JOHANNESBURG — The detection of the Omicron variant in Africa marks the next phase of the fight against Covid-19: many more people vaccinated in poorer countries where vaccines were scarce, to prevent new mutations from developing.
But while world leaders sometimes talk about this as if it’s largely a matter of delivering doses abroad, South Africa’s experience at least points to a much more complex set of challenges.
Like many poor countries, South Africa had to wait months for vaccines because richer countries monopolized them. Many countries still do not have nearly enough doses to inoculate their populations.
The problems have not ended as the shots started coming in in greater numbers.
Neglected and underfunded public health infrastructure has slowed delivery, especially to rural areas, where storage and staffing problems are common.
And now in parts of Africa, as well as South Asia, there are mounting signs that skepticism or outright hostility to the Covid vaccines may run deeper than expected, even as the new and potentially more dangerous Omicron variant spreads. In Africa, at least three countries have now reported Omicron cases: South Africa, Botswana and Wednesday, Nigeria.
Deep distrust of governments and medical authorities, especially among rural and marginalized communities, can already delay vaccination campaigns. The legacy of Western exploitation and medical abuses during and after colonialism also weighs heavily.
Misinformation circulating on social media often fills the vacuum, some pouring in from the United States and Europe, where vaccine refusal has also been an issue.
“There is no doubt that vaccine hesitancy is a factor in vaccine introduction,” said Dr. Matshidiso Moeti, the World Health Organization’s Africa director. News or rumors of possible side effects, she said, “are singled out and discussed, and some people get scared.”
Just days before the Omicron variant was first discovered, health officials in South Africa refused dose shipments from Pfizer-BioNTech and Johnson & Johnson, fearing their 16-million-shot supply would be spoiled by insufficient demand.
Although only 36 percent of South African adults are fully vaccinated, daily vaccinations are already leveling off, according to government statistics.
It’s not just South Africa.
Namibia, Zimbabwe, Mozambique and Malawi have also asked vaccine manufacturers and donors to hold off on sending more injections because they can’t use the supplies they have, according to several health officials involved in the effort to distribute vaccines to developing countries.
Research has consistently shown that factors such as public distrust and unequal vaccine distribution can increase vaccine hesitancy in any country. But these problems were often more common in poorer countries during the pandemic, said Dr. Saad Omer, a Yale University epidemiologist, and they have had a deeper effect.
Public messaging campaigns and carefully orchestrated vaccine deliveries can counter the distrust, but they are scarce.
“Almost no investment has been made in education or promotion of vaccines in low-income countries,” said Dr. omer. “Why do we expect that we just have to drop vaccines at an airport, take a picture and people will run to the airport to get the vaccine?”
Only one in four health workers in Africa has been vaccinated, World Health Organization officials said. In several countries, less than half say they plan to be vaccinated.
It’s not just a problem for Africa.
In India, health workers face sometimes violent resistance in rural communities. Vaccine hesitation rates are approaching 50 percent among those who dropped out of high school. In some parts of the country, more than a third of doses spoil amid low demand.
Still, many are eager to get vaccinated. When doses first became widely available in South Africa early this year, a third of adults in the country were quickly vaccinated, a pattern that is repeating elsewhere.
Experts emphasize that even partial incorporation will slow the spread of new or existing variants. But that may not be enough to achieve the high vaccination coverage needed if the world is to get out of the pandemic.
Mistrust of government and medical authorities predates Covid in South Africa long before Covid. But a series of setbacks with the vaccine rollout, as well as widespread allegations of corruption during last year’s lockdown, have added to public unease.
“There is a lack of confidence in the public health’s ability to provide vaccines,” said Chris Vick, the founder of Covid Comms, a South African nonprofit.
The group has held information sessions about vaccines, but it is not easy to overcome skepticism. After a session in Atteridgeville, a Pretoria congregation, a 20-year-old who attended said she was not convinced.
“I think Covid is not real,” said the young woman, Tidibatso Rakabe. “They’re playing with us, politicians and everyone.”
Many say they are afraid of side effects.
Earlier this year, reports of extremely rare blood clots prompted the United States to cut short supply of the Johnson & Johnson vaccine, causing South Africa to delay its rollout to health professionals. Both countries decided to resume firing after concluding that they were safe.
The South African government held regular briefings, but these were televised and in English, while radio remains the most powerful medium and most South Africans do not speak English as their mother tongue.
Online registration systems also left out millions of people who don’t have regular access to the internet.
Aid efforts during the lockdown have been tainted by corruption scandals, with the president’s spokeswoman being forced to resign. The health secretary also later resigned after it was revealed that his office had fraudulently awarded a $9 million communications contract.
The racial divide is another important factor.
White South Africans are significantly more likely than others to be skeptical about the vaccines, a recent study found. That’s partly due to distrust of the black-led government, but also because American Covid conspirators have found social media reach out to white South Africans, Mr. Vick from Covid Comms.
While black South Africans are more open to vaccination, they are vaccinated at lower rates, often citing the difficulty of reaching the vaccination sites. Some also express hesitation about getting a second chance.
The coronavirus pandemic: important things to know
Vaccine hesitancy has long hampered global vaccination campaigns, suggesting some of the drivers predate the pandemic, according to health experts.
Health resources are often scarce in poor, rural areas. Doctors from the capital or from abroad often oversee vaccinations. But through its history of neglect and exploitation, communities are suspicious of outsiders carrying mysterious shots.
The first modern global campaign, begun in 1959 against smallpox, sparked deep skepticism in parts of Africa and Asia, where it was seen as a continuation of the medical abuses of the colonial era. Some WHO officials used physical violence to vaccinate people, fueling mistrust. The campaign lasted 28 years.
The attempt to eradicate polio, which finally emerged in poor countries in the 1980s and is still ongoing, has met similar resistance. A study in the scientific journal Nature found that vaccine avoidance was highest among poor or marginalized groups, who believed that health authorities, especially Western governments, would never voluntarily help them.
In Nigeria in the early 2000s, amid a spike in religious tensions, unfounded rumors circulated that foreign health workers were using polio vaccines as a cover to sterilize the country’s Muslim population. Boycotts and local bans led to a resurgence of polio, with cases spreading to 15 other countries, as far as Southeast Asia.
Similar rumors surfaced among the Muslim minority in India, after which the number of polio cases increased by a factor of six in one year.
Health authorities may now be paying the price for years of pre- and post-colonial exploitation that has fueled deep distrust of western medical authorities. A survey of 15 countries by the Africa Center for Disease Control found that 43 percent of those polled believe Africans are used as guinea pigs in vaccine trials — a legacy of Western drug companies doing just this in the 1990s.
Even within their own borders, Western governments are struggling to overcome vaccine resistance. So it’s hard to imagine they do better in distant societies where they don’t have a local understanding.
Any semblance of Western powers forcing unwanted vaccines into African or Asian weapons threatens to deepen resistance.
“If the goal is to keep the US and the rest of the world safe, it should be pretty obvious that the success of the domestic program depends on what happens internationally,” said Dr. omer.
Declan Walsh contributed reporting from Nairobi.