Vaccination efforts against COVID-19 are finally underway. In a global effort that is only as strong as its weakest link, support will be desperately needed to achieve what UNICEF has described as “one of the largest mass undertakings in human history.” But as we grapple with the logistical obstacles of vaccine delivery for low-income countries, the challenges go beyond the need for cold chain storage, airfreight distribution, and the supply of needles and vials.
One of the biggest hurdles in reaching the world’s most vulnerable people will be convincing them that vaccines, and the people providing them, can be trusted. Winning this trust will require an enormous, united effort from governments, public health experts, humanitarian groups, and local community leaders.
Even before the outbreak of COVID-19, vaccination refusal threatened to reverse progress in tackling vaccine-preventable diseases. The World Health Organization named vaccine hesitancy as one of the top 10 global health threats in 2019.
This issue of public trust is perhaps most acute in conflict zones, where people have long experienced discrimination, corruption, systemic marginalization, and neglect — often at the hands of their governments.
In places like Syria, Yemen, and Somalia, we’ve already seen that a lack of trust in officials has been a particular challenge in disseminating public health information about COVID-19. Public demonstrations and anti-government protests, while initially declining during the onset of the pandemic, have risen again in some countries, underscoring the tension between governments and citizens.
As vaccination campaigns roll out, we must ensure that a person’s ability to receive the vaccine is not determined by where they live.—
Tensions emerging from vaccine distribution may also lead to violence. A forecast from the University of Denver last year projected that COVID-19 could ignite conflict in 13 more countries through 2022, resulting in more nations experiencing conflict globally than at any other point in the past 30 years.
Whether intentional or not, uneven distribution of vaccines by governments to ethnic, religious, political, and other groups, or perceived inequities in distribution, may deepen divisions or spark new grievances that feed war.
When people lose trust in their health authorities and their governments, sound guidance can fall by the wayside. But we can help restore trust in a way that supports both effective vaccine delivery and lasting peace. Lessons from other crises show this.
When the West Africa Ebola epidemic spread across Liberia six years ago, mistrust in government and public health officials was a major barrier to curbing the virus’s spread. Efforts by grassroots civil society and humanitarian organizations focused on addressing the root causes of this mistrust. Spurred by this, the government also shifted to a more inclusive approach, engaging citizens in the health care response.
My organization, Mercy Corps, joined forces with community organizations and leaders to combat rumors and myths, as well as to promote the adoption of behaviors necessary to prevent the spread of Ebola, such as washing hands and not touching sick family members. We trained over 15,000 community messengers to help combat misinformation in their own villages and reached 2.4 million people. Over five months, acceptance of health workers deployed in Ebola treatment units in these areas rose from 15% to 68%.
In Pakistan and Afghanistan, mistrust of health care workers has been a major obstacle for vaccinating people against the poliovirus. Over 40% of polio cases worldwide were recorded there in 2011 and 2012. Organizations such as the Global Polio Eradication Initiative have placed community ownership and trust building at the heart of their vaccination programs.
We’ve seen 189 countries join COVAX, the COVID-19 Vaccine Global Access Facility aimed at tackling logistical and operational challenges to get vaccines to those in greatest need. Now we urgently need donors and governments to start planning and funding comprehensive community engagement initiatives built on deep and inclusive participation.
WHO and governments should also partner with and fund organizations already on the ground, especially those with an established and trusted local presence preceding the pandemic. This needs to involve local civil society, youth, and women’s groups, and business, traditional, and religious leaders, in a meaningful way — to both design and implement grassroots campaigns that will build trust between communities and their governments, as well as trust in vaccines.
Scientists have shown that with resources and political will, the previously unimaginable can be achieved. The world now faces a herculean task as we gear up for a race to reach all corners of the planet with COVID-19 vaccines. As vaccination campaigns roll out, we must ensure that a person’s ability to receive the vaccine is not determined by where they live.
We must also acknowledge that factories, airplanes, and deep freezers won’t be enough if people refuse a vaccine when it gets to them or if they never seek it out in the first place. A truly global rollout of the COVID-19 vaccine will only succeed with the largest and best-managed community engagement and trust-building campaign that the world has ever seen. Let’s start now.