Hesitancy to vaccination: A hurdle to stemming COVID-19 pandemic

The utility of vaccine campaigns to control COVID-19 is not merely dependent on vaccine efficacy and safety. Experts, in this report by SADE OGUNTOLA, say that vaccine acceptance among the general public and the healthcare workers has a decisive role for successful control of the pandemic.

Vaccines are some of the most cost-effective public health interventions, saving millions of lives each year. They offer the best chance of stemming the spread of the coronavirus which has resulted in many cases of ill-health and deaths across the globe. Public health experts say that at least 70 per cent of any community must get vaccinated against COVID-19 to achieve an acceptable level of immunity to protect its members.

Many countries are already making substantial efforts to assess and advance their readiness for COVID-19 vaccines. Success anywhere, however, hinges on whether individuals are willing to accept the vaccine and follow the correct vaccination course. Vaccine hesitancy is a delay in acceptance or refusal of vaccination despite the availability of vaccination services.

According to the World Health Organisation’s (WHO) Strategic Advisory Group of Experts on Immunisation, “vaccine hesitancy manifests differently across people, places, and vaccine types, and the reasons for it vary accordingly, from fears of nefarious covert effects to concerns about inadequate testing.”

Currently, it is a mixed picture. In a global survey of potential acceptance of a COVID-19 vaccine, positive responses ranged from 55 per cent in Russia to 87 per cent in China. In September 2020, a pew survey suggested that 49 per cent of American adults would refuse a COVID-19 vaccine.

In December 2020, a survey by Centres for Disease Control and Prevention (Africa CDC), in partnership with the London School of Hygiene & Tropical Medicine (LSHTM), suggested that 79 per cent of participants in Africa would take a proven safe and effective COVID-19 vaccine while 14 per cent would refuse it outright. An additional 14 per cent said they would hesitate to take the vaccine.

Data from the survey that interviewed more than 15,000 adults aged 18 years and above, across 15 African countries, Nigeria inclusive, shows significant variations in willingness across countries and the five regions in the continent.

Only 46.3 per cent of Nigerians said they would do so. This is slightly higher than the results found in Spain, Sweden, Poland, Brazil and Ecuador.

Overall, willingness, or not, to take a COVID-19 vaccine depended mostly on trust in vaccines as well as perceptions of its importance, safety and efficacy. Safety was of utmost consideration; on average 18 per cent of respondents believed that vaccines generally are not safe and 25 per cent believed that a COVID-19 vaccine would be unsafe. Some of the respondents expressed distrust for vaccines generally while others expressed distrust for a COVID-19 vaccine specifically.

Before the COVID-19 pandemic, there has been a global decline in vaccine acceptability and uptake because of doubts about the efficacy and safety and the spread of misinformation about vaccines. The pandemic has further exacerbated controversies around vaccines as a preventive measure against infectious diseases.

But Dr Funmi Makanjuola, a consultant medical microbiologist, University College Hospital, said COVID-19 vaccine hesitancy in Nigeria may be linked to misinformation and disinformation on vaccines in general. And this cuts across different groups and professions.

Some of them believe that vaccines can change people’s mental wellbeing, causing autism in them. Others feel that a vaccine is a way of population control.  Some question why there is already a COVID-19 vaccine in the last year even though there are no vaccines to prevent many other diseases that have been around for decades.

Another group of people question the rationale of spending so much money on developing a vaccine for a disease that in their opinion only cause few deaths and is also preventable by merely embracing wearing of face masks, physical distancing, and sanitising of hands.

Hesitancy in the last few weeks was also because of reports of adverse reactions, including deaths, to the vaccine as well as the content of the vaccine.

Dr Makanjuola declared, “Some of these reasons have been scientifically proven to be wrong; some will require some religious reorientation to dissuade people’s minds from rejecting the vaccine.”

She stated that although adverse reactions to vaccines or drugs are possible, but they are not expected to occur in every individual that takes the COVID-19 vaccine.

According to her, common reactions reported included swelling at the injection site, feeling uncomfortable for a few days and so on.

She added, “now, abroad when they give the vaccine, the person is placed on observation for at least 15 minutes before they can go home to be sure that there is no reaction.”

However, the report of some elderly people above the age of 80 years dying a few weeks after taking the vaccines at an old people’s home, she said, may not even be directly linked to the COVID-19 vaccine but the other diseases that often are prominent in people of such age group.

Chairman of the Oyo State chapter of the Nigerian Medical Association (NMA), Dr Ayotunde Fasunla, said in some instance, hesitancy to the COVID -19 vaccines in Nigeria was due to the antecedence of Pfizer in northern Nigeria. They had a botched drug trial.

However, Dr Fasunla said notwithstanding, the case is not sufficient to make people always have a reservation on everything that Pfizer is involved in.

Dr Fasunla declared that Pfizer is just one of the companies that have produced vaccines to combat the pandemic and there is no time to have these COVID -19 vaccines again revalidated in Nigeria since they had been approved for use by WHO and there are not enough provisions in the hospitals or isolation centres to treat people infected by the coronavirus.

That the COVID -19 vaccines were developed in less than a year, he said, does not negate the fact that they are efficacious.

He added, “don’t forget that when they brought in other vaccines against hepatitis B, mumps and meningitis,  we did not ask them to do a trial on them in Nigeria.  We accepted them because we trust them. The trust went away because of what happened at that time in northern Nigeria.”

The medical expert declared that even in instances that people talk about adverse side effects, what determines whether a drug or the vaccine will be given is when the benefits of using it outweigh the risks coming from its use.

Dr Fasunla, however, raised concern on how Nigeria intends to maintain a cold chain system that is required to preserve the vaccines when they are received in the country considering the country’s poor electricity supply.

Since there are also concerns that investment in COVID -19 vaccines by the government may further worsen Nigeria’s economy, he stated that steps to look at other alternatives at curtailing the infection such as the use of medicines like ivermectin is therefore important.

So what must be done to get on track for a successful African vaccination programme against COVID-19? Drs Aanuoluwapo Adeyimika Afolabi and Olayinka Stephen Ilesanmi at the University of Ibadan, suggested optimal community involvement in the structure and modalities for the delivery of the prospective COVID-19 vaccine.

Also, feedback mechanisms for the acknowledgement of community efforts in previous health interventions they declared in the 2021 Pan African Medical Journal should be improved upon to encourage the acceptance of the prospective COVID-19 vaccine.

Besides, they said an improved multi-sectoral collaboration should be initiated and promoted to enhance the acceptance of COVID-19 vaccines through the provision of more resources required to address COVID-19.

According to them, the integration of the COVID-19 vaccine into the routine immunisation schedule would strengthen the health system, improve uptake of the COVID-19 vaccine, and improve the health of all persons living on the African continent.

 

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