Institutional distrust a serious barrier for little one vaccination progress in Africa

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Institutional mistrust a major barrier for child vaccination progress in Africa

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Distrust of local and national authorities plays a major role in slowing progress in child vaccination in Africa – the continent home to half of the world's unvaccinated and vaccinated children, new research shows.

A study published in BMJ Global Health found that vaccination rates for children in African countries are significantly lower in areas where the local population has high levels of distrust of local authorities. Even when comparing children from households with similar socioeconomic characteristics who live in the same region and have similar access to health care facilities, distrust of local authorities, governments, courts or the electoral system is significant when it comes to parents having theirs Vaccinate children.

Researchers from Lancaster University, UCLouvain, the University of Antwerp and the International Food Policy Research Institute (IFPRI) examined information on the status of child vaccinations for nearly 167,000 children in 22 African countries and compared it with information on the level of confidence people had in local and national authorities.

In regions where people did not trust the courts, parliament, head of state and local government, child vaccinations were significantly lower. For example, when distrust of local government increased by 10 percentage points, children in that region were 11% more likely to receive none of the eight basic vaccines (BCG or Bacillus Calmette-Guérin vaccine, three doses of the combined diphtheria). Pertussis and tetanus vaccine (three doses of the polio vaccine and one dose of the measles-containing vaccine) and 3.4% less likely to get all eight basic vaccines.

"The hesitation about vaccines was recognized as a major threat to global health even before the COVID-19 outbreak, but it has been mostly documented in high-income countries like France or the US," said co-author Dr. Jean-Francois Maystadt. Associate Professor of Economics at Lancaster University and UCLouvain. "Our quantitative analysis shows that institutional mistrust is a major obstacle to achieving universal vaccination among children in Africa and poses a significant risk to vaccination campaigns – which are more important today than ever before."

The co-author Dr. Nik Stoop of the University of Antwerp said: "Our findings are based on qualitative case studies across Africa which suggest that distrust is an important contributor to vaccine hesitation. A well-known example of the effects of distrust is The Way, How Nigerian communities boycotted polio vaccination in the early 2000s, leading to an outbreak of an almost eradicated disease. However, other examples can be found in many African countries, including Cameroon, Chad, Democratic Republic of the Congo, Mozambique, Nigeria and South Sudan. "

The authors say that while their study is the first comprehensive attempt to quantify the role of institutional distrust of child vaccination intake in Africa, the problem is not only felt across the continent. In high-income countries such as Russia, the United States, France and Croatia, there has already been documented distrust of authorities who have an impact on vaccine intake. Therefore, researchers suggest that this new finding should be of use to government agencies around the world.

Based on their findings, researchers argue that there is an urgent need to recognize the importance of suspicion of vaccination campaigns, especially in a post-COVID world where the global adoption of vaccines is seen as critical to ending the pandemic.

“There is no doubt that COVID-19 vaccination in Africa is limited by supply bottlenecks and enormous logistical challenges. But even if global allocation mechanisms such as COVAX or the availability of new vaccines were to overcome these challenges, we would still have to convince people to vaccinate leave ", continues Dr. Maystadt away. "The lack of action leaves room for anti-Vaxxer in a context where traditional medicine has been overdeveloped in several African countries and poses serious health risks for individuals and the continent as a whole."

In light of the pandemic that led to the lifting of multiple vaccination campaigns, the authors are calling for "trustworthy" guidelines to protect the 2.6 million under-5s who are at risk of dying from vaccine-preventable diseases by 2030.

They say that while fighting myths and communicating about the benefits of vaccines is important, it is unlikely to be enough without a significant improvement in confidence in information providers.

"The lessons of successful campaigns in Africa show the importance of working with local communities, trustworthy political or religious leaders, and creating space for open dialogue. A top-down approach is unlikely to work," adds Dr. Kalle Hirvonen, co-author and senior, also research fellow at IFPRI. "However, there are still great uncertainties about how grassroots initiatives can be expanded and questions need to be asked about the role of social media in local communities. In a post-COVID world where mobility is limited and people are more isolated, we are I have seen social networks become ideal platforms for the dissemination of views on vaccinations. "

The paper "Institutional distrust and reporting on child vaccinations in Africa" ​​is published today in the BMJ Global Health.

Black Americans report high levels of vaccine reluctance

More information:
"Institutional distrust and reporting on child vaccinations in Africa", BMJ Global HealthDOI: 10.1136 / bmjgh-2020-004595

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Lancaster University

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