A survey on confidence about being vaccinated against COVID-19 in 15 African countries indicates that work on communication around vaccines is needed. Udani Samarasekera reports.
Africa is gearing up to vaccinate at least two-thirds of its adult population against SARS-CoV-2, the proportion expected to be needed for herd immunity. As of Feb 4, the African Union had secured 1·27 billion doses of COVID-19 vaccines for the continent and five African countries had begun COVID-19 vaccination programmes for frontline health-care workers. Mass vaccinations campaigns could begin in Africa in March. Although concerns over equitable access to the vaccines and country preparedness continue, another key issue for the continent is vaccine confidence.
On Dec 17, the results of a survey by the Africa Centres for Disease Control and Prevention (Africa CDC) and London School of Hygiene & Tropical Medicine (LSHTM) provided some promising news. It showed that four out of five respondents in Africa would take a COVID-19 vaccine if they deemed it to be safe and effective. Done between August and December 2020, the survey involved more than 15 000 adults aged 18 years and older in 15 African countries across the five regions of the continent.
Across the countries, willingness to take COVID-19 vaccines varied from 94% in Ethiopia to 59% in Democratic Republic of the Congo. Overall, vaccine safety was the leading concern; 25% of respondents believed that a COVID-19 vaccine would be unsafe and 18% believed that vaccines generally were not safe. Respondents who were older, those who knew someone who has tested positive for COVID-19, and those living in rural areas were more likely to take a COVID-19 vaccine than younger people, those who have not seen COVID-19 affect anyone, and those living in urban settings. Reasons for vaccine refusal included a belief that COVID-19 does not exist, or its threat is exaggerated. The Africa CDC said that the findings would help guide the organisation, member states, and partners to optimise vaccine uptake on the continent. “The findings go a long way towards the way we frame risk communication around the vaccine and also the way we approach our community in terms of the deployment strategy for COVID vaccines”, the survey's co-principal investigator Raji Tajudeen, head of public health institutes and research at Africa CDC (Addis Ababa, Ethiopia), told The Lancet Infectious Diseases.
Misinformation circulating in the media was responsible for a lot of mistrust and suspicion around COVID-19 vaccines on the continent, says Tajudeen. The survey found that many respondents believed that COVID-19 was a planned event by foreign actors, that people in Africa were being using as guinea pigs in vaccine trials, and that the spread of COVID-19 was linked to 5G technology. “You need to know what information is out there for you to know how best to counter it”, Tajudeen comments. The Africa CDC is producing individual reports for countries involved in the survey to aide their public health messaging, he added.
Susan Goldstein, deputy director of South African Medical Research Council/WITS Centre for Health Economics and Decision Science (Johannesburg, South Africa), thinks the misinformation stems in part from a dearth of positive public communication around vaccines. “I think the misinformation is partly because people really don’t have the correct information to start with. As a human species, we really haven’t celebrated vaccines as one of the greatest prevention tools we have for health”, she explains. The pandemic, however, might provide an opportunity for such promotion. Charles Wiysonge, director of Cochrane South Africa at the South African Medical Research Council (Cape Town, South Africa), sees a chance for public education about vaccines generally and COVID-19 vaccines specifically. “There's never been a time where people are talking so much about vaccination. This is an opportunity to really educate people about vaccines, about what they are, how they work, and how they have been very successful”, he says.
Goldstein thinks African countries need to develop “carefully thought-out” communication strategies to address their citizens’ concerns over COVID-19 vaccines. However, she notes an important role for WHO too. “WHO could guide countries that communication has to be part of their immunisation strategy and it has to be funded”, she comments. Interventions to boost vaccine confidence need to be context-specific and tailored, notes Wiysonge, as vaccine hesitancy can exist in all socioeconomic groups. “It is important that we try to understand what the issues are in every setting; we shouldn’t assume anything. Though we might have [vaccine] education for all, for specific populations, we might need different additional interventions”, he says.
As for the fact that the global north has started immunising large numbers of people against SARS-CoV-2 before the global south, Goldstein sees one positive for vaccine confidence. “In some ways we are lucky, because so many millions of doses have been given in the north already, we are able to see the safety profile and we can see how safe it is”, she says. Africans concerned about COVID-19 vaccine safety might be reassured by this track record too.
© 2021 Flickr - Julia Maudlin