countries such as China, Germany, and the United States to Africa, because such prejudicial treatment led to the importation of COVID-19 to Africa. In addition, community involvement was lacking while social distancing, hand hygiene, and other COVID-19 control measures were being implemented. Furthermore, little was done by the African government to debunk theories on social and traditional media that the African continent was "immune" to COVID-19 due to the climatic conditions present therein.

Proposed strategies for preventing/addressing COVID-19 VH in Africa include:

• Community participation - Through the involvement of community stakeholders such as traditional heads, chiefs, opinion group leaders, and religious leaders, community members can be mobilised for vaccination. Community mobilisation is designed to discredit false reports on the COVID-19 vaccine and to ensure health education on the benefits of the COVID-19 vaccine. In this regard, community health workers, community pharmacists, patent medicine vendors, and civil-society-based organisations have a role play. Such community participation could enhance planning for the structure and modalities for making vaccines available in each African setting, and enable location of vaccine collection points in community-wide acceptable areas.
• Positive feedback - Celebrating the religious and community leaders who have participated in the success of past immunisation programmes like polio could enhance community participation regarding the COVID-19 vaccine. The authors note that expressing gratitude is not a herculean task that requires long-term planning. Rather: acknowledgement letters that have been duly signed could be forwarded to the community head; appreciation meetings where community members and leaders are present could be held in town halls; or incentives could be provided to community members who participated in a successful health project. When community members become aware of how much value is placed on their participation, commitment is strengthened, and VH could be reduced.
• Multisectoral collaboration - Due to the low-resourced nature of many countries on the African continent, collaboration of the both private and public sectors may help enhance the affordability of the COVID-19 vaccine. Furthermore, all sectors in each country on the African continent should play a role in improving health education on the importance of the COVID-19 vaccine. Community informants could also be employed to notify sectoral representatives in each county or local government area to ensure that false pieces of information regarding the COVID-19 vaccine are addressed immediately. In addition, multi-sectoral collaboration could be optimised to conduct research on COVID-19 VH or COVID-19 vaccine acceptance among social media users. Knowledge gained through such investigations would be helpful in implementing strategies to correct COVID-19 VH.
• Integration of the prospective COVID-19 vaccine into the existing healthcare services - Certain costs are associated with registration at health facilities and could be doubled if the COVID-19 vaccination is implemented vertically; however, integration of the COVID-19 vaccine prevents the placement of a double burden of care for each member of the household, as well as the waiting time for vaccination. Routine immunisation activities in Nigeria, for instance, have been faced with the challenge of VH, secondary to vaccine misconceptions, long distance to travel to clinics, and unavailability of parents. These challenges could be overcome if the COVID-19 vaccine is made readily available and accessible to community members.

The authors conclude by calling for further research on COVID-19 VH on the African continent.