Why are some folks reluctant in getting Covid-19 vaccination?

Sidney Muchemwa – Institution: University of Zimbabwe – Programme of study: Occupational Therapy Final Year

Coronavirus disease 2019 (COVID-19) a relatively unknown condition caused by severe acute respiratory coronavirus 2(SARS-COV2) which was initially discovered in December 2019 within the Chinese province of Hubei.

Since December 2019, it has spread across the 7 continents to 50 African nations and over 200 countries globally.

The World Health Organization (WHO) has since declared COVID-19 a global pandemic.

The COVID-19 pandemic has not only had unparalleled effects on overall health and well-being of populations around the globe, it has impacted the economy of a number of countries.

In Zimbabwe, the index case was reported on 20 March 2020, and more than 129 625 cases and over 4 600 deaths have been reported since then. As with the Human Immunodeficiency Virus (HIV) pandemic of the 90s, the novel nature of the ongoing coronavirus outbreak follows on the absence of specific medications existing for its cure and treatment, instead, various trial and error therapies continue being employed to manage known symptoms of the disease.

The highly infectious nature of the virus and recurrent spikes in number of new cases in many affected counties has led to the need for continuous development of more accurate testing methods, effective treatment drugs as well as a vaccine for the disease.

Vaccination remains one of the milestone achievements in the history of modern medicine and it is the greatest human design intervention apart from the provision of clean water, sanitation and hygiene services (WASH).

It has been reported as one of the top notable public health achievements to have occurred during the 1900s.

In Zimbabwe, vaccination has led to the eradication of smallpox and control of poliomyelitis, measles, rubella, tetanus, diphtheria, and other infectious diseases.

Though reduction of deaths and infection related complications remain a top concern among the public, vaccines have a critical role in preventing development of severe disease symptoms and in some cases protect through herd immunity, protect individuals who did not receive the vaccine.

Accordingly, widespread uptake of an approved vaccine significantly impacts the progression and longevity of the COVID19 pandemic in Africa. Zimbabwe, a landlocked country in the southern part of Africa received its ?rst delivery of a COVID-19 vaccine on the 15th of February 2021 with the roll-out of the vaccination program beginning 18th February 2021.

In Sub-Saharan Africa, only a number of countries have rolled out COVID-19 vaccination programs, Mauritius, South Africa, Seychelles, Rwanda and Zimbabwe leading the African pack.

As of 26 September 2021, 3 037 013 people had been vaccinated against COVID19, translating to less than a third of the Zimbabwean national population. This represents a minute chunk of the national population and despite all the public health successes in reducing the spread of infectious diseases through vaccines, the statistics from Zimbabwe are indicative of a larger portion of the African population still expressing concerns about the safety and need for vaccines, a phenomenon known as vaccine hesitancy

Vaccination has offered major public health solutions since the discovery of the smallpox vaccine by Edward Jenner, it has been repeatedly proven that it is possible to save millions of lives at a relatively nominal cost. Vaccine hesitancy in Africa has inadvertently plagued this great discovery. Vaccine hesitancy (VH): according to the World Health Organization, VH is defined as the delay in the acceptance or blunt refusal of vaccines, and has been identified as a growing trend in global health. It was classified as one of the top ten threats to global health by the World Health Organization in 2019.

Vaccine hesitancy is a complex phenomenon, with a growing continuum between vaccine acceptance and refusal. Despite the proven effectiveness and safety of vaccines, an increasing number of individuals in Africa perceive vaccines as unsafe and unnecessary thus fuelling the reluctance or refusal to vaccinate against COVID-19 despite the availability of vaccines.

Africa as a continent has a convoluted history of vaccine hesitancy. In Nigeria is the most populated country in Africa vaccination coverage has continuously dropped since its peak of 81.5% in the 1990s, and by 2013, only 25% of children under the age of 2 were fully vaccinated. In 2003/2004 polio vaccine refusal in Nigeria had a far-reaching consequence. It increased the incidence of polio by many folds in Nigeria and contributed to outbreaks of polio beyond Africa to three other continents

One of the major reasons for the reluctance of vaccines in Africa has been attributed due to low levels of education resulting in poor health literacy, distrust in vaccine, distrust in government due to conflicts and insecurities, possible influence of cultural and religious beliefs among others.

However, the contribution of low education levels does not necessarily imply that refusal would be higher in the educated population.

Other significant reasons for non-acceptance of the COVID-19 vaccine in Africa include the purported unreliability of clinical trials, with a general agreement among the African people that the development process was too fast, and that the COVID-19 vaccine is not safe.

Another common emerging theme among the younger and sexually active population is that many young people “worry about side effects”, and concerned that it will temper with their ability to reproduce yet infertility was a problem they were not prepared to face in their future relationships.

Vaccine reluctance in Africa will definitely have a direct and wide-reaching effect on the uptake of COVID-19 vaccine(s) by individuals in the community .This remains a public health  threat not only on the reluctant individual but on the community as a whole, as delays and refusals would make it impossible for communities in Africa to reach the threshold of vaccine uptake necessary for the conferment of herd immunity thus the urgent need for a multi-stakeholder approach in addressing this challenge.

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