Will COVID-19 vaccine hesitancy damage other immunization advances?

“I am particularly worried about the COVID-19 vaccination,” said Abu Bakarr Kargbo, procurement manager for EducAid, an education charity in Sierra Leone. “But polio, measles, or any other vaccination — people are also afraid.”

Kargbo does not trust the COVID-19 vaccine. Many factors provoke vaccine hesitancy, but Kargbo is afraid because he believes COVID-19 is a man-made illness sent to kill Black Africans — a project that backfired on its makers and also infected them. He has watched Sierra Leonean politicians take the vaccine but believes the liquid in the syringes for the layperson is different. He is so fearful: He now distrusts all vaccinations and says other people feel the same.

His position is replicated in Ghana, where Ernestina Akorteye, a senior high school graduate, told Devex she would not take the COVID-19 vaccine or any others either. This is because she distrusts health workers. “They don’t have my best interests in mind,” she said.

Anecdotal evidence heard by Devex suggests COVID-19 vaccine hesitancy could extend to hesitancy in taking other vaccines. In Nigeria, Mali, and the Democratic Republic of Congo, outreach workers for MSI Reproductive Choices, which offers the HPV vaccine against cervical cancer, have reported lower uptake in areas where people mistakenly believed they were offering COVID-19 vaccinations.

“If there was a rumor that MSI outreach teams are coming and they will be vaccinating you then we’ve had a decline in our client flow for that day,” said Raveena Chowdhury, head of integrated services at MSI Reproductive Choices.

“There have been other communities where, actually, people are asking us for [COVID-19] vaccines … and they're disappointed when we don't have vaccines to provide. But … mostly it's the other way around — there's a fear we might vaccinate them.”

A study of 15 African countries published by Africa Centres for Disease Control and Prevention in February corroborates these stories. While it found almost half of some 15,700 respondents were now more likely to vaccinate themselves in general as a result of the current, global coronavirus outbreak, one-sixth of those surveyed said they were now less likely to do so. Results varied between countries. Senegal reported the highest proportion at 26%, while in Ethiopia only 6% held this view.

“It seems that the pandemic and associated public discussion around the pandemic has exacerbated existing views,” the report suggested. “Those who disagree that vaccines are safe in general are more likely to have been put off [by] vaccinations, while those who view them as safe are more likely to say the pandemic would encourage them even more to pursue vaccination.”

A hindrance and a help

In addition to vaccine fears, COVID-19 has disrupted routine global immunization programs in other ways. In July, the World Health Organization and UNICEF reported routine childhood vaccinations had fallen behind for preventable illnesses including measles, polio, and meningitis.

Some 23 million children missed out on basic vaccines of illnesses through routine services in 2020 — 3.7 million more than in 2019. Dr. Ann Lindstrand, unit head at WHO Essential Programme on Immunization, said the disruptions were caused by lockdowns, transport difficulties, and “fear and distrust” when it came to risk of transmission in health care centers. “Health care workers were diverged, they were put in places where they were needed in the pandemic response instead,” she added.

Devex spoke to several other public health experts who suggested the potential negative impact of COVID-19 on immunizations for life-threatening illnesses could be countered if vaccinators respond carefully to communities’ individual needs.

Dr. Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, believes the COVID-19 vaccine effect could be both “a hindrance and a help” for other vaccine programs.

“It depends on where people were in the spectrum of questioning and hesitancy,” she said. “The COVID-19 experience has opened the book on how vaccines are made. It could either make you feel more informed and relieved or for others it's like, ‘told you so.’”

Larson says the situation is similar to polio vaccination programs, in that both vaccines have an “extremely singular focus.” She describes how people feel their needs are ignored if public health systems keep returning with just one health aim, and not to address additional health concerns. A lesson Larson learned while working for UNICEF on delivering polio vaccinations in India in 2002 was the importance of listening.

“The public health community sometimes makes a lot of assumptions about what people think,” she said.

In India, people blamed rumors about the polio vaccine for their decision to refuse it. But upon deeper questioning, they admitted they did not want men administering vaccines to their children.

“By changing to local women vaccinating them, all of a sudden, the rumor worries disappeared,” said Larson.

‘Limited’ impact

Dr. Ike Anya, co-founder of Nigeria Health Watch and EpiAFRIC said it was difficult to predict how much of an impact COVID-19 vaccine hesitancy would have on other vaccinations. But based on past controversies — such as the polio vaccination program in Nigeria, which in July 2003 halted for 11 months following rumors vaccines were deliberately contaminated, and the 1998 measles-mumps-rubella vaccine scare in the U.K. based on claims of a link to autism — he believes it will be “limited.”

“Obviously this depends on what communication strategies and mechanisms are adopted to counter the misconceptions and continue promoting vaccination,” he said. “The best options are to use targeted channels and opinion leaders that are well-known and trusted as authoritative sources of information.”

Lisa Menning, team lead for vaccine demand and behavioral sciences at WHO, believes people’s responses to different vaccines differ.

“For COVID-19, for now, most of the barriers are unique to COVID-19 vaccines,” she said. “This is similar to what we’ve seen with other vaccines in the past — safety events or concerns with specific vaccines like HPV or measles but rarely with consequences for uptake of others.”

EducAid’s Kargbo said he could be persuaded to take the COVID-19 vaccination, and others, if those administering vaccines would answer his questions and explain exactly what they contain and their potential side effects.

“If you create a platform for the citizens to be asking questions, I believe we can take these vaccines,” he said. “But the platform has not been created.”

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