Misunderstanding poor adherence to COVID-19 vaccination in Africa – Authors' reply

Abstract

We welcome Bernard Seytre's engagement with our Comment.1Mutombo PN Fallah MP Munodawafa D et al.COVID-19 vaccine hesitancy in Africa: a call to action.Lancet Glob Health. 2022; 10 (022): e320-e321Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar However, his response leaves us more perplexed than enlightened. It is not clear whether Seytre is questioning the sources or disputing the facts. In any event, a careful reader of the US study we cited,2Jaklevic MC Researchers strive to recruit hard-hit minorities into COVID-19 vaccine trials.JAMA. 2020; 324: 826-828Crossref PubMed Scopus (23) Google Scholar for example, will find therein explicit treatment of racism, medical abuse, and public trust (page 2 of the study). This finding has direct bearing on vaccine hesitancy and the history of colonial medicine and medical abuse in Africa, as shown by several studies (see Lowes and colleagues for a sample).3Lowes S Montero E The legacy of colonial medicine in central Africa.Am Econ Rev. 2021; 111: 1284-1314Crossref Google Scholar We certainly hope Seytre does not dispute the facts about global vaccine apartheid.4Gordon BrownThe world is making billions of Covid vaccine doses, so why is Africa not getting them?.https://www.theguardian.com/commentisfree/2021/aug/16/world-billions-covid-vaccine-doses-africa-unprotectedDate accessed: March 15, 2022Google Scholar Comparing vaccine uptake for COVID-19 with that of diphtheria-tetanus-pertussis (DPT) is a false analogy. Vaccines for children have been widely accepted in Africa as a result of decades of investment in health workers and community engagement by governments and various partners, and the 80% coverage of DPT vaccines has been achieved by the WHO regional office over a long period of time. Additionally, and irrespective of knowledge, it is mandatory in most African countries for a child to be vaccinated to be enrolled in school. It seems somewhat disingenuous that Seytre has referred to a dearth of knowledge in relation to his findings on risk perceptions, while castigating us for doing the same thing. This lapse, unwittingly, supports our conclusions. And if the whole point of Seytre's response is that vaccine hesitancy can be addressed by communicating on the fact that COVID-19 is present in Africa, how the virus is transmitted, and who is at risk for the disease, we do not know how one could do so effectively without understanding and combatting fake news and misinformation, which was one of our four recommendations. Seytre seems to stage his own research as the ultimate truth. Yet our approach, unlike his, is holistic. Instead of a narrow focus on lack of knowledge and perceptions, we situate communication in the larger structural determinants of vaccine hesitancy and apartheid by analysing the causes of that risk perception. A detailed causal analysis of COVID-19 misinformation and vaccine hesitancy in Africa5Aborode AT Fajemisin EA Ekwebelem OC et al.Vaccine hesitancy in Africa: causes and strategies to the rescue.Ther Adv Vaccines Immunother. 2021; 9 (2515135521104751)PubMed Google Scholar confirms our argument. It is unfortunate that Seytre's response generates more heat than light. Hair splitting and fault finding only distracts from attending to global vaccine apartheid and working towards global justice, which our Comment attempted to do. We declare no competing interests. COVID-19 vaccine hesitancy in Africa: a call to actionIn addition to low COVID-19 vaccine coverage in Africa due to vaccine nationalism and vaccine diplomacy, the gradual effort to distribute COVID-19 vaccines to low-income and middle-income countries (LMICs) is threatened by vaccine hesitancy. In Africa in particular, the low vaccine coverage1 and the ubiquitous vaccine hesitancy in a concerning proportion of the population undermine efforts to fight the COVID-19 pandemic. We advocate for humane, culturally relevant, and rapid public health action to address these issues. Full-Text PDF Open AccessMisunderstanding poor adherence to COVID-19 vaccination in AfricaAlthough I can only applaud the call to action in favour of COVID-19 vaccination in Africa by Polydor Ngoy Mutombo and colleagues (March, 2022),1 their analysis of so-called COVID-19 vaccine hesitancy is questionable. Full-Text PDF Open Access