Vaccination is one of the most important ways to protect people against diseases such as measles, mumps, rubella, polio, diphtheria, tetanus, pertussis (whooping cough), hepatitis B, influenza, and even the coronavirus. It is a simple, safe, and effective way to save millions of lives and prevent countless cases of serious illness.
Despite the many benefits of vaccination, some people still hesitate to get vaccinated. Alarmingly, vaccine hesitancy and denial of the climate crisis are similar, both hindering disease control and posing a harmful threat to our health and well-being.
The climate emergency is causing animals to migrate to higher elevations, bringing diseases with them. Mosquitoes, ticks, and fleas, vectors of many dangerous diseases, are now active for longer periods due to rising global temperatures.
Erratic weather patterns, such as extreme droughts and floods, are also creating new breeding grounds, according to experts at the Pandemic Tracking Collective.
In the next two decades, between 2030 and 2050, the climate crisis is projected to kill an additional 250,000 people each year due to climate-related threats, such as malaria and water insecurity, according to the World Health Organization. The burden of disease from climate change in the future will continue to fall mainly on children in developing countries, but other population groups will be increasingly affected, the WHO says.
Science skepticism is fueling a dangerous mix of vaccine hesitancy and climate denial.
A growing body of research suggests that people who are skeptical of the climate crisis may also be more likely to be hesitant about vaccines. A study, published in the journal Nature, suggests that this may be because both climate change and vaccines are complex scientific issues that can be difficult to understand, and that people who are skeptical of one may be more likely to be skeptical of the other. However, it’s important to note that not all climate change skeptics are vaccine skeptics, and vice versa.
The world has the tools it needs to mitigate the impacts of climate-driven disease, but it needs to act quickly and decisively to develop and deploy a global plan of action.
In an interview with allAfrica’s Melody Chironda, Dr. Charles Shey Wiysonge, Senior Advisor and Regional Immunization Advisor at the World Health Organization Regional Office for Africa in Brazzaville, Congo, discusses the complex and interconnected threads of vaccine hesitancy and climate change skepticism. Wiysonge also oversees the Vaccine Preventable Diseases Program for WHO, where he plays a pivotal role in spearheading the organization’s efforts to combat vaccine-preventable diseases throughout Africa.
What is vaccine hesitancy?
“Vaccine hesitancy is a term that has been used more and more recently, especially in the context of COVID-19 and COVID-19 vaccination. The World Health Organization defines vaccine hesitancy as a delay in acceptance or refusal of vaccines despite the availability of vaccination services,” said Wiysonge. “This means that someone who is vaccine hesitant may be unsure about whether to get vaccinated, or they may be planning to get vaccinated but are putting it off. Vaccine hesitancy is different from vaccine refusal, which is when someone outright refuses to get vaccinated.”
COVID-19 vaccine hesitancy is a complex phenomenon that captured a range of motivations and concerns.
COVID-19 vaccine acceptance rates in Sub-Saharan African countries vary widely, with some studies reporting rates as high as 68% and others as low as 55%. However, vaccine hesitancy and refusal continue to impede the effectiveness of these interventions. Drivers of vaccine hesitancy are context-specific and include lower education, mistrust in science and governments, and misinformation.
According to various studies, vaccine hesitancy in South Africa has been strongly linked to the spread of misinformation and disinformation about vaccines on social media. A study conducted by African researchers from Western Sydney University in Australia, Cape Town, and Kwazulu-Natal universities in South Africa, and Jos, Benin, and Calabar universities in Nigeria found that resistance to COVID-19 vaccines was most common (87%) among social media users and least common (37%) among newspaper readers.
The World Health Organization identified the climate crisis and vaccine hesitancy as significant global health threats in 2019 due to the risks it poses to individuals and communities. Vaccine hesitancy, as Wiysonge explained, can be caused by a variety of factors, including misinformation, lack of trust in healthcare providers, and personal beliefs. It can also be influenced by social and cultural factors.
Wiysonge made these remarks ahead of the AfricaCDC’s third-annual International Conference on Public Health in Africa (CPHIA 2023), to be held in Lusaka, Zambia in late November.
Challenges of vaccinating remote and underserved areas
Wiysonge noted that underserved areas can be found in both rural and urban settings. People in these areas may be socially inaccessible due to factors such as vaccine hesitancy or lack of access to healthcare services.
Yes, let’s consider the words “remote and underserved areas,” he said. “Remote areas are typically geographically distant, such as rural or remote areas. Underserved areas can be anywhere, even in urban areas. They are characterized by people who have limited access to healthcare services, often due to socioeconomic factors such as poverty, lack of insurance, or discrimination. Underserved areas may also have high levels of vaccine hesitancy.”
Wiysonge said that remote and underserved areas face a number of challenges in transporting vaccines. These areas may be geographically isolated, with poor roads and limited transportation options.
They may also lack health facilities, making it difficult to store and administer vaccines. In addition to these logistical challenges, remote and underserved areas may also experience vaccine shortages. This may be due to a number of factors, such as high demand for vaccines, limited supply, or difficulty transporting vaccines to these areas.
He said that vaccines must be kept in the cold chain, or refrigerated, to maintain their potency and effectiveness. This can be challenging in remote and underserved areas that experience power outages or have unreliable or nonexistent energy supplies. Vaccines in these areas are at risk of spoilage. Wiysonge added that one way to address this challenge is to use alternative energy sources, such as petrol-powered fridges or solar panels to store vaccines.
Why vaccine hesitancy and climate change skepticism go hand-in-hand
Vaccine hesitancy and climate crisis skepticism are two sides of the same coin. Both are rooted in a distrust of science and institutions and a susceptibility to misinformation and disinformation.
People who are hesitant to get vaccinated often cite concerns about the safety and efficacy of vaccines. However, these concerns are often based on misinformation and conspiracy theories that have been widely debunked by scientists. Similarly, people who are skeptical of the climate emergency often cite concerns about the accuracy of climate science and the motives of climate scientists. Again, these concerns are often based on misinformation and conspiracy theories.
This distrust of science and experts is a major obstacle to addressing both vaccine hesitancy and the climate crisis.
“Climate change is a fact,” he said. “Science-based vaccines are important. They are effective. They are one of the greatest achievements of humankind, and they have helped to reduce disease.”
“We know about smallpox, which does not exist anymore,” he said. “It used to kill millions of people many decades ago. Various diseases like polio have been stopped because of vaccination. There are only very few places that have outbreaks of measles and other diseases because of vaccinations.
“So science has brought us vaccines and through science we also know that climate change exists. So what is the link between this?”
Wiysonge says that the link may be “science denialism, maybe misinformation, people who don’t believe in the benefit of science and the facts that have been found through science.”
The rapid spread of information on social media has made it challenging to discern reliable information from misinformation, contributing to vaccine hesitancy. The WHO coined the term “infodemic” to describe this information overload during disease outbreaks, which exacerbates doubts about vaccines. Efforts to address vaccine hesitancy and climate denial require a better understanding of the underlying reasons for skepticism and distrust in science.
Role of misinformation in vaccine hesitancy in Africa
“Misinformation does play a very big part,” Dr. Wiysonge said. “And there are some people who will have good intentions, but they may not be experts and may spread misinformation inadvertently. But there are also people out there who intentionally want to misrepresent facts and drive fear and lead people not to take vaccines.”
“We have found in a lot of our studies that where there is a lot of misinformation, there is also a high level of vaccine hesitancy,” Wiysonge said.
So how to counter misinformation and vaccine hesitancy?
“For some people, they are simply unsure about the benefits of vaccines because of the things they have heard,” Wiysonge said. “We need to provide them with good information about the safety and efficacy of vaccines.”
“For other people, their vaccine hesitancy may be rooted in a lack of trust in science or authority. “In these cases, we need to find ways of building trust beyond just providing information. This means engaging with communities and working through people whom they trust to pass the right information along.”
Is international collaboration key to Africa’s vaccination efforts?
“International collaborations and partnerships play a vital role in supporting vaccine acceptance and distribution in Africa. However, it is important to start with the bedrock of national ownership of vaccination programmes. Communities should also own their vaccination system, as they are the ones who are most impacted by it,” said Wiysonge.
“International collaboration can help in two ways: technical support and financial and other resources. One example of technical support is providing tools to measure vaccine hesitancy. This is important because it allows countries to track progress over time and determine if interventions are effective. The World Health Organization has developed a validated framework for measuring vaccine hesitancy that includes four domains: behavioral and social drivers of vaccination, what people think and feel about vaccine-preventable diseases and vaccines, social processes, and motivations. This framework can help countries to identify the specific challenges they are facing and develop targeted interventions.”
“With a tool like this, we could have countries to be able to measure vaccine hesitancy in their communities and how much of it exists, and to be able to measure over time if those interventions have had an impact,” he said. “And then of course, there are other forms of technical assistance and financial assistance to countries that can help in making sure that vaccines are available, and that they are taken up by the populations.”
Vaccine hesitancy varies by place and time
“Various studies have been done, and the results do vary from place to place. What we know about vaccine hesitancy is that it varies from place to place, and even in the same place, it varies from time to time. So depending on people’s experiences with health services, with science, and with authorities, it does affect that. So, to be able to say that in South Africa, for example, that we have specific environments or groups that are more hesitant, may not be very correct.”
“What people express sometimes as vaccine hesitancy and lack of decision or even refusal to take vaccine might be because of the experiences they have had.”
Wiysonge also addressed the prevalence of vaccine rumours in Africa, which he attributed to a history of research misconduct in the region. “One reason why we found, for example, why rumours were very prevalent in Africa, and many people believe them, is because people have had bad experiences of a lot of research misconduct in the past, led from the West in Africa. So people, some people, they’re able to use that to say, you can see, these people don’t like you.”
Wiysonge warned that misinformation about vaccines can be particularly effective in South Africa, given the country’s history of apartheid. “So if you take the example of South Africa, if people use misinformation, taking the past or the pilfered parts of South Africa into consideration, and people link that to vaccines, it is easy to sway people away and misinform them.”
Why Africa lags behind
Despite the increasing global vaccine production rate, Africa is still facing an acute vaccine supply shortage. As of December 31, 2021, only 8% of Africans had received all recommended vaccinations, compared to more than 70% of the population in affluent nations. This disparity is due to a number of factors, including the lack of knowledge, equipment, logistics, and financial resources in many low- and middle-income African countries.
In addition, the African region has the highest incidence of mortality caused by infectious diseases, yet it has limited capacity to manufacture affordable, essential vaccines. This is due to a number of challenges, including a lack of government coordination, limited capacity of national committees, inadequate funding, and limited research skills and facilities, reports WHO.
The persistent sluggishness of the global economy, declining yet high inflation rates, and challenging global and domestic financial conditions, all of which contribute to high levels of debt, explain the lack of economic growth in Sub-Saharan Africa, reports the World Bank. If immunization rates in Africa are not maintained, there is a risk of reversing progress made, leading to more than 2.4 million deaths and a negative economic impact of $59 billion over the next decade, according to a WHO report.
Strategies to reduce vaccine hesitancy
“What strategies have been used to increase uptake of vaccines in general?. “Vaccine hesitancy varies from place to place and from time to time, it will then mean that we cannot have a one-size-fits-all approach. We need to tailor strategies and interventions to the barriers that have been identified,” he said.
Wiysonge added that some strategies that have been used to improve vaccination coverage include telecommunication, community engagement, changes to the time and location of vaccination services, support for health workers, and locally designed strategies that address the root causes of hesitancy. These strategies can help to improve the experiences of vaccination and make it easier for people to get vaccinated.
Missed opportunities for vaccination are a major barrier to achieving high immunization coverage in Africa.
A recent report by UNICEF found that 12.7 million children in Africa missed out on one or more vaccinations over three years. This is a significant number, and it means that millions of children are at risk of preventable diseases. The report, The State of the World’s Children, confirms that the COVID-19 pandemic disrupted childhood vaccination almost everywhere.
Half of the 20 countries with the most unvaccinated children, or “zero-dose” children, are in Africa, UNICEF said. Nigeria has the highest number of zero-dose children in the world, with 2.2 million children who have never received a vaccination. Ethiopia is also among the top 20 countries, with 1.1 million unvaccinated children.
The report warned that this was a major setback for global efforts to protect children from preventable diseases. In 2021, an estimated 6.7 million children died from preventable diseases, the highest number in 30 years. The top reasons for missed opportunities include lack of awareness or knowledge about vaccines, distance to the nearest vaccination facility, cost of transportation, and vaccine hesitancy or refusal.
By addressing missed opportunities and vaccine hesitancy, African countries can make significant progress toward achieving the goals of the Global Vaccine Action Plan (GVAP) and ensuring that all people have access to life-saving vaccines. The GVAP was a landmark initiative that brought together partners from across the globe to broaden vaccine coverage and include newer vaccines, such as those for rotavirus and hepatitis B.
In 2023, 18 million doses of the first-ever malaria vaccine have been allocated to 12 African countries for 2023-2025, according to GAVI, WHO, and UNICEF. This rollout is a crucial step in the fight against one of the leading causes of death in Africa.
Economic status should not be a barrier to vaccination
He said that economic constraints can impact vaccine acceptance in a number of ways. “First, people who live far from vaccination services may have difficulty with transportation, paying for the vaccines, or accessing the vaccination services. This can be especially challenging for people with low incomes.”
“Second, people who have had negative experiences with vaccination services in the past, such as having to wait a long time or being unable to access the vaccine, may be less likely to accept vaccines in the future,” he added.
“To address these challenges, we need to make vaccination services more accessible and convenient for everyone. This means ensuring that vaccination services are available every day, at all times of day, and in convenient locations. We also need to make vaccination more affordable,” he added. “This may involve providing free or subsidized vaccines to people with low incomes.”
“There’s quite an interaction between people’s experiences with the health services and their acceptance of vaccination. So the things that we could do in such cases is to ensure that vaccination is available every day, every time of the day in our health facilities and that people can come anytime because at times people need to go to work before they come to vaccination, either for themselves or their children. So we need to make vaccination times more convenient for people even using weekends to do vaccinations.”
Wiysonge discussed how the availability of vaccines influences vaccine acceptance in different African countries.
“If people go to vaccination centers at health facilities and vaccines are not available one or two times, then the next time they will either lose interest in vaccination or lose trust in vaccination services. Or, if, for example, what we have found with the COVID-19 vaccination, where Western countries or richer countries got the vaccines for themselves and we’re only getting them later on in line, that’s an issue that makes people lose trust in the health system, lose trust in health authorities, and lose trust in government, and you just have trust issues around international collaboration. And that may eventually also lead them to believe in rumours and misinformation about vaccines, leading to probably low acceptance of vaccines.”
Vaccination is hope
“Vaccination is probably the most important achievement of humankind,” he says. “It has led us to eradicate smallpox and has reduced many vaccine-preventable diseases, some of the greatest killers of children like measles, diphtheria, pertussis, and polio.”
“We should all join hands as one person to ensure that vaccines are available, that people have access to these vaccines, and that people understand the importance of vaccination. This cannot be done by one nation or one community or one profession. It needs to be the whole community. It needs to be all of us because vaccination saves lives, vaccination saves our lives.”
“I’m hopeful that vaccines will continue to play a very big role in our health,” Wiysonge said. “We are going to find new vaccines for diseases for which we don’t have vaccines anymore. I’m hopeful that we’ll be able to find new vaccines for TB, we’ll be able to find vaccines for HIV, we’ll be able to find vaccines for other diseases for which we don’t yet have vaccination.”
He also expressed his hope that people would take up the vaccines that are already available and that everyone everywhere in Africa and around the world would have access to the vaccines they need. “Vaccination is hope,” said Wiysonge.