Vaccine hesitancy undermines fight against SARS-CoV-2

The decisions of governments in under-developed nations and the Aid organizations to carry out critically needed infrastructure projects are usually finalized in cities far away from the regions.  If they quickly build a bridge across an African river to benefit the local population, the latter will never “see it as theirs.” They might even refuse to use it in spite of the evident convenience to facilitate their mobility. Absent from their collective imagination, they view it as an extraneous artifact that was “parachuted down in their reality” by anonymous bureaucrats and do not feel they have a stake in it.  In his book Les Damnées de la Terre, Frantz Fanon, a French physician, philosopher and political activist, said that citizens must first start imagining their “need of a bridge” and then discuss details with their representatives of how to remedy it . If they are engaged in that process from the start, they will cooperate in its build-up and maintenance.

A similar situation will arise if the governments just inform their population that a vaccine for SARS-CoV-2 is ready and they should line-up for its administration. The suspicion, and even overt resistance, against vaccines in general has been sadly building up in the modern nations, fueled by shady political and business interests. On September 12, Natalie Allen, an anchor at CNN International, interviewed Dr. Heidi Larson, director of the Vaccine Confidence Project based in London. They have been studying data from almost 140 countries to determine confidence in them. At the end of the interview she precisely made that point, saying that now is the time to engage the local entities like civic institutions, religious organizations, etc., in order to make the common citizenry feel that “they have been consulted in this task.”

In an article recently published in The Lancet, Alexandre de Figuereido, Clarissa Simas, Emilie Karafillakis, Pauline Paterson and Heidi Larson reported the results of their “large-scale retrospective data-driven analysis, we examined global trends in vaccine confidence using data from 290 surveys done between September 2015 and December 2019, across 149 countries, and including 284,381 individuals.” They divided their project as follows:

  1. One country (the Philippines) was surveyed over six different timepoints.
  2. Thirteen countries were surveyed over four timepoints.
  3. Twenty-eight countries were surveyed over three timepoints.
  4. Forty countries were surveyed over two timepoints.
  5. Sixty-seven countries were surveyed only once.

With the collaboration of Gallup International, the European Commission, the Philippines Survey and Research Center, and Wellcome, they used online, telephone and face-to-face interviews to determine the participants’ perception of the Public Health importance, safety, and effectiveness of vaccines. The responses to the three statements were measured on Likert scales ranging from “strongly disagree” to “strongly agree.” The researchers used previously published data on vaccine confidence collected since 2015 from almost 250,000 participants and the survey responses collected in 2019. The researchers found that:

  1. Argentina, Liberia, and Bangladesh had the highest estimated percentage of respondents strongly agreeing that vaccines are safe in late 2015 whereas Japan, France and Mongolia had the lowest.
  2. Ethiopia, Argentina, and Bangladesh had the highest percentage of those agreeing that vaccines are important in 2015, whereas Turkey, Morocco and Georgia had the lowest.
  3. Ethiopia, Argentina, and Mauritania had the highest percentage of respondents who strongly agreed that vaccines are effective in late 2015.

“Between November 2015 and December 2019, we estimate that vaccine confidence fell for all three elements of confidence in Indonesia, the Philippines, Pakistan and South Korea, and for two elements in Afghanistan and Vietnam.” The Philippines, which had ranked in the Top 10 countries for all three elements in 2015, had the most precipitous drop, ranking no higher than the 70th position in the 2019 study. There is a strong public reason for that unusual change of mind in their citizenry. In November 2017, after having vaccinated thousands of its citizens with Dengvaxia—a new vaccine against Dengue form the Sanofi company—the Philippines received a notification from the company that all the vaccinated individuals not previously exposed to the disease might have serious side effects after injection. The Philippine society reacted with extreme outrage and the government officials, who had hastily approved its purchase, were openly shamed by a body politic that suddenly lost confidence in vaccines.

The researchers found that being male and having fewer years of formal education were significant determinants of respondents’ aversion for vaccines; on the other hand women, who usually nurture the young children, are much more aware of the benefits of vaccines and the need to protect the safety of the society as a whole. Only in South Korea and Malaysia they found organized opposition and mobilization against vaccines, buttressed by mendacious disinformation campaigns in the web.

In a recent article in The New York Times, Denise Grady, Katherine Wu and Sharon LaFraniere said: “AstaZeneca revealed details of its large coronavirus vaccine trials, the third in a wave of disclosures by drug companies under pressure to be more transparent about how they are testing products that are the world’s best hope to end the pandemic. Polls are finding Americans increasingly wary of accepting a coronavirus vaccine. And scientists inside and outside the government are worried that regulators, pressured by the president for results before Election Day on November 3, might release an unproven or unsafe vaccine.”

In all political camps, there is a growing public mistrust against the authorities and the scientific community in general, after decades of disclosure of their misdeeds, real or imaginary, that have sapped the confidence of the common citizenry in them. Any clinical fiasco provoked by any major vaccine candidate against the SARS-CoV-2 will boycott its public acceptance and their eagerness to have it administered. If a large enough number of citizens refuse to be vaccinated, the herd immunity that we are all expecting in the next few months, will never materialize.

Now is the time to actively discuss the vaccine candidates and how to deploy them efficiently. 

Now is the time for regulatory agencies to inform what their guidelines for approval really are.

Stay distant. Stay safe. Stay beautiful.

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Don’t leave me alone.