On the 9^th of November, pharmaceutical developer Pfizer announced the most promising results from a COVID-19 vaccine trial to date, claiming that their vaccine appears to be over 90% effective in preventing viral infection. This release is based on the preliminary results of trials taking place in over 40 000 people across six countries, including in South Africa. With many countries across the world currently experiencing their second waves of COVID-19 cases, and governments cracking down with tighter restrictions amidst growing resistance, this milestone breakthrough appears to be some light at the end of the tunnel.

However, access to vaccines is not a panacea. While there is much valid debate about whether the vaccine will be safe, which groups of people will be first in line to get the vaccine, and widespread concern about whether the global distribution will be equitable, there is scant attention to another critical issue – even if people have access to an effective vaccine, will they take it?

Vaccination campaigns are one of the most important interventions in public health and are responsible for laudable successes in significantly decreasing various infectious diseases such as polio, tetanus and cholera, as well as the complete eradication of smallpox. However, the World Health Organisation (WHO) placed vaccine hesitancy on their list of “Top 10 Threats to Global Health” for the first time in 2019.

Research from 2018 has found that despite high levels of trust in vaccines globally, there has been a rising number of people reported to be losing confidence in vaccines. While there is much higher trust in vaccines reported amongst low-income regions in comparison to high-income regions, a more recent study by the World Economic Forum has shown that on average, public confidence towards taking a COVID-19 vaccine has dropped by a 4% average from August to October 2020 alone. Understanding and addressing this increasing disinclination towards immunisation may be critical to the efficacy of any potential COVID-19 vaccine, and equally critical in ending the pandemic.

The reasons for vaccine hesitancy are multiplex, with the WHO identifying complacency, lack of confidence and inconvenience in accessing vaccines as some of the key underlying reasons. Many concerns surrounding a potential COVID-19 vaccine are based on legitimate uncertainties, such as whether there will be adverse side-effects, issues regarding taking multiple doses and fears of rushed testing. Addressing these concerns falls within the purview of the scientists involved in vaccine development and distribution, who hold the responsibility for ensuring the vaccine’s safety, reliability and efficacy.

However, even if a vaccine is developed that fulfils these criteria, it is the increasingly unfounded push-back towards vaccines that holds the main cause for concern.  Particularly in the rise of Western ‘anti-vaxxers’, the growing culture of online misinformation, political polarisation and religious extremism has been linked to increasing vaccine scepticism. While the Western ‘anti-vaxxer’ movement was historically rooted in [later disproved] fears of vaccines causing autism, recent strains of the movement have been merging with new conspiracy theories, and merging with a broader anti-science, far-right agenda.

But for some Africans, anti-vaccination attitudes have different roots, including a deep-seated resentment towards Western intervention in Africa. Earlier this year, two French doctors were accused of racism in response to their comments about potentially testing a COVID-19 vaccine in Africa due to its context of “no masks, no treatments, no resuscitation”. This attitude, reminiscent not only of the colonial era but of various ethically disreputable trials in Africa, was unsurprisingly met with massive backlash. Within the same month, misinformation spread about Bill Gates allegedly planning to launch a vaccine in Africa, adding traction to increasing anti-vaccination rhetoric and highlighting underlying distrust and suspicions towards Western philanthropic intentions.

In South Africa, trust in vaccinations lags behind other African countries, with only 82% of South Africans believing that vaccines are safe, in comparison to Nigerians (91%) and Rwandans (94%). On a large scale, this is a worrying statistic. Hesitancy in vaccine take-up goes further than the individual choice of risk-taking, as it consequently increases health risks to others. Moreover, this statistic is likely a dynamic one – with these recent online scandals and emerging conspiracies constantly causing these attitudes to fluctuate.

Lack of confidence and trust in vaccines threaten to derail not only the progress of the global fight against vaccine-preventable diseases, but the hopes pinned on the COVID-19 vaccine. While the reasons for vaccine hesitancy vary across countries, misinformation appears to be a common thread in the proliferation of unfounded justifications. This prompts the question – what role should the state play in increasing public understanding of vaccines, quelling fears and combatting myths?

Throughout the pandemic, the South African government, alongside many other governments worldwide, has been faced bitter criticism for providing unclear, incomplete or inconsistent communication. According to the South African Reconciliation Barometer (SARB) 2019 survey, citizens’ trust in the state is relatively low with only 42% of South Africans displaying “quite a lot” or “a great deal” of confidence in national government.

But promisingly, the 2019 SARB survey also found that the South African Broadcasting Commission (SABC) was the institution in which South Africans have the most confidence, and that television and radio are the news sources most regularly relied upon for news. These platforms therefore have significant potential for scaling up public campaigns to combat misinformation and replacing unfounded claims with comprehensive, accurate scientific communication. This calls for deeper collaboration between the media, government, scientific and medical communities, and local leaders.

These upcoming months are paramount for the government to champion science, build trust amongst the citizenry and mitigate the toll of the pandemic through addressing vaccine fears. As an effective vaccine tentatively approaches on the global horizon, South Africa must be ready to hit the ground running.

Kayla Arnold is Communications Assistant at the Institute for Justice and Reconciliation in Cape Town. She holds an Honours degree in International Studies from the University of Stellenbosch and is currently completing an MSc in Global Health and Development at University College London. Her work focuses on sociopolitical development, conflict, and global health.

Article first published on News24.