Overcoming COVID-19 vaccine hesitancy: Addressing the many sources of hesitation

COVID-19 disease was first detected on November 17, 2019, in Wuhan City, China and quickly spread across the world. On January 30, 2020, the World Health Organization, also known as WHO, declared the COVID-19 outbreak a Public Health Emergency of International Concern.

The disease has caused millions of deaths worldwide, and one of the strategies to control the pandemic is mass vaccination. More than 11 billion doses of COVID-19 vaccines have now been administered worldwide, and vaccines have played a critical role in preventing serious disease and death from COVID-19.

In today’s program, we find out why some people in Kenya are hesitant to take the COVID-19 vaccines and what measures are being taken by the Kenyan Ministry of Health to change their minds.

MUSIC UP THEN OUT

Abdi is one one of the many Kenyans who was hesitant to take the COVID-19 vaccine. He just recently took it. I spoke with him and wanted to find out why he did not want to take the vaccine in the first place and what changed his mind.

You know I come from the Somali community and I am also Muslim. I had heard stories that the vaccine is made from pork, and that goes against my religious beliefs. I also had heard that the COVID-19 vaccine is meant to reduce the population of some communities.

Like the Somali community?

Yes.

Why?

You know we have many Somali immigrants in Kenya and our population is growing fast. I heard some Somalis say that this could be one way of reducing our numbers.

How?

(LAUGHING) You know, I heard that … (WHISPERING) it reduces a man’s strength.

A man’s strength—what do you mean?

I mean sexually, it will affect men and maybe make them weak during sex.

Abdi, a 53-year-old man, was hesitant because of his religious beliefs and he was also afraid that the vaccine would affect him sexually. On the other hand, Allan, a young man in his 20s, is very enthusiastic about the COVID-19 vaccine. He was not always enthusiastic about it and at first was not interested at all—until he got infected with COVID-19. I caught up with him in Nairobi and asked him if he has taken the vaccine.

Oh yes! I got my shot in May 2021.

You sound like you were happy to get the shot.

Yes, I actually went to look for it. I did not wait for the Ministry of Health to come to my area. I travelled several kilometres to get it.

Why?

About a month before I got the vaccine, I had COVID-19 and I was really sick. I thought I would die.

Did you find out how you got COVID-19?

Yes, I attended a house party at a friend’s place and at some point, very few of us had masks on and we were not quite keeping social distance. One of my friends seated next to me kept coughing, but I did not think much of it. About a week later, I started feeling sick.

So you did the COVID-19 test?

No. At that time, I did not think I had COVID-19, I actually thought it was malaria. I have had malaria a few times and I had the same symptoms. I bought some medicine at the pharmacy and took it, but there was no improvement. One day after work, I passed by the clinic and they did a malaria test and it was negative. They tested for typhoid. It was positive. I was then put on typhoid medication. A few days later. I was feeling worse. I stayed at home to rest, and in the evening took a walk around the neighbourhood. I collapsed outside my house. My neighbours helped me into the house. After feeling a bit better, I went to the pharmacy and explained my symptoms. They gave me some supplements and advised me to go for the COVID-19 test. I was very hesitant.

Hesitant of taking the test?

Yes, I think I was in denial that I might have COVID-19—and at that time, there was so much stigma around people with COVID-19. I was afraid of being taken to the quarantine centres in the city where they were taking people suspected to have COVID-19. So I went home, took the supplements, and hoped that I would improve. I did not.

So what happened then?

I got so sick that I decided to call the COVID-19 emergency numbers that the Ministry of Health had issued. The person who picked my call was very good to me. She asked about my symptoms, which were very high fever, and at that point I had lost my sense of taste and smell. I had joint pains and fatigue.

Did she convince you to go for the test?

Yes, she directed me to the nearest place I could get the COVID-19 test and I did the test. During the first days of COVID-19 in Kenya, we could wait for 24 to 48 hours to get the test results. I got a call and was told that I had a positive COVID-19 test. Luckily, because I lived alone, I was asked to stay indoors and told that the Ministry of Health staff would be checking on me. They also advised what medication I should get for my symptoms from the pharmacy. I was indoors for 14 days and after the first seven days, I was much better. But it took some months before I got my sense of taste and smell back. I still have some fatigue several months later, but I am much better now.

Were you thinking of getting the vaccine before you contracted COVID-19?

No! In fact, I did not think I needed it.

Why?

I am young—well at 26, I consider myself young. I do not have any health issues. I thought I was always careful in keeping to the COVID-19 hygiene measures recommended by the Ministry of Health. I was working from home and when out, I wore my mask religiously and kept distance until that one time when I was at the party. I also had fears about the vaccine.

What fears?

I have a close friend who almost lost his left leg when he was three years old because of wrong administration of the baby vaccines. He spent many months in hospital and missed many classes in primary school because of that.

Abdi and Allan, two people with varied reasons for not taking the vaccine. Salim Husein is the Head of the Department of Primary Health Care at the Ministry of Health in Kenya. He understands very well the issue of vaccine hesitancy because he deals with it every day. I asked him how many people are vaccinated in Kenya now.

About 8.4 million Kenyans are vaccinated currently. That is about 1% of the population.

That is a small percentage. Why aren’t people taking the vaccine?

There is some hesitancy in getting the vaccine, which is for many reasons. The main one is misinformation or lack of proper information and in some cases no information at all on the disease or the vaccine.

Where are people getting the wrong information?

Most of the misinformation is through social media as well as word of mouth. This contributes to the largest percentage of people who are hesitant. This is where myths fall.

What are some of the myths that you have dealt with?

There is a lot of contradictory information about the COVID-19 vaccine and therefore there are many myths and misconceptions. For example, there are those who are convinced that when they get the vaccine, they are being injected with COVID-19 and they will die. And since the vaccine is from a foreign country, it is a means to reduce the population of people in Kenya or Africa. Others beleive that it can kill their unborn child, or cause men to lose their libido or cause infertility in women.

Both Abdi and Allam have had to deal with their own fears about the vaccine. For Abdi, it was for religious reasons and fear that it may affect his sexual health. For Allan, it was from the experience his friend underwent when he got the vaccines given to newborn children. Kenya has had a history of vaccine hesitancy even with the childhood vaccinations. I asked Allan if he has received other vaccinations.

Yes, I did get childhood vaccinations and according to my mum, I did not suffer at all. I even got the yellow fever vaccine with no side effects when I needed to travel out of the country. But I guess with COVID-19 and all the unknown details about it, I was hesitant and I also felt I did not really need to take it. After the positive COVID-19 test, I resolved to take it—no one convinced me. If I could, I would have taken it immediately I tested positive for COVID-19.

What questions did you have about the COVID-19 vaccines?

Well firstly, I thought that they were developed too fast. And secondly, I had questions about some side effects. For example, I heard that, early on in Europe, people were getting blood clots from the vaccine.

Thanks, Allan. I think now is a good time to ask Dr. Salim about these issues. Dr. Salim, what do you have to say to Allan’s questions?

Thanks very much. And thanks for those questions, Allan. These are very valid concerns and I want to address each one of them.

First, about the development of the COVID-19 vaccines … During the pandemic, an incredible amount of money was made available to fund vaccine research, and scientists around the world pulled together and shared their data. Thanks to this, scientists were able to create the vaccines very quickly.

Also, researchers have been studying coronaviruses for decades and have learned a lot from two other coronaviruses that affected humans in the past 20 years: SARS and MERS. After the virus that causes COVID-19 was identified, scientists mapped its genetic information within two weeks. This helped them identify exactly what kind of vaccine would work against COVID-19.

However, you can be sure that no shortcuts were taken, and all the necessary steps were followed to make sure that the vaccines are safe and effective. The COVID-19 vaccines approved for use meet strict standards set by government health agencies in countries around the world. And studies about the vaccines continue to this day!

That’s reassuring, doctor, thank you.

My pleasure! You also had a question about blood clots. It’s true that there have been some reports of blood clots three to 30 days after vaccination with the AstraZeneca and Janssen vaccine, also called the Johnson and Johnson vaccine. These cases are serious but VERY rare.

In fact, studies show that you are more likely to get a blood clot from being infected with COVID-19 than you are from any COVID-19 vaccine!

Wow, that’s interesting.

Yes. The side effects of the COVID-19 vaccine are almost always mild and typically include arm soreness, mild fever, fatigue, headaches, and muscle or joint aches.

And Allan, about your final concern: COVID-19 is a risk to everyone, young and old! Getting sick with COVID-19 can have serious lasting impacts on your health and well-being. Vaccines are the safest and most effective way to prevent severe illness, hospitalization, and death due to COVID-19.

Thanks, doctor. Those are very important messages for our listeners. Now Allan, back to you for a final question: Did you have any side effects after getting the vaccine?

Honestly, I cannot tell because I still had some lingering effects of COVID-19 at the time I got the vaccine, even though I had tested negative. I was still very fatigued, and my sense of taste and smell was not fully back. But by then, I was much better and able to go to work and do everything normally—so my assumption is that I had very few side effects, if any.

Allan is happy with his COVID vaccine. Abdi, on the other hand, feels the vaccine is not necessary. I asked him if he was vaccinated.

Yes, but you know it was not out of choice. When COVID-19 hit Kenya, the Eastleigh area where I live and where most Somalis live in Nairobi was affected. The government put a lockdown on the area for a month. We really suffered. I am the sole breadwinner and I cannot let my family suffer, so I took the vaccine because there were rumours that we may not be able to access government services without a vaccine certificate.

That’s the only reason you took the vaccine?

I also saw my imam, my leader at the mosque, get the vaccine. So, I thought if the imam is taking it, perhaps it does not have traces of pork. But the main reason was that I needed to be able to transact business without a problem.

Have you observed any changes in your body since you took the vaccine?

First of all, I made sure I took the one-dose vaccine. I thought maybe a single dose would have less after-effects. I also heard from my friends and family in America and Europe that the one-dose vaccine is better. Well, I did get a bit sick. Fever and headache for a few days and then I was fine.

How about your sexual health?

Oh that! Well, (LAUGHING) my wife would be better placed to answer that (LAUGHING). I have not yet seen any negative change. But you know, I am an old man now. I am over 50 and I am not as active as I was, so I don’t know perhaps in one or two years, I will see. I am still observing (LAUGHING).

Did anyone else in your family take the vaccine?

No! Just me. I told them to wait to observe how it would affect me before anyone else takes it. But they have been observing all the necessary hygiene measures—handwashing, wearing a mask, and keeping distance—and none of us have been infected by COVID-19 so far.

And now that you have observed?

It has been less than a year. Let me give it another six months or a year and who knows if COVID-19 will not be there anymore.

It is individuals like Abdi that Dr. Salim is working hard to convince that there is false information about the vaccine. I asked Dr. Salim if these myths are true. Hi again, Dr. Salim.

Hello. No, these rumours are not true. Initially, there was inconsistent and uncoordinated information coming from various sources. This made it easy for people to create false claims about the COVID-19 vaccine. There is also true information that scares people. For example, we spoke earlier with Allan about the normal, mild side effects of COVID-19 vaccines. The idea of side effects scares many people, but I want to reassure all the listeners again that the side effects from COVID-19 vaccines are normal and typically very mild, including things like arm soreness, mild fever, fatigue, headaches, and muscle or joint aches. Other people are scared of blood clots, but again, these are EXTREMELY rare and actually, you are more at risk of getting blood clots if you get COVID-19 than from being vaccinated.

There were also concerns that the vaccines being distributed in Africa were inferior or fake. This is untrue as well. The COVID-19 vaccines approved for use meet strict standards set by government health agencies in countries around the world.

Unfortunately, though these rumours are untrue, they can scare people away from taking the vaccine. So I urge our listeners to listen to doctors and health professionals, and be very wary of fake news, misinformation, and rumours. The COVID-19 vaccines are safe and effective.

Besides misinformation, is there another reason for hesitancy?

Yes. Lack of access to the vaccine also contributes to lower numbers of people being vaccinated. This was mostly true in the first few weeks when vaccines were in limited supply. This resulted in long queues that discouraged individuals from getting the vaccine as they feared exposing themselves to COVID-19 in the process. Others were not able to access the vaccine because registration was online and there is a population of Kenyans who are not able to access internet.

Right now, we have millions of vaccines but we have few people coming for them because of the hesitancy that we are trying to address.

So how are all these reasons for hesitancy being addressed?

By giving facts on the disease as well as the vaccine. Also, just being transparent in terms of which vaccines are available, how many people have been vaccinated, the possible side effects of the vaccine, the number of infections, and the deaths as a result of COVID.

We also address myths and misconceptions on media online using The Ministry of Health portal and website. The president and Minister of Health also communicate the real situation concerning COVID and the vaccine. Within the ministry, we also have the rumour tracker system looking out for information that is false online and countering it by giving factual information. Frequently asked questions on the Ministry of Helath portal are always being reviewed to capture any concerns from the public and give the right information. Every week, we can determine what is the main myth or rumour circulating and address it with facts.

That’s for the the urban population who can access information online. How about dispelling false information by word of mouth that is mostly in the village. How is that being addressed?

By working with the county governments in the rural areas as well as community health workers. We first train them so that they know the facts about the disease and the vaccine and then pass this on to people. We are also working with different groups of people like religious leaders, teachers, prison wardens, people with disabilities, motor bike riders, and the youth. After being trained, they become champions and they help sensitize different groups within the population.

How about women? Are they also affected by the rumours and are they also involved as champions to encourage more women to take the vaccine?

At first, there were many women who worried about the vaccine. Pregnant women worried that their unborn children would be negatively affected by it. But in fact, the COVID-19 vaccines are safe and effective for pregnant women, breastfeeding women, and women planning their pregnancy. COVID-19 is more dangerous for pregnant women than for others, so it is very important for pregnant women to get vaccinated.

For breastfeeding women, we have seen that it’s possible for the COVID-19 vaccine to pass through breastmilk to breastfeeding newborns. This means that breastfeeding women who get vaccinated may also be passing on protection against COVID-19 to their babies, which is an amazing thing.

Many women also worry that the vaccine may interfere with their reproductive system, cause a change in their menstrual cycle, and eventually cause infertility. But this is untrue. Vaccines do NOT cause infertility. In fact, they do not affect the reproductive system at all.

All these issues had to be addressed for women to understand the vaccines and trust them. I must say that more women are taking the vaccine now and we have been able to make a lot of progress in the last six months. So yes, to answer your question, women are excellent champions for the COVID-19 vaccines.

MUSIC UP THEN UNDER

Dr. Salim has just explained to us how the Ministry of Health has been working to convince the Kenyan people of the importance of getting the COVID-19 vaccine. According to Dr. Salim, in the last six months, there has been a huge increase in people taking the vaccine after the ministry decided to use all means to get the right information to people.

Meaningful engagement is important for those who are hesitant. Find out why they do not want to take the vaccine and address the issue with facts. When we started doing this in Kenya, we saw the numbers of people taking the vaccine increase from five million to 18 million in less than six months. If they are hesitant because they are breastfeeding and pregnant, give facts about how the vaccine will not affect their newborn or unborn child. If it is a man fearing for his sexual health, we give facts showing that the vaccine does not affect libido or cause infertility in men or women.

What about those who are hesitant because they may have chronic diseases?

There is no evidence that the vaccine makes their conditions worse. What we have observed is that those who get the COVID-19 disease after getting the vaccine do not get severely sick. In fact, most are able to go on with their lives in a short time. It is also worthwhile noting that many of those who are currently hospitalized in the Intensive Care Unit in Kenya have not been vaccinated. It is possible for vaccinated people, especially those with pre-existing health conditions, to develop severe illness from COVID-19 and require hospitalization. But these cases are very rare.

Do you think people are scared that the situation with COVID-19 may be a lifetime of vaccines and booster shots?

We need to remember that the yellow fever vaccine which is required in many countries also required people to take booster shots for several years. It took quite some time before we finally got to the point where a vaccine shot could last for 10 years. So the COVID vaccine like the yellow fever vaccine may have to go through several tests over the years until we get to a point where a shot is taken once in many years. For now, the COVID-19 vaccines that we have are safe. They may have mild to moderate side effects, but all of them are safe and effective and they will save us not only from infection but also severe illness and death.

Allan too has advice for someone who is hesitant about taking the vaccine.

I can only speak from experience. COVID-19 is not a joke! I would rather take the vaccine anytime than suffer the pain of having COVID-19. Actually, right now, I want to go for the booster shots. I can only say go for it for your own protection and for the loved ones you live with.