Vaccines are vital to the prevention and control of infectious-disease outbreaks. They protect us from the time we are children into adulthood. Today there are vaccines available to protect against at least 20 diseases, such as diphtheria, tetanus, influenza and measles. Together, these vaccines save the lives of up to 3 million people every year.
Stopping a pandemic requires using all the tools we have available. While wearing masks and physical distancing helps reduce our chances of being exposed to the virus or spreading it to others, these measures are not enough. The COVID-19 vaccine is a critical tool in the battle against the COVID-19 pandemic.
Several factors contribute to the public acceptance of vaccines including concerns about safety and efficacy, as well as the spread of misinformation -- which is particularly rampant in the context of the COVID-19 pandemic. Misinformation about vaccines is not new in Nigeria. For example, during the monkeypox outbreak in 2017, there was a widespread rumour that the military was injecting school children with the monkeypox virus. This fake news led to the closure of schools, low immunisation rates for other vaccine-preventable diseases during the period, and general widespread panic.
In March 2021, Nigeria received 3.94 million doses of the Oxford-AstraZeneca COVID-19 vaccine to stop the spread of the coronavirus and save lives. Acceptance of the vaccine is instrumental to ending the pandemic, especially in the face of prevailing conspiracies and myths about the vaccine. To guide needed communications and engagement strategies to support the rollout of the vaccine, in February 2021, Nigeria Health Watch conducted a COVID-19 Household Vaccine survey.
Understanding COVID-19 perception to drive vaccine acceptance advocacy
The survey sought to investigate public knowledge and perception of both the vaccine and its acceptance. The overarching goal was to understand the behavioural and cultural insights of the public on COVID-19 vaccines and to use the findings to guide advocacy and social mobilisation interventions towards the acceptance of vaccines in Nigeria.
The survey was carried out in Bauchi, Bayelsa, Ebonyi, Kebbi, Lagos and Niger states as well as the Federal Capital Territory (FCT). Two Local Government Areas were randomly selected per state, one urban and one rural to fully represent both rural and urban perceptions. A total of 1,089 respondents participated in the survey -- 730 respondents in the urban areas and 359 in the rural areas. This was a cross-sectional study design with mixed methodology that adopted both qualitative and quantitative research methodologies which included face to face household interviews, in-depth interviews and focus group discussions.
The survey sought to determine the respondents' general attitude when faced with health challenges. Quantitative results revealed that about three out of four respondents indicated that the first thing they do when they or a family member is unwell, is visit the General Hospital. Urban dwellers are however twice more likely to take a family member to a General Hospital compared to rural dwellers who are more likely to go to a local health clinic. But in-depth interviews revealed that some respondents prefer to drink local herbs or visit traditional healers, others prefer to go to a chemist or pharmacy first. Most respondents agreed that they would eventually go to the hospital when their conditions get worse.
How do Nigerians get information about COVID-19?
From the onset of the COVID-19 pandemic, there has been a surge of new, constant, and complex information which has left people feeling overwhelmed. The World Health Organization (WHO) referred to this as the COVID-19 infodemic. To combat this infodemic in Nigeria, the Nigeria Centre for Disease Control (NCDC) adopted different measures, including the launch of a chatbot as part of a misinformation campaign aimed at providing Nigerians with timely and accurate information on COVID-19.
To understand the factors that influence people's opinion on COVID-19 and general health matters, the Nigeria Health Watch COVID-19 Household Vaccine survey which was funded by Meedan and conducted in partnership with EpiAFRIC examined respondents' sources of health information. Results revealed that 'Radio, TV and Social Media' were the most popular sources of information nationwide. Text messages (SMS), family members and faith leaders were other sources of information. A group of taxi drivers in Ebonyi State said, "The information we get is through networks like radio, TV and this social media. One of us might say, 'This is what they are saying o', then another person will browse it and show us."
The survey showed that some people dismiss the possibility of taking the vaccine simply because they do not believe that the COVID-19 virus exists. Responses portrayed a general mistrust of public information as well as a desire to see before believing.
A small percentage of the respondents, about a tenth of respondents stated that they do not believe that COVID-19 exists because they do not know anyone affected by the disease. A businesswoman in Niger State said, "I don't think it is real. Because I have not seen anyone that has COVID-19 with my eye like this o. I only see them on television. In fact, it is even recently that they started showing us those that are in hospitals suffering from COVID-19. As at last year that COVID-19 started, they were not showing anything, they were only showing numbers on television."
Perception and acceptance of the COVID-19 Vaccine
Nigerians cannot wait to see the end of the pandemic and the restrictions it has brought to their lives. Many expected that the introduction of a vaccine would have been met with widespread acceptance. It seems instead that respondents' perception towards the vaccine was influenced by their beliefs about the disease itself.
Although about 85% of the respondents surveyed had heard about the COVID-19 vaccine, just over two thirds were willing to take the vaccine. Of those surveyed, 56% did not have any major fears about the vaccine. The fear of infertility was a view held by under a tenth of respondents. So far, public health advisories from WHO have stated that pregnant women may receive the vaccine if the benefits "outweigh the potential vaccine risks". While the US Centers for Disease Control and Prevention found no evidence the COVID-19 vaccines cause fertility problems.
Some respondents said they will not take the vaccine because of what they have heard from others, and images and videos of adverse reactions on traditional and social media. Religious beliefs showed up strongly as a reason why respondents said they were unwilling to take the vaccine. Comments such as, "It is the plan of the devil to insert something in our body" and "it may alter my genes", were quite common but unfounded rumours. These perceptions may simply be regurgitated unwillingness as evidenced by people citing videos they had watched as reasons why they would not take the vaccine. Other respondents said that they would not take the vaccine simply because no one had explained how it works to them.
The COVID-19 Vaccination Update by the National Primary Health Care Development Agency (NPHCDA) on April 25th announced that 1,717,515 Nigerians have been vaccinated, meaning that 58.2% of the vaccine shots received have been administered.
What should Nigeria do to increase vaccine acceptance?
Accurate information unique to Nigeria's peculiar landscape needs to be developed and extensively disseminated to help Nigerians differentiate between fact and myth so they make informed decisions about their health.
The 1,717,515 Nigerians who have been vaccinated should be encouraged to share their experiences. People want to hear testimonies of people who have received the vaccines with no side effects. This will encourage and motivate them to take the vaccine.
While fact-checking organisations and government institutions continue to support by debunking rumours and misinformation, more innovative communication channels should be introduced to engage and correct misinformation especially in communities.
Community mobilisation with the support of religious and traditional institutions to pass the right message about the vaccine at the grassroots is key to addressing concerns about the COVID-19 vaccine.
Effective vaccination campaigns should aim to carefully explain in simple language a vaccine's level of effectiveness, expected side-effects and the importance of population-wide coverage to achieve herd immunity.
It is important that health institutions and the government build trust through clear and transparent communication about the vaccines. Key messages should be passed in local languages through appropriate channels to key audiences.
Clearly, the COVID-19 vaccine is the fastest and safest way to combat the COVID-19 virus. As we celebrate World Immunisation Week 2021, themed, "Vaccines bring us closer," we must remember that as long as misinformation remains, vaccine hesitancy and rejection will persist. Breaking down the barriers against uptake will bring us closer to a world where we can gather freely, travel safely and protect our young, old and vulnerable from dangerous vaccine preventable diseases.
The full Nigeria Health Watch COVID-19 Household Vaccine Survey Report will be released on Friday 30th June 2021.