key: cord-1053857-wpltzsvg authors: Ekwebelem, Osmond C.; Yunusa, Ismaeel; Onyeaka, Helen; Ekwebelem, Nicholas C.; Nnorom-Dike, Obinna title: COVID-19 Vaccine Rollout: will it affect the Rates of Vaccine Hesitancy in Africa? date: 2021-01-28 journal: Public Health DOI: 10.1016/j.puhe.2021.01.010 sha: 82cba0b7d2222087106c374010a8a96a229aa74e doc_id: 1053857 cord_uid: wpltzsvg nan As of 14th January 2020, of over 92.7 million COVID-19 cases (with 1,986,900 deaths) worldwide reported to the WHO, Africa accounts for 3,157,992 cases, approximately 3.4% of the global COVID-19 burden. 1 Earlier, due to non-availability of safe and effective vaccines, experts recommended non-pharmaceutical interventions (NPI) as the most effective public health interventions against COVID-19. However, safe and effective COVID-19 vaccines are now available, but will Africans be willing to be vaccinated? In times of disease outbreak and pandemic, vaccination is a crucial public health intervention that stands at the juncture between individual's decision and community immunity. As a result, the success of a vaccination program lies in the people's level of acceptance. Vaccine hesitancy, which is the reluctance to accept available vaccines, 2 has been listed by the World Health Organization (WHO) as one of the top ten threats to health and well being in 2019. 3 Some champion literatures point out that vaccine hesitancy is driven by cultural, social, historical, political, and individual factors such as emotions, values, risk perceptions, knowledge, or belief. 4, 5 Interestingly, Africa is a continent with multi-cultural patterns, and this diversity in cultural beliefs and practices spread across different states, nations, races, tribes, and ethnic groups. 6 Socio-cultural and demographic influences thrive in Africa due to the culture and social structure where people are strongly influenced to believe or accept what others do or expect them to do. 6 Undoubtedly, this socio-cultural complexity has contributed immensely to sporadic vaccine hesitancy in Africa. Hence, like all vaccines, 2, hesitancy to the COVID-19 vaccines is also expected to vary ultimately, in different contexts, as well as in different patterns. International. 10 Sample sizes of about 1,000 people, with a mix of genders and age groups from both urban and rural populations, served as a nationally representative in each country. The results showed that about 80% of the people are willing to accept COVID-19 vaccine once it's J o u r n a l P r e -p r o o f available and considered safe and effective. 10 Though the overall results were encouraging, there were significant regional differences across Africa. Ethiopia and Niger recorded the highest willingness-94% and 93% respectively-whereas only 65% and 59% of the surveyed people in Senegal and Democratic Republic of the Congo, respectively, would be willing to take a vaccine. 10 If compared to other areas of the world, the results show tremendous levels of willingness. 11 However, there is concern that vaccine opponents could influence the "fencesitters" who are still uncertain about whether they will eventually accept it. 11 Undoubtedly, anti-vaccine activists, encompassing social influencers and religious, traditional, and political leaders are prepared more than ever to campaign against COVID-19 vaccine in Africa. Currently, a wide range of misinformation and conspiracy theories are making rounds that COVID-19 vaccine will be used to moderate the rising global population, inject microchips to track people's daily lives, 12 and spread COVID-19 across Africa, where COVID-19 case loads have been unexpectedly low. Most susceptible to this anti-vaccine information include people from North Africa, men, younger people, and those who believe that the risk of the disease is exaggerated. 12 The current anti-vaccine information trends are gaining worrying traction that could lead to an acute increase in vaccine hesitancy rates in Africa. For that reason, all potential hindrances to vaccine acceptance need to be proactively addressed using culturally and linguistically proficient communication strategies, which are focused on involving sociocultural influencers, engaging community leaders, targeting vaccine rumors, 9 and carrying out grassroots sensitization, particularly in the hard-to-reach rural areas where about 56.4% of Africans reside. 13 Whilst COVID-19 vaccines are still not fully rolled out in Africa; it is equally vital to understand better the populations' and subgroup's concerns and socio-cultural factors that may J o u r n a l P r e -p r o o f affect the rates of COVID-19 vaccine hesitancy in Africa. In a similar vein, since Africa is largely religious, 14 evidence-informed sensitization strategies should also include places of worship (churches, mosques, temples, and synagogues) and through religious leaders. As widespread campaigns to distribute COVID-19 vaccines in Africa is expected to be slow, possibly in the second quarter of 2021, 10 it is highly likely not going to be mandatory for the public. This is why experts and analysts are increasingly interested in people who might reject COVID-19 vaccine based on safety concerns, and people who might refuse vaccination services because they believe it is inconvenient to get vaccinated, especially in the hard-to-reach rural areas. 9 The COVID-19 vaccination program is considered Africa's largest-ever immunization program, 11 and people will be asked to get vaccinated voluntarily, possibly in a way that they have never been asked before. Therefore, it is paramount to understand how people plan to reject COVID-19 vaccine and reasons behind their decision. Accomplishing this will help identify types of effective communication and awareness campaigns that might successfully convince people to accept vaccination services. Furthermore, it is vital to equip vaccinators and healthcare providers with strong interpersonal and communication skills and relational approaches to support their effort in addressing trust issues that might prevent vaccination compliance in communities and households. 9 Finally, the largest immunization drive in Africa's history is right around the corner, and failure to tackle religious, cultural or other context specific concerns related to COVID-19 vaccine will result in escalating rates of vaccine hesitancy in Africa, which could mean a very long road to normalcy. Clearly, more work is needed to quell infodemic that undermine public health intervention in Africa. J o u r n a l P r e -p r o o f World Health Organization (WHO) Vaccine hesitancy: definition, scope and determinants Ten threats to global health in 2019 Underlying factors impacting vaccine hesitancy in high income countries: a review of qualitative studies Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature Vaccine Hesitancy in Nigeria: Contributing Factors -Way Forward How can a global pandemic affect vaccine hesitancy? Social resistance drives persistent transmission of Ebola virus disease in Eastern Democratic Republic of Congo: a mixedmethods study COVID-19 Vaccine: how prepared is Africa for a Mass Vaccination Campaign Am Majority of Africans would take a safe and effective COVID-19 vaccine 4 out of 5 Africans would take a COVID-19 vaccine: Africa CDC survey The online competition between pro-and anti-vaccination views Threats of COVID-19 to achieving the United Nations Sustainable Development Goals in Africa Beyond belief: how powerful is religion in Africa million COVID-19 cases (with 2,117,407 deaths) worldwide reported to the WHO, Africa accounts for 3,407,171 cases