Excitement around COVID-19 vaccine tempered with big questions on vaccine hesitancy

Dr Kim Lamont-Mbawuli

By Dr Kim Lamont-Mbawuli


According to Worldometre COVID-19, reached pandemic status on March 2020.There are currently over 90 million COVID infections, in 218 countries and territories with 1,944,516 deaths to date. An estimation provided by the International Monetary Fund Blog has stated that the cumulative effect of the pandemic over the next 2 years shall reach global economic cost of 9 trillion US dollars. To slow down the spread of the virus; social distancing, wearing a mask and quarantine measures were implored to protect vulnerable societies. The dire need for a vaccine to protect the population and safeguard severely strained economies cannot be overstated.


As provided for by the US National Institute of Health the first clinical trials were initiated in March in the US as well as other clinical trials around the world. In Africa, Egypt and South Africa (SA) are participating in these trials. Further to this in SA the first screening for participants started in August 2020 to enrol in COVID-19 vaccine study by Novavax, a US drug developer, at Wits University. The ground breaking developments offer hope and optimism. However, given the costs associated with purchasing vaccines, there is already concern that less wealthy nations will be further behind in the race to vaccinate. Interestingly, a report from the Peoples Vaccine Alliance found that wealthier countries have stock piled their vaccine supply and that as many as 90% of populations in low- and middle-income countries will not receive a vaccine in 2021.


It is apparent that the procurement and distribution of the vaccine may be affected by intellectual property rights. Currently the World Trade Organisation (WTO) is considering to temporarily waive certain rules around Trade-Related Aspects of Intellectual Property Rights (TRIPS). In doing so, it may better enable countries access to vaccines, drugs, and medical technologies that are needed to prevent, contain and treat COVID-19. The waiver has the support of 100 developing countries, UN agencies and the Director-General of the World Health Organisation, and was propose by SA and India. Surprisingly, there has been opposition in countries that are home to large pharmaceutical companies. Pharmaceutical companies desire reward for the risk taken in research and development of the COVID-19 a quid pro quo for innovation developed. With over 12 billion US dollars spent in vaccine discovery and development. Many governments have already entered into agreements for the Pfizer vaccine. Sales of which are expected to generate extensive profit margins. Albeit, vaccinations are already under way in high-income countries while developing countries remain in the balance as they wait for decision in respect of WTO. Raising the question of what other initiatives can be implemented so that developing countries are not left behind while still supporting and driving innovation-a tough but pivotal balancing act.


There is also the pertinent question of the willingness to vaccinate because to achieve herd immunity we need at least 67% of the population to vaccinate. In Africa, vaccine access has improved greatly over the past thirty years, however the dissemination of false information and conspiracy theories has led to an increase in vaccine hesitancy, which is the resistance and/or delay in acceptance or refusal of the COVID-19 vaccine, despite the availability, which in turn threatens all the progress made thus far.


An article printed in Nature Medicine stated that in June 2020, 13,426 people from 19 countries comprising of 55% of the global population were surveyed to determine potential vaccine acceptance rates and factors influencing acceptance of a COVID-19 vaccine. Of these surveys, 71.5% of participants reported that they would either be “very” or “somewhat likely” to take a COVID-19 vaccine and 61.4% reported that they would accept their employer’s recommendation to take the vaccine. Differences in acceptance rates ranged from almost 90% (in China) to less than 55% (in Russia). Further to this a survey from the African CDC interviewed more than 15,000 adults, across 15 African countries. The data evaluated suggests that 79% of all Africans would take the vaccine. Whereas a survey done in SA by Ipsos provided that 64% of South Africans would be willing to vaccinate against Covid-19. Of that 64%, only 29% “strongly agreed” to a vaccine while the rest “somewhat agreed” demonstrating hesitancy to vaccinate against COVID-19 of which a shortfall of 26% in vaccine confidence can have a dampening effect on the effective rollout. In light of this it is imperative that we change the perceptions that the general public have to the COVID-19 vaccine.


The Vaccine Confidence Project found that vaccine confidence is the belief that vaccination, and the providers thereof whether in public or private sector, as well as political actors behind it, serve the public’s best health interests. Similarly, with ‘hesitancy,’ it is highly variable and rooted in political-economic context. With the number one reason for rejecting vaccine or being impartial thereto is derived from the fear of adverse side effects followed by concerns about the effectiveness of a vaccine against COVID-19.

Other confounding factors in respect of vaccine uptake include the speed at which it was produced. In the minds of many the expedited development of the vaccine to the novel virus raises questions around; vaccine safety, clinical trials usually take years and now in a matter few months the vaccine is safe, effective and ready for use. Or does this merely demonstrate that if you remove issues around funding, red tape around clinical trials and vaccine development that with the sharing of knowledge in a collaborative approach amongst vaccine developers for the greater good of humanity, that indeed the impossible can be ascertained and vaccines can be developed and roll out in minimal time.

Notwithstanding the fact that certain concerns are undeniable, for example pharmaceutical companies do not often publish trial protocols or release results as this may compromise trial methodology (e.g. blinding) or damage their market competitiveness, which raises questions around how long does the vaccine last? Or rather how long can the vaccine prevent disease and/or prevent transmission, including in different demographic groups and to what extent is immunity obtained.

Unfortunately, South Africa falls in the group with the least intention to get vaccinated (at 64%) other countries with a low vaccine confidence includes Russia (54%), Poland (56%), Hungary (56%), France (59%) Italy, Germany, the US, and Sweden (all at 67%), of which the reticence to vaccine uptake is primarily driven by people’s exposure to misinformation. On the other hand countries that have a high vaccine confidence with a strong willingness to get a COVID-19 vaccine includes China (97%), Brazil (88%), Australia (88%), and India (87%).


Consequently, governments need to be ready for large-scale, equitable, access and distribution of the COVID-19 vaccine. Strategies employed need to guide policy makers, public health officials, vaccine developers, health workers, researchers, advocates, communicators, media actors that are involved in vaccine development and vaccine roll out. Transparent communication and deployment of the COVID-19 vaccine may bolster confidence and reduce vaccine hesistancy. It is imperative that we build public trust. To do this we need to reduce vaccine hesitancy by improving sufficient health system capacity. The barriers to vaccination are inter alia the following;

  • lack of access to vaccines due to shortage of resources to increase coverage,
  • language or literacy difficulties,
  • lack of knowledge about the proven benefits and safety of vaccination,
  • religious beliefs, and
  • mass misinformation via social media platforms and some healthcare professionals.

Bearing this in mind we need to improve health education by addressing pertinent questions like; What is a vaccine? How does a vaccine work? What will the COVID-19 vaccine do? It’s about providing the public with clearly communicated information and providing data in accessible formats that are digestible by the general public. Sharing of trial protocols and results where possible (including explanations when adverse medical events occur).

Notwithstanding the reasons why people are reluctant to take vaccines are namely;

  • lack of confidence with questions raised such as; is the vaccine effective, is the vaccine safe,
  • complacency, and
  • Inconvenience in accessing vaccines (time constraints).

In light of the above there is a collective responsibility in understanding that the vaccination isn’t only for your own good, but for others as well in order for us to obtain herd immunity- when most of a population are immune to an infectious disease. The use of social media platforms by health care professionals can also be key in reversing misinformation on vaccine use.

In conclusion, I am of the opinion that we need to build trust by being transparent as to the efficacy of the vaccine. Policy that’s being developed needs to be evidence informed and must be communicated in a way that is clear and accurate. Increased vaccine literacy and confidence will be required in order to support the uptake of a potential COVID-19 vaccine, as well as to bolster overall immunization programs for all vaccine-preventable diseases

Author: Dr Kim Lamont-Mbawuli holds an Honours in Human Biology, MSc in Medicine and PhD (Med). In 2015, she completed an MPhil in Intellectual Property Law. In 2019 she graduated with her LLB at Unisa, she completed her Practical legal training with LEAD and was admitted as an Attorney of the High Court in 2020. She is the CEO of Simanye Clinic, Associate at Shihlamariso Ndlhovu Inc, Chief Legal Officer at Alternative Energy and Chairperson for Pan African Network for Investment and Development.

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