Authors; Joanes Atela, Nora Ndege, Uzma Alam, Samson Kinyanjui, Verrah Otiende

COVID-19 vaccination

The COVID-19 pandemic has had clearly negative impacts on health and socio-economies worldwide. For Africa in particular, there is widespread concern that the pandemic could get far worse owing to the continent’s weak research and information systems as well as unstable socio-economic safety nets.

The number of COVID-19 infections is still increasing on the continent as African countries constantly adjust their response depending on the characteristics of the pandemic in a given community at a given time. The development of safe vaccines is a significant milestone in global efforts to “flatten the curve” of the pandemic, offering the promise of a restoration of socio-economic activity. To-date, multiple COVID-19 vaccines have been developed and approved as safe for administration by the WHO.

Vaccine hesitancy in Africa

As the rollout of COVID-19 vaccines takes shape in Africa, there is serious concern about how little of the population has been vaccinated: less than 1% of Africa’s population has been fully vaccinated. This proportion varies significantly among countries and across different population groups. Multiple factors drive these differences. For example, Sudan received 132,000 doses of the AstraZeneca vaccine in March, with an expiry date of the end of June; South Africa declined to deploy the vaccines it received as a new South African variant of COVID-19 took hold in that country, against which the available vaccine had not been tested. For all African countries, financial and logistical variables are also significant factors.

In addition to the limitations of unavailability of vaccines, there have been indications of vaccine hesitancy: delayed acceptance and/or refusal to receive a vaccine despite availability. This is not new in the history of vaccines, but there has been a major upsurge of it in the case of COVID-19 vaccines. This is attributable to a combination of legitimate concerns – mostly related to the observation that vaccines were developed rapidly, leading some to question their safety notwithstanding assurances from the WHO and other regulatory bodies – and widespread misinformation, which travels rapidly, seamlessly, and freely through a digitally connected world.

The prevalence of misinformation about COVID-19, its treatment and vaccination has been reported by several African sources [i]. It is fed by various perceptions, attitudes and is influenced by the media and other channels. The consequent hesitancy reflects a lack of confidence in vaccines; this in turn has a direct impact on vaccine rollout and administration strategies.

High-level dialogue on vaccine hesitancy

While vaccine hesitancy is widely observed in Africa, there is limited data on its drivers, and in particular the impact of the media and other platforms. This blog explores some of the drivers of hesitancy based on a high-level dialogue among African policy makers, researchers, and other stakeholders as part of a broader project on science policy engagement to support evidence-informed policy responses to COVID-19 in Africa. The initiative is led by Alliance for Accelerating Excellence in Science in Africa (AESA), is funded by the UK Foreign, Commonwealth & Development Office’s East Africa Research and Innovation Hub (UK FCDO’s EARIH) and is supported by the Africa Research and Impact Network and other partners.

The tele-convenings are expected to inform more targeted, relevant and context specific rapid review of existing evidence around the priority areas identified by the African Scientific Prioritization program (ASP) with the aim of setting an evidence platform to inform African Government’s policy responses to COVID-19 in a timely manner.

Summary outcomes

The framework of the consensus-building exercise was “Rethinking, Information, Engagement and Learning (R-I-E-L)” to derive an effective COVID-19 vaccine management strategy.

Reflecting critically on vaccine hesitancy: It was determined that vaccine hesitancy needs to be well understood and articulated, recognizing that it does not mean just a lack of willingness to receive the vaccine, but also encompasses issues of access and costs, as well as factors that impact the management and strategy for vaccine development, testing and administration.

Information: Adequate information and effective messaging about vaccines is critical. For example, vaccines may be presented as a public good, yet can be mandated by COVID-19 emergency committees under government control. The media has a major impact on the degree to which, and ways in which, information is distributed. For instance, the media has served a critical service by providing real-time reports of disease outbreaks in a manner that accounts for public attitudes and behaviours towards public health emergencies [ii]. Conversely, influential media messages can amplify misinformation about vaccines, resulting in a lack of trust.

When there is a lack of adequate public information or a failure of messaging to provide digestible scientific evidence and transparency, doubt and mistrust are likely to result. More clear, accessible, and evidence-based information through locally relevant media channels could help rebuild public confidence in vaccines. These must be targeted by governments to the public for citizens to be able to detect “fake news”, weakening vaccine uncertainty.

Engagement: The public must be engaged and involved in policy development to promote effective evidence-based administration of the COVID-19 vaccine. To date, vaccine policy and administration has remained relatively political and exclusive to some segments of society. Sparse evidence exists on the factors that impact vaccine hesitancy and acceptance due to lack of adequate science policy engagement and funding.

Learning and Exchange: The record of COVID-19 vaccine acceptance, access and administration policy varies from one African country to another, as well as within countries, and is influenced by gender, age, and income status among other variables. Similarly, experience between low-income and high-income countries is also differentiated by socio-economic status and culture. Best practices on vaccine management must be shared among policy makers urgently. Moreover, impediments to sharing vaccines and information across national borders and between social groups has also contributed to perceptions of exclusion and discrimination.

African nations must create and implement a more integrated approach to vaccine management that encompasses inclusion, affordability and effective vaccine development and information management.