African countries

Reports of vaccine hesitation in African countries contradict reality

MBARARA, UGANDA – When word spreads that Covid-19 vaccines are available locally, crowds rush to the regional referral hospital in Mbarara, western Uganda. Hundreds of people will wait for hours in the sweltering heat outside the hospital’s still full vaccination tent; many are refused when vaccine doses run out.

As public health workers supporting vaccination efforts in Uganda – two of us (AH and SA) on the ground in Uganda – we constantly face the challenges of getting people vaccinated in places like Mbarara. The local vaccination team, responsible for an area of ​​around one million inhabitants, sometimes receives consignments as small as 200 doses due to the fact that Uganda has only enough vaccines for 15% of its total population. People in rural areas often have no transport to get to towns like Mbarara where vaccination sites are clustered. Even those who live within walking distance often cannot afford to stray from work to queue for hours, especially when uncertainty over local sourcing arises.

Our work continually reminds us that local demand for vaccines is high and that access is the biggest barrier to increasing full immunization rates – less than 3% for Uganda and 9% for the continent as a whole. African.


So we have seen with dismay an alternate narrative seep into the mainstream of the American dialogue: that the low vaccination coverage in Africa stems from the fact that people do not want to be vaccinated.

In recent days, The New York Times and other media have painted a different picture than what we are seeing in Mbarara, warning of an increase in “skepticism or outright hostility towards Covid vaccines” in the community. African countries after several countries refused shipments of doses. White House press secretary Jen Psaki cited global “hesitation concerns” during a press briefing hours after President Biden described South Africans’ “reluctance” to do so. vaccinate. Weeks earlier, Pfizer CEO Albert Bourla had said levels of vaccine reluctance in poor countries on the continent were “much, much higher” than in Europe or the United States. United.


None of these claims refer to the high percentages of Africans who report wanting to be vaccinated, which are similar or even higher than the vaccine acceptance rates reported in the United States. This distortion of the global vaccine fairness narrative is detrimental to progress.

Earlier this year, the African Centers for Disease Control and Prevention (Africa CDC) released the results of a large survey carried out in 15 African countries in which 79% of those surveyed said they would be vaccinated against Covid -19, with even higher acceptance rates among the population. living in villages. In August, another study of 12 countries found acceptance rates ranging from 67% to 89% in Burkina Faso, Mozambique, Nigeria, Rwanda, Sierra Leone and Uganda.

For comparison, the same study in 12 countries found that only 65% ​​of Americans planned to be vaccinated, a number consistent with current immunization coverage levels.

Admittedly, these surveys revealed pockets of hesitation with regard to vaccination in all in the countries studied, an unsurprising finding anywhere, especially in communities still affected by colonialism, unethical clinical trials and extractive global health practices. In Mbarara, community members regularly ask questions about vaccine safety and side effects, and people expect us to fully answer these questions before asking for their injection.

Effective immunization campaigns anticipate, plan and respond to people’s concerns, knowing that confidence in vaccines is vibrant and achievable through sustained community engagement. Low- and middle-income countries have consistently shown the rest of the world how to achieve excellence in vaccine delivery, from Nigeria eliminating polio after partnering with religious leaders to promote vaccinations, to Rwanda immunizing 93% of girls against human papillomavirus (HPV) after enlisting local leaders in awareness raising.

Instead of acknowledging this remarkable immunization record, outsiders have taken in reports of declining vaccine shipments to some African countries – likely the result of many factors, including poorly coordinated donations and the difficulty of moving supplies. doses to rural areas – as evidence of widespread distrust across the world. continent, overlooking the heterogeneity of 54 countries, more than a billion people and distinct local health, cultural and political contexts that strongly influence immunization.

Hesitation is a red herring when it comes to vaccination in Africa. Multiple challenges abound in meeting the World Health Organization’s goal of immunizing 70% of the world’s population by mid-2022. In addition to poorly coordinated donations, these include receiving expired doses, receiving a large number of different types of vaccines with unique storage and transport requirements, overly centralized vaccine production, profits during the pandemic, etc.

In Mbarara, we worry about the death of our friends, the suffering of local economies, and the emergence of new variants not because of reluctance to face the Covid-19 vaccine – something local officials of health know how to work – but because, despite outstanding Ugandan responses to contain Covid-19 in 2020 and 2021, vaccines are still barely available.

Instead of exaggerating, distorting and oversimplifying claims of reluctance over the Covid-19 vaccine in African countries, commentators would better respond to the urgent need for global control of Covid- 19 by amplifying the real urgent demands of health experts to the rest of the world: doses, supporting intellectual property exemptions, sharing manufacturing know-how, supporting regional vaccine production and strengthening local health systems .

At best, claims of widespread vaccine reluctance in African countries are uninformed speculation, unsupported by data. At worst, these are deliberate attempts to distract public attention from the injustice of unequal access to life-saving Covid-19 vaccines by blaming Africans. To support immunization efforts in Mbarara and around the world, please help us call on those sharing this story about their bluff.

Azfar Hossain is the coordinator of the Vaccine Advocacy Accelerator – Uganda program and a Harvard medical student, currently based in Mbarara, Uganda. Stephen Asiimwe is an epidemiologist and program director at Massachusetts General Hospital’s Global Health Collaborative at Mbarara University of Science and Technology, as well as a principal investigator at the Kabwohe Clinical Research Center, both in Uganda. Louise Ivers is Acting Chief of Infectious Diseases at Massachusetts General Hospital, president of global health equity at the Center for Global Health at Massachusetts General Hospital and professor of medicine at Harvard Medical School.