The Challenge of Covid-19 Vaccine Hesitancy in Africa


The Challenge of Covid-19 Vaccine Hesitancy in Africa

Posted on: 25th May 2021
OB Sisay
Country Head in The Gambia and Senior Covid-19 Advisor

This week, our attention is on vaccine hesitancy. The recent ban on vaccine exports from the Serum Institute of India has caused significant supply disruptions, especially for many countries in Africa that heavily relied on COVAX for their vaccine supplies. There are concerns vaccination programmes may be halted and policymakers are scrambling to secure supplies from elsewhere – whether through the African Union’s AVATT scheme or via bilateral agreements and donations from elsewhere.

One factor to highlight, however, is that in many African countries, the slow rollout of vaccines (less than 2 per cent of the continent’s population is vaccinated) is not just a result of poor planning logistics and clinical resource challenges. It is also being driven by vaccine scepticism and hesitancy – many people just don’t trust the vaccines.

Many African countries are therefore likely to end up discarding or destroying some of the limited stocks they have as they expire because of low uptake – as seen in Malawi recently, where expired doses were burned in an attempt to boost public confidence in vaccines – even as their leaders rush to find more. In some African countries, at the current rate of vaccination, it could take up to a decade to hit the sorts of numbers needed for herd immunity.

Studies completed last year, before the vaccines were successfully developed, showed that Africans were generally more likely to take vaccines than others, but perceptions on the continent have since hardened. In March 2021, the Africa Centres for Disease Control and Prevention released a study on perceptions and hesitancy in 15 countries. The responses showed a sharp rise in vaccine hesitancy on the continent, driven by conspiracy theories and other factors that have probably taken hold in the face of confusing global regulatory advice on the safety and efficacy of different vaccines. 

The top five reasons given by respondents to the survey for not wanting to take the vaccines were:

  1. Lack of trust
  2. People believing the virus doesn’t exist
  3. Concerns about vaccine safety
  4. Low perceptions of the risk of getting infected
  5. Lack of information to make a decision 

To increase vaccine absorption rates, policymakers need to move quickly to improve perceptions. Otherwise combined with emerging shortages, destroying vaccines due to low take-up is likely to see vaccination rates fall even lower than their current levels on the continent.

In November 2020, before vaccines were developed, the Institute published a paper - A Covid-19 Vaccination Plan for Africa - highlighting some of the challenges policymakers would face when rolling them out on the continent.

In that paper, we offered advice to policymakers on how to get ahead of the problem of hesitancy, including launching comprehensive and effective national awareness campaigns, to prepare and encourage people to be vaccinated. We cited what the United States Centers for Disease Control and Prevention described as Burkina Faso’s “aggressive and successful” meningitis vaccination campaign, which illustrated the value of immunisation. But few have taken the steps we feel were necessary, even before they started their programmes.

Some of the damage may be too late to reverse, but we are working on updated advice to policymakers about how to increase their vaccine absorption rates across the board – including, but not limited to, how to tackle hesitancy.

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