Coronavirus (1424) Lancet Global Health: COVID-19 vaccine hesitancy in Africa

31 December, 2021

Below is the text of a Comment in the Lancet Global Health, and a comment from me.

CITATION: COVID-19 vaccine hesitancy in Africa: a call to action

Polydor Ngoy Mutombo et al.

Published:December 20, 2021


In addition to low COVID-19 vaccine coverage in Africa due to vaccine nationalism and vaccine diplomacy, the gradual effort to distribute COVID-19 vaccines to low-income and middle-income countries (LMICs) is threatened by vaccine hesitancy. In Africa in particular, the low vaccine coverage and the ubiquitous vaccine hesitancy in a concerning proportion of the population undermine efforts to fight the COVID-19 pandemic. We advocate for humane, culturally relevant, and rapid public health action to address these issues.

Vaccine hesitancy in LMICs is due to a dearth of knowledge about the fact that vaccines are the most effective public health interventions, and have reduced significantly the burden, morbidity, and mortality of communicable diseases. There are also historical, structural, and other systemic dynamics that underpin vaccine hesitancy among people who recognise the public health importance of immunisation. A history of colonial medical and vaccine research abuse in Africa diminishes trust in current vaccines. Additionally, an absence of nuanced and culturally informed understandings of vaccine hesitancy and misinformation are major contributing factors. Vaccine hesitancy in Africa is also linked to the duplicity of the global community. Although the global community recognises the need for global vaccine coverage to end the COVID-19 pandemic, it exhibits no firm commitment to expedite vaccine deployment to the African continent, which further reinforces and perpetuates vaccine hesitancy...

A just vaccine landscape will accelerate the promotion of vaccines through a bottom-up health approach. When vaccines are made available, community engagement will become the single most powerful mechanism to successfully combat any vaccine hesitancy and resistance. A commitment to innovative health promotion that is anchored in locally responsive and culturally relevant knowledge, transparency, equity, and access to COVID-19 vaccines will be a strong antidote to vaccine hesitancy in the continent...

We issue a call to action in support of global vaccine access and acceptance, and have four recommendations to curtail vaccine hesitancy in Africa: (1) Africa CDC and the WHO Regional Office for Africa should effectively coordinate the continental advocacy drive for COVID-19 vaccines and to minimise vaccine hesitancy through effective community engagement, and contribute to a robust COVID-19 vaccine roll-out strategy; (2) WHO should share experiences and lessons learnt from social mobilisation and communication campaigns for the clinical trials of the Ebola vaccines to effectively overcome hesitancy towards the COVID-19 vaccines; (3) an observatory should be established, under the umbrella of WHO and Africa CDC, in each African country to monitor and combat fake news, rumour mongering, and misinformation about COVID-19; (4) dedicated resources should be mobilised from national and international funders to support the logistics and human resources needed to implement robust health promotion for COVID-19 vaccination that would complement the vigorous advocacy for vaccine procurement and manufacturing on the continent to increase access and equity.

Only by owning the response through committed leadership will it be possible to take these actions forward and to achieve the universal immunisation that we need to protect the people of Africa and that of our world, ensuring that no-one is left behind.

COMMENT (NPW): The authors make important points about drivers of vaccine hesitancy in Africa. However, there is much also to learn from vaccine hesitancy in other parts of the world, where hesitancy is a major issue despite the vaccine being available to all in many countries.

Best wishes, Neil

Neil Pakenham-Walsh, HIFA Coordinator,