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Addressing vaccine hesitancy: potential COVID-19 fight challenge

BY: Dr Nana Yaa Koram, MD MPH

The COVID-19 pandemic has wreaked havoc on the health, economies and societies of countries globally.

As of the time of writing on February 26, 2021, the number of COVID-19 recorded infections in Ghana stood at 81,673 with 588 deaths (Johns Hopkins Coronavirus Resource Centre).

While the number of deaths may seem minuscule, relative to the number of recorded cases, for the families and friends of all who have lost their life to the disease, the loss is devastating.

The personal, economic and mental health impact on those left behind cannot be quantified, and its ripple effects will continue to be felt for years to come.

The long-term health consequences of COVID-19 infections also keep manifesting in patients who have seemingly got over the infection.

Protocols

Various health protocols have been instituted to help curb the spread: social distancing, handwashing, sanitising and other appropriate hygiene behaviours. 

Thankfully, there is now another arsenal in the COVID-19 fight toolkit, vaccines!

Ghana recently became the first country in the world to receive vaccines acquired through the global United Nations backed COVAX vaccine initiative.

It received 600,000 doses of the COVISHIELD AstraZeneca vaccine, produced by the Serum Institute of India on February 24, 2021.

The government also recently issued a COVID-19 vaccine rollout plan, with the vaccination process set to be rolled out in three different phases.

The first phase will involve frontline healthcare workers, individuals with underlying conditions, frontline security personnel, members of the Legislature, Executive and Judiciary.

Vaccine hesitancy

Vaccine hesitancy is a massive danger to the success of any vaccination programme, and COVID-19 vaccination is certainly no exception. 

It is considered one of the 10 main threats to global health by the World Health Organisation (WHO). 

According to www.thinkglobalhealth.org, the mere existence of vaccines alone doesn’t save lives, they must actually be administered through vaccination programmes in order to protect lives.

Vaccine hesitancy is a well-recognised phenomenon, which has up till date, mainly affected the uptake of childhood vaccinations in Africa.

It refers to the delay in acceptance of vaccines or the refusal of vaccines, despite the availability of vaccination services (thinkglobalhealth.org).

This is a complex and context specific phenomenon that varies with time, place and the type of vaccine; some vaccine hesitant individuals may take the vaccine, but have doubts about it, some may refuse certain vaccines, and some may refuse all vaccines outright.

There is no available concrete data in Ghana about the degree of vaccine hesitancy.

However, a review of popular social media platforms of several major news sites in Ghana indicates  significant numbers that barely believe COVID-19 actually exists.

There is the belief that even if it does, COVID-19 infections are the preserve of the middle and upper middle class.

Rumours

Such vaccine hesitancy has been fueled by false rumours and conspiracy theories which are incredibly contagious.

Numerous examples abound in literature, with prime examples of such are the theories about MMR vaccines causing autism, concerns about polio vaccines in Northern Nigeria, suspicions about cholera immunisation in Mozambique, and vaccines being used to sterilise girls in Cameroon.

Such conspiracies have led to vaccine hesitancy and the ensuing low uptake in immunisation, and hence difficulty in eradicating the diseases. 

Social media has emerged as another powerful and pervasive means of spreading vaccine conspiracy theories.

Gold standard

There is currently no gold standard for measuring vaccine hesitancy. It is, therefore, difficult to quantify what we cannot measure.

However, we do know it exists, because we have dealt with it in various forms over the years.

How do we tackle this, to build public trust in our COVID-19 vaccinations, and ensure a high uptake in the general populace, once vaccines become readily available, to increase Ghana’s chances of achieving herd immunity.

Literature

The literature of vaccinations tells us that most patients, similar to most parents, who refused vaccinations for their children, may not be really resistant to the vaccine or immunisation, but they are seeking information and largely need reassurance and clarification from their physicians and healthcare providers.

Studies have shown that a doctor’s recommendation is the most important reason a patient accepts an immunization.

For example, lack of healthcare professional’s recommendation was listed as one of the top three reasons children didn’t get the HPV vaccination. 

The onus, therefore, lies on healthcare workers to be at the forefront of building confidence in the novel vaccine.

Transparency

Transparency and clear and direct information delivery are crucial in building trust in the vaccine.  As our patients become more empowered, and our healthcare system becomes less paternalistic, patients should be encouraged to ask questions of their physicians and healthcare providers about their health and health problems.

It is hoped that our esteemed healthcare workers will, in turn, respond respectfully as always, and ask further probing questions to clear all the concerns of patients.

Some of the patients may still refuse the vaccination; this doesn’t mean that these patients should be ostracised or considered ignorant.

Such patients should be encouraged, their concerns acknowledged, and the relationship they have with their healthcare provider preserved, to keep open channels of communication.

The goal of tackling vaccination hesitancy, as with all advocacy in health care, is to give people a sense of empowerment and control over their health and decision making.

The COVID-19 pandemic has turned our world as we know it upside down and has left many rudderless and without a sense of purpose or direction.

The very least we can seek to do, as healthcare workers, with this novel vaccine, is to help consolidate this sense of empowerment and control, as we seek for life to return to a semblance of normality.

The writer is a Board Certified Internal Medicine Physician, with a Master’s degree in Public Health from Harvard University