Vaccine hesitancy challenges our response to the COVID-19 pandemic in the U.S. and around the world. I recently had a chance to address this issue first-hand while visiting my research collaborators in Burkina Faso. COVID-19 vaccines have been in short supply in Africa. But, things have improved, and the Johnson & Johnson and AstraZeneca vaccines are now available in Burkina Faso. Supplies are limited and will certainly not meet the projected needs of this country of more than 20 million. However, vaccines appear to be readily available right now because nobody seems to want them. I saw this among my colleagues, rational physicians and scientists well-versed in medical science, who were universally unvaccinated.
Burkina Faso, a landlocked country in West Africa, has been quite lucky so far, with under 100 cases reported per day in most of 2020 and a mild surge from December 2020 to January 2021, but few cases reported since, even after recent surges in other African countries. In Ouagadougou and Bobo-Dioulasso, the vast majority are unmasked, indoors or out. And perhaps we cannot blame them, as the virus appears to remain at bay. But one can expect future surges. The right time to protect the population with vaccination is now, and so it is frustrating that vaccine uptake has been quite poor.
I was in Bobo-Dioulasso to discuss our program in malaria research, but, unsurprisingly, conversations often turned to the pandemic. And I found myself more and more a vaccine evangelist.
Why hadn’t my colleagues been vaccinated? There were no good answers. My long-time collaborator in Bobo-Dioulasso, somewhat advanced in years like myself and therefore a high priority for vaccination, was interested but had delayed over the last few months, as he was having trouble convincing his wife to also get the vaccine.
Others just hadn’t gotten around to it. But deeper probing did elicit concerns: for example, many were afraid following the misinterpretation of a widely-cited quote from Luc Montagnier, MD, a prominent French AIDS researcher, arguing against vaccination because it might select for dangerous viral variants. This claim has been debunked by many experts, and regardless, his statement was not suggesting that the vaccine was harmful to the recipient. But, as related by my colleagues, it had evolved to a supposed prediction that the vaccine was lethal — Francophone fake news.
How have we stumbled to this point of having effective vaccines but trouble convincing people to receive them? Vaccine hesitancy is not new. It has challenged vaccine programs in the U.S., leading to measles outbreaks, and around the world, enabling persistence of polio and inadequate responses to other preventable illnesses. From my vantage point, I can’t help blaming in part the torrent of misleading information from our former administration, usually not directly arguing against the vaccine (after all, our ex-President took personal credit for the rapid vaccine push), but allowing vaccine skepticism to become a standard right-wing talking point. But, this is clearly not just a U.S. phenomenon. Similar opposition to mainstream public health recommendations is widespread worldwide. Eagerness to counter science-based recommendations of any sort results in preference for hydroxychloroquine and ivermectin over proven therapies, denial of mask efficacy, communication of unfounded concerns about vaccine safety, and aggressive opposition to all of these proven measures.
Without public acceptance, improved delivery of vaccines to countries around the world will not be enough to adequately protect populations. What can we do to improve vaccine acceptance? Improving public health literacy and acceptance of science are high, but challenging, priorities. More immediately, replacing complex arguments with simple persuasion can help. In my case, a few conversations led to a stream of vaccine converts. Due to perceived social obligations, direct health concerns, guilt, or simply a wish for me to stop bugging them, they held out their arms. As of now, my senior colleague (but not his wife), our lead study physician, two lead lab researchers, and the driver who I cajoled for a week all have slightly sore arms and freshly inked vaccination cards. Seeing these actions by their leaders, others on the team are promising to follow.
My personal efforts of vaccine proselytizing in Burkina Faso have hardly made a dent in the pandemic, but they have highlighted both challenges and some reason for optimism. Without attention to vaccine hesitancy, aggressive efforts to improve vaccine delivery to low-income countries won’t have the desired impact due to the failure of many to agree to vaccination. On the other hand, personal persuasion may quite easily push some individuals to take the appropriate action. We may not convince anti-vax fundamentalists, but many “hesitants” may need only a soft push. I can only reach a few, but celebrities and thought leaders can reach many, with the latest surge further inducement. With a continued push, emphasizing personal engagement, we can improve protection against COVID-19 and speed up the end of this devastating pandemic.
Philip Rosenthal, MD, is a professor of medicine at the University of California San Francisco and editor-in-chief of the American Journal of Tropical Medicine and Hygiene.