The European Medicine Agency announced yesterday afternoon that the Oxford-AstraZeneca vaccine is “safe and effective” following their investigation into a potential link with blood clots that had caused more than 20 countries to suspend or delay their use of the vaccine. The EMA’s executive director, Emer Cooke, said the agency had come to a “clear scientific conclusion”, adding that the vaccine was “not associated with an increase in the overall risk of thromboembolic events or blood clots”.
Unfortunately public opinion does not always follow the science as closely as we might like. It is too soon to tell exactly how the events of recent days and weeks will impact the global vaccine roll-out, but past polling suggests the reputational damage caused by the scare could have a significant impact on people’s trust. When considering where this damage may be worst, it may be useful to look beyond Europe to Africa, where the AstraZeneca vaccine forms a much more integral part of the Covid-19 recovery plan.
Even before the blood-clot scare, the AstraZeneca vaccine was already having issues in Europe. In January, the German newspaper Handelsblatt mistakenly published that the AstraZeneca vaccine was only 8 per cent effective among the over-65s. French president Emmanuel Macron later also furthered the belief that the vaccine was “quasi-ineffective”. Despite these claims being debunked, polling data shows that the worries of the public could not be so quickly assuaged, and research at the end of February by YouGov found that almost a quarter of people in Germany, Italy and France said they would refuse the AstraZeneca vaccine if offered it.
The latest YouGov polling from March shows people’s fears have only worsened, with 61 per cent of French respondents, and 55 per cent in Germany, saying they believe the AstraZeneca vaccine is unsafe, compared to just 9 per cent in the UK. Interestingly, there has been no significant impact on the perceived safety of the Pfizer or Moderna vaccines.
But it won’t be European countries who are worst hit by this reputational storm. Analysis from our international coronavirus vaccine tracker shows that the African Union is far more reliant on the AstraZeneca vaccine, because it is much more straightforward to store and distribute, and crucially, it is cheaper. The African Union paid $3 per dose for the AZ, as opposed to $6.75 per Pfizer dose and $10 per Janssen dose, according to Unicef.
Figures from the Duke University Global Health Innovation Center show that AstraZeneca makes up three-quarters of the vaccine doses the African Union has purchased; in the EU and the UK, AstraZeneca only accounts for a quarter of purchased doses.
Africa is already far behind wealthier countries in the race to vaccinate, and non-AstraZeneca vaccines are being prioritised in areas which are at risk of the South African-variant.
Much of the global polling on general vaccine hesitancy has not studied Africa, but specific research by the Africa Centres for Disease Control and Prevention (Africa CDC), in partnership with the London School of Hygiene & Tropical Medicine (LSHTM), found large disparities between African countries – with 94 per cent of Ethiopians saying they would take the vaccine but only 59 per cent of those in the Democratic Republic of Congo.
The survey of 15,000 people across 15 countries found that vaccine hesitancy was higher among those in large cities, with one-in-five saying they wouldn’t take the Covid-19 vaccine, compared to just 14 per cent in villages. In another survey by GeoPoll, the main concern raised about the vaccine was its safety. Tanzania’s President John Magufuli, who passed away this week, was among those who propagated coronavirus-scepticism, and the Tanzanian government refused to purchase vaccine doses.
Previous examples of the dangers of vaccine hesitancy cause understable concern – in 2003/4, five Nigerian states boycotted the polio vaccine, fuelled by rumours that the vaccine was an American conspiracy to spread HIV, or cause infertility in Muslim girls. The boycott caused annual polio instances to increase five-fold between 2002 and 2006, and was a major setback in the fight to eradicate polio.
Raji Tajudeen, head of public health institutes and research at Africa CDC told the Lancet that misinformation in the media is responsible for a lot of the doubts and mistrust around the Covid-19 vaccine – two-thirds (66 per cent) of the survey respondents said they had seen or heard rumours about the vaccines.
Half of the respondents believed that Covid-19 was a planned event by foreign actors, with another common belief being that people in Africa were being used as test subjects in vaccine trials (45 per cent), or that vaccine trials have led to the deaths of children (33 per cent). Sixty-two per cent of those who heard disinformation stories said they shared them with their friends and family.
Charles Wiysonge, director of Cochrane South Africa at the South African Medical Research Council told the Lancet that understanding concerns about the vaccine is key to being able to counter misinformation. “This is an opportunity to really educate people about vaccines, about what they are, how they work, and how they have been very successful,” he says. “It is important that we try to understand what the issues are in every setting; we shouldn’t assume anything.”
This data shows that while there isn’t necessarily a greater mistrust of the vaccine in countries within the African Union, there is still hesitancy, fuelled by misinformation and social media. If African countries suffer the same confidence hit to AstraZeneca that has been seen in western Europe, this could have a huge impact on their efforts to vaccinate their population, and further widen the gap between the richest and poorest parts of the world.