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How can we deal with Covid-19 vaccine hesitancy? Lessons learnt from the HIV pandemic

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What will the influence of Covid-19 hesitancy and anti-vaccine philosophies towards the attainment of Covid-19 herd immunity be?

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By Dr Vimbai Chibango

SOUTH Africa’s vaccination programme has been up and running since February 2021. On the 19th of January 2022, South Africa celebrated the inauguration of a new vaccine manufacturing plant in Cape Town, the very first in Africa to produce Covid19 vaccines and other pharmaceuticals. This is indeed a giant step towards the provision of locally made Covid19 vaccines. However, the key question is, what will the influence of Covid-19 hesitancy and anti-vaccine philosophies towards the attainment of Covid-19 herd immunity be? Will the establishment of a vaccine manufacturing facility obtain the intended results?

The challenges associated with hesitancy to vaccinate or to take any newly manufactured drugs aimed at treating an epidemic are not new. Prior to Covid-19, the world was shaken by yet another pandemic, HIV, which came in just over 30 years ago. The hesitancy associated with HIV happened at two interconnected levels that are; at testing and also at the point of initiation of antiretroviral therapy for people that receive a positive HIV test result.

There are various reasons linked to this reluctance. For example, a study conducted in Swaziland by academics Adams and Zambeira shows that some of the reasons associated with hesitancy to test or to take HIV antiretroviral therapy include fear of a positive result, concerns about early initiation of ART, stigma and discrimination, HIV conspiratorial theories and lack of trust in the commitment and financial capacity of governments.

When it comes to the uptake of the Covid-19 vaccine, the reasons for vaccine hesitancy remain complex. However, a study conducted by academics Machingaidze and Wiysong in low- and middle-income countries to understand Covid-19 vaccine hesitancy show lack of information as a major hindrance to vaccine acceptance.

One more worrying factor that thwarts vaccine acceptance are conspiracy theories and myths surrounding Covid-19 vaccines which portrays negative physiological consequences emanating from vaccination. We can therefore draw a similar pattern between the HIV and Covid-19 pandemics which explain reluctance to receive therapies designed to address each of the distinct viruses.

In the midst of all the uncertainties regarding ART, global and collaborated efforts were made to increase HIV testing rates and that people living with HIV receive ART. For example, the UNAIDS report of 2021 shows that globally, the number of people on ART has been rising significantly from 2000 to 2020 (0.6 million to 30 million respectively).

When it comes to Covid-19 vaccinations, the South African Department of Health shows that the country is making progress though we are still yet to achieve herd immunity. To date, over 31 million people were vaccinated and 17.6 million having been fully vaccinated in South Africa since February 2021. The ratio of the fully vaccinated is about 29% of the total population. Over 800,000 people also received a booster dose.

According to the Centre for Disease Control and Prevention (CDC, 2022), vaccines help to lower the risk of getting and spreading the virus that causes Covid-19 as well as prevent serious illness and death. Also, the National Institute for Communicable Diseases (NICD) considers vaccination not only as an individual asset but as an important measure against Covid-19 which benefits the whole country, which they refer to as ‘population immunity’.

Similarly, we have also learnt from the HIV pandemic that for persons infected with HIV, the ART helps to stop the virus from multiplying, thereby increasing ones CD4 count. It also prevents progression to Aids.

Thus, the idea of weakening the viral load as a result of ART is central in fighting HIV.

However, delays in acceptance or refusal to vaccinate has proved to be detrimental to progress towards preventing the spread of Covid-19. News from the South African Medal Research Council (SAMRC) state the following reflections and facts about vaccine hesitancy:

* Reports from South Africa’s biggest hospitals, show that almost 99% of hospital admissions, resulting in serious illness or death due to Covid-19 affected unvaccinated individuals.

* [Vaccine hesitancy] can result in communities being unable to reach thresholds of coverage necessary for herd immunity, thus unnecessarily perpetuating the pandemic and resulting in untold suffering and deaths.

* Failure to improve vaccination coverage will mean further infections that carry with them the threat of driving the development of mutations and new Covid-19 variants that can create large-scale outbreaks and be even more deadly.

The launch of the vaccine production plant in South Africa is indeed a milestone as it is intended to address many gaps specifically in the roll-out of Covid-19 vaccine, cancer vaccines and other pharmaceuticals. However, there is an urgent need to address the challenge of vaccine hesitance and anti-vaccination philosophies that might be counterproductive to the success towards the fight against Covid-19.

A study by academics Cooper, Rooyen and Wiysonge investigated the extent and determinants of Covid-19 hesitancy in South Africa and it demonstrates that vaccine hesitancy is likely to be influenced by age, race, education, politics, geographical location, and employment.

There are a number of lessons that can be learnt from HIV which can also be relevant in the fight against Covid-19. In the context of HIV, it was necessary to understand the problems, challenges and setbacks towards the prevention and treatment of HIV. This provided an opportunity to reach the real issues and address them accordingly. In the same vein, South Africa and other countries that are faced with vaccine hesitancy may need to look into the real causes of vaccine hesitancy and pave the way for dialogue with communities in fighting the pandemic.

Such an approach is likely to facilitate progress towards the fight against Covid-19 which is expected to be aided by the production of home-grown vaccines.

South Africa’s initiative to have a Covid-19 vaccine manufacturing plant reminds us of the significant developments it made in the early years of the HIV pandemic. The country began to develop home-grown antiretroviral drugs which helped to circumvent the costs of importing drugs and other challenges associated with foreign-based pharmaceuticals for HIV treatment. To date, South Africa prides itself as one of the leading countries in the world with a high ART roll-out. It is also our hope that the objectives of the Covid-19 vaccine production initiatives be soon realised.

* Dr Vimbai Chibango is attached to Gender Justice, Health and Human Development. This piece emerges from a RADLA (Research and Doctoral Leadership Academy) workshop. Vimbai writes in her personal capacity.

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