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Africa Is Waging a War on COVID Anti-Vaxxers

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Africa Is Waging a War on COVID Anti-Vaxxers news feature Prospective recipients of a vaccine against COVID-19 waited to be called from under a shed at a public vaccination site in Nigeria’s southwest city of Ibadan. Credit: Paul Adepoju / Nature Medicine Africa is waging a war on COVID anti-vaxxers Misinformation about COVID-19 vaccines often starts life in Europe or the United States but has found fertile ground in Africa, which poses a challenge for local health leaders. Paul Adepoju hade is a 58-year-old Nigerian So many uncertainties made me doubt expressed doubt about the vaccination,” frontline health worker living with whether I really need the vaccine,” she tells says Roger Tatoud, deputy director for Sosteoarthritis. She is also overweight, Nature Medicine. HIV Programmes at the International diabetic and hypertensive, all of which Shade is not the only frontline health AIDS Society. made her first in line for a vaccine against worker to refuse a vaccine against Whether or not to receive a vaccine is COVID-19 when it finally became available COVID-19, despite its availability. a person’s individual decision, but vaccine in Nigeria. Her eldest daughter booked an hesitancy may prevent herd immunity from appointment for her at their local primary Africa’s anti-vaxxers being reached, especially in sub-Saharan healthcare center, but when the day came to Vaccine hesitancy is a phenomenon that Africa, where vaccine doses are sparingly receive her first dose of the vaccine against predates COVID-19. A 2015 report by the available and the anti-vaccine campaign has COVID-19, she changed her mind. Shade European Centre for Disease Prevention influential mouthpieces. instead chose to take her chance with the and Control noted that vaccine-hesitant In January 2021, former Tanzanian virus instead of getting vaccinated. healthcare workers might spread unfounded President John Magufuli cast doubt on the “It isn’t about my trypanophobia [fear of concerns about vaccines to the general effectiveness of vaccines against COVID-19, needles], it’s the aftermath of a constellation population, recommend vaccines less and even denied the existence of of conflicting, confusing and scary frequently to their patients, and reduce SARS-CoV-2 in his country. After his death, messaging and reports on the safety and vaccine confidence and uptake. Vaccine his successor, Samia Suluhu Hassan, decided politics of the vaccine. I saw videos of people hesitancy is therefore a major concern in the to take a different approach when she getting dizzy and fainting after receiving global fight against the COVID-19 pandemic. said the country “cannot isolate ourselves the vaccine. We also heard of people that “We should be worried that up to 40% of as an island while the world is moving developed blood clots and died afterwards. medical staff in a number of countries have in a different direction.” Even though a 1122 NATURE MEDICINE | VOL 27 | JULY 2021 | 1122–1125 | www.nature.com/naturemedicine news feature of social media. We’re working on aggressively supporting countries on how to provide the right information to educate the people,” Mihigo adds. Nothing like Ebola Africa has vast experience with vaccinations, so much so that countries like Ethiopia have been able to continue routine immunization exercises for measles, reaching millions of children in the middle of the pandemic. The WHO and the Africa Centres for Disease Control and Prevention were keen to report that several African countries, including Rwanda and Ghana, quickly rolled out doses of vaccines against COVID-19 from COVAX and other donors. But not all African countries have performed as well. Formerly known as Zaire, the Democratic Republic of Congo (DRC) A primary healthcare officer fills out a COVID-19 vaccine card for a frontline health worker after is located in Central Africa, and by area, it registration online as required by the health authorities. Credit: Paul Adepoju / Nature Medicine is the largest country in sub-Saharan Africa, the second largest in all of Africa and the eleventh largest in the world. The DRC has committee to advise the government on in Western countries, especially the United a battered health system that leaves children COVID-19 has been set up and its members States and Europe, and these were fueling at the mercy of killer diseases, including are public-health and medical experts, and vaccine hesitancy in Africa. malaria, cholera and measles. The DRC has strict COVID-19-prevention measures “Building vaccine confidence is an reported more Ebola outbreaks than any have been reintroduced, Tanzania is yet issue across the globe. What we’re really other country in the world and continues to to announce any vaccination plans. There concerned about is that these pieces of face a complex humanitarian crisis. remains formidable opposition to vaccines misinformation that are created in the USA Since the COVID-19 pandemic began against COVID-19 in Tanzania, even by or in the UK, they’re traveling and finding in the DRC in 2020, misinformation has some key players in the country’s science some fertile ground in Africa as well,” been a major force slowing down progress, ecosystem. Fleming says. according to warnings from Doctors In early April 2021, Wilcox Richard Mihigo, coordinator of the Without Borders. Misinformation is further Onyemekeihia, Secretary of Programmes to Immunization and Vaccine Development complicated by skepticism about the the Senior Special Adviser on Youth Affairs Programme of the World Health seriousness of COVID-19 relative to that of in Nigeria’s Cross River state, was on a Organization (WHO) Regional Office for Ebola and other leading causes of death in panel that discussed the myths and realities Africa, says vaccine hesitancy in Africa is the DRC. The vaccine rollout in DRC was of vaccine hesitancy for COVID-19 and not being driven by people’s fears alone. paused following news of vaccine-linked other vaccine-preventable diseases. To the According to Mihigo, international groups complications in Europe. This suspension alarm of some on the panel, Onyemekeihia are fueling anti-vaccine tendencies that had was subsequently lifted but may have queried the vaccine’s quick development not been seen in Africa before COVID-19. further damaged vaccine acceptance, as seen process, overhyped the side effects of the “Anti-vaxxers in some Western countries when the DRC returned 1.3 million doses vaccines and questioned the true status of are taking advantage of all the concerns of vaccines against COVID-19, supplied the pandemic in Africa—implying vaccines about the adverse effects of vaccines. We by COVAX, for redistribution to other were unnecessary, given the associated risks. need to address the spread of vaccine countries. All of these talking points were straight from misinformation in Africa,” says Mihigo. the anti-vaccine playbook. When the first case of COVID-19 Do as I do Onyemekeihia continues to share was confirmed in Nigeria, officials at the Some of the health infrastructure used to vaccine-hesitancy sentiments on social Nigeria Centre for Disease Control, led by combat COVID-19 was acquired in the media, views that may be influenced by one the director general, Chikwe Ihekweazu, fight against human immunodeficiency of Nigeria’s top pastors, who connected 5G described a miscommunication menace, virus (HIV) and AIDS. At the first to COVID-19 and spread other enabled by social media, as a major threat to virtual HIVR4P conference in January vaccine myths. the country. COVID-19 is the first pandemic 2021, Anthony Fauci, director of the US since mobile, internet and broadband National Institute of Allergy and Infectious Spread from the West use expanded in Africa. The number of Diseases, described how decades of HIV In early December 2020, before doses people in sub-Saharan Africa with access research influenced the development of of vaccines against COVID-19 became to a mobile broadband network more than vaccines against COVID-19 and attributed available in Africa, vaccine hesitancy was doubled from 120 million people (13%) in reluctance and vaccine hesitancy among already gaining momentum globally. Melissa 2014 to 270 million (26%) in 2019. African Americans to the strained Fleming, chief spokesperson for the United “In terms of vaccine hesitancy, we’ve seen history the community has had with High Commissioner for Refugees notes that a surge in misinformation, particularly in government-funded research, including miscommunications probably originated urban areas where there’s high penetration the infamous Tuskegee Study of Untreated NATURE MEDICINE | VOL 27 | JULY 2021 | 1122–1125 | www.nature.com/naturemedicine 1123 news feature poliomyelitis. This was in part because of a Matshidiso Moeti, WHO Regional polio-vaccine boycott that began in August Director for Africa, notes that African 2003 in three Nigerian states where rumors countries now have another chance to get started that the oral polio vaccine was laced their logistics and communication plans in with antifertility drugs in order to sterilize order, due to the delay in the shipment of young Muslim girls. doses of vaccines against COVID-19 from “The vaccine boycott in Nigeria was COVAX. Moeti says that vaccine hesitancy influenced by a complex interplay of in Africa can be preempted, identified and factors—lack of trust in modern medicine, tackled by carrying out simulation exercises, political and religious motives; a long history listing priority groups and communicating of perceived betrayal by the political class, early with communities. the educated elite and big business; and the spread of false information,” Tomori says. Pause and rewind The suspension of vaccination against When countries in Europe decided to pause polio in Nigeria sparked a global polio the rollout of the ChAdOx1 vaccine from outbreak that quickly spread to 20 countries Oxford–AstraZeneca following reports of in Africa, the Middle East and Southeast very rare side effects, John Nkengasong, A Nigerian medical practitioner draws diazepam Asia, causing 80% of the world’s cases of director of the Africa Centres for Disease into a syringe for a patient booked for an paralytic poliomyelitis.
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