Is conflicting information driving COVID-19 vaccine hesitancy in Nairobi?

Zakiya Abbas, a 57-year-old woman sits with a mask on, outside the district commissioner’s office in the informal settlement of Kibera, in Nairobi, waiting for a meeting to discuss scholarships for children in her community. She is treasurer of the local primary and secondary schools.

Her meeting is taking place in the same compound where the government offers COVID-19 vaccines, but she has not received one. People in her community told her not to, saying it’s not safe because she has hypertension.

“I’ve been told that if you take a vaccine, and you have an underlying condition, it will worsen that condition,” she said. “That’s why I have not taken the jab, but I would very much like to be vaccinated.”

Despite what her community has told her, the World Health Organization highly encourages people like Abbas with underlying conditions to be vaccinated, saying the vaccines are safe and highly effective. And it’s a crucial line of protection, as hypertension increases the risk of severe cases of COVID-19.

But this information doesn’t always reach communities, whereas conflicting information does. Rumors discourage many people from getting the jab. An August survey found 36% of Kenyans are unsure about the shot.

This is a global problem and the levels of vaccine hesitancy vary country by country. Studies have found that hesitancy is higher in high-income countries — a survey this summer found 4 out of 5 people in the low- and middle-income countries polled wanted the vaccine, compared with 65% of Americans.

A survey from the Africa Centres for Disease Control and Prevention released in March found that vaccine hesitancy levels varied greatly across the continent. In Ethiopia, 94% of respondents were willing to take a vaccine, whereas only 59% of respondents in the Democratic Republic of Congo were willing to be immunized. And perceptions are constantly shifting.

Only about 5% of Kenya’s population is fully vaccinated. The country has received 7.5 million vaccine doses, and has administered 4.7 million. The vaccines have trickled into the country at a glacial pace — in sporadic and small batches. This unpredictability means health centers don’t always know when they might have supplies of vaccines, meaning people might show up to be vaccinated on a day when there are none.

Collins, a Nairobi-based health worker who wished to go by a false name because he was not authorized to speak, said some of the conspiracy theories include that the vaccines are an effort by global leaders to reduce the population size in African nations — that the vaccine might cause infertility, or that vaccinated people might “drop dead” in a few years. Others are concerned the vaccine is the biblical “mark of the beast,” with those accepting the “mark” as signifying their allegiance to Satan.

Collins said that many go to his facility for the vaccine because their employers require it.

“They’ll come in half-heartedly,” Collins said. “They are hesitant and have questions.”

He admits he was also “very hesitant” about getting the vaccine, saying he was concerned about the speed at which the vaccines were developed. Experts have debunked this concern, saying that no safety steps were skipped in their development.

While there are national efforts to inform citizens about vaccines, Nairobi residents told Devex there is a need for the broader dissemination of information by the government, faith leaders, non-governmental organizations, and the media so people have a better understanding of the benefits of the vaccines and their side effects.

“A lot of people have not been vaccinated because the information is limited. The government should be open and tell us the side effects as well as the benefits,” said Happiness Machogu, a 23-year-old university student. She added there isn’t widespread understanding around how the vaccines may not prevent infection but are very effective at preventing severe disease and death.

“There is a lot of hesitancy among my friends and my family,” Machogu said. “If you have a friend that gets vaccinated, and that friend still contracts the virus, people say: ‘What’s the point of getting the vaccine if you can still get sick?’ People need information.”

There aren’t any vaccines, for any disease, that are 100% effective, so breakthrough infections and diseases are always expected. But the COVID-19 vaccines are still considered very effective.

Nassur Mohamed, a 60-year-old man, is not planning to get vaccinated. He is confused about all the different types of vaccines. He thinks the government should conduct door-to-door education campaigns, like they’ve done for awareness of other vaccines in his community.

“If I had more information, I think I might be convinced. I might go get vaccinated,” he said.

Vaccine hesitancy in the United States also weighs on him. “In a country like America, why are people choosing to not get the vaccine? If some Americans are refusing to get the vaccine — then we are also worried.”

Many people also want clarity on the side effects a person might experience in the days following injection.

Juma Ali, a 34-year-old petroleum salesman, is worried he might become bed-ridden with side effects. He would only receive a vaccine if he were paid so that if that were to happen, he could still support his family.

WHO says the vaccines mostly have mild, short-term side effects, such as a fever or aches. Serious, long-term reactions are “extremely rare,” it says.

Some also said they weren’t aware of the vaccine’s delayed protection, such that it takes time before a person receives the vaccine’s full benefits as the levels of antibodies increase.

There are also a lot of opinions on the type of vaccine distributed. Health workers say they have people coming in asking for specific brand names of vaccines — and leaving if those types are not available.

On a recent Sunday afternoon, a Baptist church in Nairobi hosted a vaccine drive, offering both Moderna and AstraZeneca vaccines. A woman managing the vaccination drive yelled over a megaphone: “Does anyone want AstraZeneca? There is no queue for AstraZeneca.” But nobody came forward. Instead, dozens of people waited in line for more than a half hour to receive a jab of the Moderna vaccine.

News around blood clots linked to the AstraZeneca vaccine have complicated the vaccine’s reputation in the country.

Thirty-six-year-old Hassan Ahmed said his aunt was vaccinated and now has blood clots that have left her unable to move for weeks. He thinks this is linked to the vaccine. These blood clots are considered a “very rare” side effect of the vaccine, whereas people who contract COVID-19 were found in one study to have a much higher risk of experiencing blood clots.

Ahmed knows the devastation COVID-19 can cause. “There was a time when we buried five to 10 people per day,” he said. But he still doesn’t want to get vaccinated.

He added that getting vaccinated is also a hassle for people managing busy lives. He knows some people who went to get vaccinated, only to find the clinics were out of stock. “It makes the process tedious,” he said.

Because of the miniscule number of doses circulating in Kenya, vaccine hesitancy is not necessarily harming vaccination efforts at this point, according to health workers, who said people are showing up in large numbers for vaccination. The supply of vaccines remains the primary issue.

Simon Karange, an Uber driver, said he jumped at the chance to receive a vaccination. “The most important thing in this world is your life. Everything else comes second,” he said.

Peter, another Nairobi-based health worker that wished to remain anonymous, said people start lining up early in the morning at his clinic. The facility doesn’t store the vaccine itself, so someone picks the doses up early in the morning, meaning they are never completely sure how many they will receive that day.

“Some days we find that we are not vaccinating because the vaccines are not there. It’s not that the health care workers are not there — it is that the vaccines are not there,” he said.