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Africa only 5% vaccinated? Not enough supplies or distrust of public health?

Why Africa is so far behind in vaccination rates.

A Johannesburg vaccine clinic.Joao Silva/The New York Times

Last week, just days before scientists discovered the Omicron variant, South Africa’s government asked Johnson & Johnson and Pfizer not to make some planned deliveries of their Covid-19 vaccines. The country already had more doses in storage than it could use — about 16 million, in a country of 60 million people — and officials were worried that further supplies would spoil before they could be used.

How could that be?

The main answer should be familiar to Americans: vaccine skepticism. “There is a fair amount of apathy and hesitancy,” Dr. Shabir Madhi, a vaccination expert in South Africa, told Reuters. For similar reasons, Namibia, Zimbabwe, Mozambique and Malawi have asked donors to pause vaccine deliveries, my colleague Declan Walsh has reported.

(This article on vaccine skepticism in Africa, by Lynsey Chutel and Max Fisher, has more detail.)

The sources of the skepticism are different in the U.S. and in Africa. In much of Africa, they are related to decades of exploitation and poverty. In the U.S., the biggest cause is political polarization: More than 35 percent of Republican voters are unvaccinated, compared with fewer than 10 percent of Democrats.

But both forms of skepticism stem from distrust — of experts, institutions and government leaders. And that distrust has become a major reason that the world is struggling to defeat Covid. The more people remain unvaccinated, the more the Covid virus spreads and the more people die. Less vaccination also increases the chances that dangerous variants will emerge.

“I think that Covid is not real — they are playing with us, politicians and everyone,” Tidibatso Rakabe, a 20-year-old resident of a township near Pretoria, told The Times. She does not plan to be vaccinated.

After scientists in South Africa announced the discovery of Omicron, some commentators in the U.S. jumped to the conclusion that unequal vaccine distribution between rich and poor countries was the cause. But that’s not quite right, as the stories of Africa’s unused vaccines make clear. (Plus, Omicron may not have originated in Africa.)

The airport drop

Unequal vaccine access was a major issue earlier this year. High-income countries were faster to order vaccines and could afford more of them initially. They also had the infrastructure to produce and distribute the shots. India and South Africa are among the few lower-income countries that manufacture Covid vaccines.

As a result, even residents of many low-income countries who were eager to receive vaccines often had to wait weeks or months to do so.

Today, though, a simple lack of access is less of a problem in many places. The U.S. and other rich countries are distributing hundreds of millions of doses for free, and pharmaceutical companies are selling others at a discounted price, often less than $10 a dose. In many poor countries, vaccinating the entire adult population would cost significantly less than 1 percent of annual G.D.P.

It still is not close to happening, however. Worldwide, about 56 percent of people have received at least one vaccine dose. Every continent is above 50 percent except for Africa — which is at about 10 percent. In South Africa, the share is 29 percent.

One problem is a lack of public health infrastructure in poorer countries, especially in rural areas, as Lynsey and Max note in their article. There often are not places to store the vaccines or people to administer to them. Governments have also failed to explain the vaccines’ importance to their citizens.

“Almost no investment in vaccine education or promotion has gone into low-income countries,” Dr. Saad Omer, a Yale University epidemiologist, said. “Why do we expect that all we will have to do is drop vaccines at an airport, do the photo op, and people will come running to the airport and grab the vaccine?”

A legacy of mistreatment

The lack of vaccine education plays into an underlying mistrust of many medical treatments, especially those that come from other countries. That mistrust has its roots in a history of horrific experiments under colonialism.

In present-day Namibia during the early 1900s, German officials sterilized some local residents, injected others with arsenic and deliberately infected people with smallpox, typhus and tuberculosis (as this Times essay by Kavena Hambira and Miriam Gleckman-Krut explains).

Such direct harm became less common in the second half of the 20th century, but mistreatment was still common. Drug companies sometimes conducted research trials without people’s consent. Only a decade ago, Pfizer made financial payments to the parents of dead children in Nigeria after a research trial went wrong.

Arguably the biggest source of modern distrust in southern Africa is H.I.V. After inventing lifesaving treatments, Western pharmaceutical companies initially kept their prices too high for many Africans to afford, and governments did not fix the situation for years. In South Africa, Zimbabwe and some other countries, life expectancy fell by more than a decade from 1990 to 2005 — a decline with little modern equivalent.

Given this history, it’s not exactly surprising that many Africans are skeptical of the Covid vaccines, even though all available evidence suggests they safe and effective. Online misinformation exacerbates the problem, as it does in the U.S.

In a survey of 15 African countries done late last year, 49 percent of respondents said they believed rumors that Covid was planned by a foreign actor and 45 percent said they believed Africans were being used as guinea pigs in vaccine research trials. Those misperceptions are costing people their lives.

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