Addressing vaccine hesitancy, a potential problem in the fight against coronavirus

The COVID 19 pandemic has wreaked enormous havoc on the health, economic and social fabric of nations around the world. Ghana is certainly no exception. As at the time of writing (February 26th, 2021) the number of SARS COVID 19 recorded infections in Ghana stood at 81673 with 588 deaths (Johns Hopkins Coronavirus Resource Center). Whilst the number of deaths may seem minuscule relative to the number of recorded cases, to the families, friends and loved ones of each person who has lost their life to COVID 19 infection, the loss is one hundred percent. 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 SARS COVID 19 infection also keep manifesting in patients who have seemingly gotten over the infection.

Various measures have been instituted to help curb this menace. These have mainly involved social distancing of at least 6 feet from others, wearing of face masks and liberal use of sanitizing techniques such as frequent washing of hands and use of hand sanitizers to maintain appropriate hygiene. Other key measures have included a ban or limiting of the numbers at social gatherings like funerals, weddings and parties as well as closure of schools by the government. How effective these have been is an entirely different question, as these rules have been flouted by all segments of our populace.

Thankfully, there is now another powerful arsenal in our COVID fighting toolkit, vaccines! Due to massive financial investments, cutting of the bureaucratic tape, as well as the sheer ingenuity and brilliance of scientists all over the world, COVID 19 vaccines have been developed at an amazing speed. The world now has numerous vaccines, including the Pfizer vaccine and Moderna vaccine, both of which have been proven to provide up to 95% efficacy in preventing COVID and severe COVID infections.

Other vaccines include the AstraZeneca vaccine, Sputnik and Johnson and Johnson vaccines. Ghana recently became the first country in the world to receive vaccines acquired through the global United Nations backed COVAX vaccine initiative. Ghana received 600,000 doses of the COVISHIELD AstraZeneca vaccine, produced by the Serum Institute of India on February 24th, 2021. The government also recently issued a COVID vaccine rollout plan, with the vaccination process set to be rolled out in 3 different phases. The first phase will involve frontline healthcare workers, individuals with underlying conditions, frontline security personnel, members of the Legislature, Executive and Judiciary.

This begets the crucial question; will Ghanaians willingly and happily take the vaccines? Vaccine hesitancy is a massive danger to the success of any vaccination program, and COVID 19 vaccination is certainly no exception. It is considered one of the ten main threats to global health by the World Health Organization (WHO). According to www.thinkglobalhealth.org, the mere existence of vaccines alone doesn’t save lives, they must actually be administered through vaccination programs in order to protect lives.

Vaccine hesitancy is a well-recognized 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 a significant number of our populace barely even believe COVID 19 actually exists. There is a prevailing belief that even if it does exist, COVID infection is the preserve of the middle and upper middle class in society. As such, how will people even believe in the authenticity of the vaccine for a disease they don’t think exists?

Such vaccine hesitancy has been fueled by false rumors and conspiracy theories and is 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 immunization in Mozambique, and vaccines being used to sterilize girls in Cameroon are a few of the rumors and conspiracy theories that have led to vaccine hesitancy and the ensuing low uptake in immunizations, and hence difficulty in eradicating the diseases in question. Social media has emerged as another powerful and pervasive means of spreading vaccine conspiracy theories.

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 vaccinations, and ensure a high uptake in the general populace, once vaccines become available, to increase Ghana’s chances of achieving herd immunity.

Literature tells us that most patients, similar to most parents who refused vaccinations for their children, may not be really resistant to the vaccine or immunization, but 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 3 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, 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 elucidate the concerns of patients, in order to assuage them.

It must be said that some of the patients may still refuse the vaccination; this doesn’t mean that these patients should be ostracized, their intellect ridiculed, 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.

Dr. Nana Yaa Koram, MD MPH

Board Certified Internal Medicine Physician with a Masters degree in Public Health from Harvard University