FROM THE EDITOR

Misinformation and vaccine confidence

The COVID-19 pandemic brought with it a flood of misinformation, from people who clearly believed that there were millions of little elves making up numbers, according to set algorithms, every day, to people who warned those of us who were vaccinated that we would die in 2 years' time. At the same time there were very real adverse effects from the COVID-19 pandemic, which has threatened decades of progress in health in all regions of the world, including positive trends in decreasing inequality. In 2020, the pandemic disrupted essential health services in 92% of countries globally. As many as 22.7 million children missed basic immunisation, the number of malaria and tuberculosis (TB) cases rose, and global deaths from TB rose for the first time since 2015.^[1]

Arguably one of the worst and possibly more far-reaching effects of the pandemic is the massive fall off in routine childhood vaccination. The latest figures from the United Nations Children's Fund (UNICEF) show that 12.7 million children in Africa missed out on one or more vaccinations between 2019 and 2021.^[2] A disturbing new study shows that this under-vaccination is not only due to the disruption to routine services as a result of pandemic response. There is evidence of declining confidence in vaccines across much of the African region.^[3] De Figueiredo et al.,^[3] publishing in Human Vaccines and Immuno therapeutics, report that, across eight countries sampled, there were declines in perceptions towards the importance of vaccines for children. They also found mixed trends in perceptions towards vaccine safety and effectiveness. The Democratic Republic of Congo was one country where substantial declines in vaccine confidence were found. And South Africa was the other country specifically singled out, particularly in Eastern Cape, KwaZulu-Natal, Limpopo and Northern Cape provinces. The data came from 16 national surveys and over 17 000 individuals across the eight countries, conducted in 2020 and again in 2022. The measure was of perceptions of the importance, safety and effectiveness of vaccines themselves, rather than broader confidence in, for example, the systems and people that deliver vaccines.

This trend is alarming, described as an 'early warning signal' by Charles Shey Wiysonge, Team Lead, Vaccine Preventable Diseases, at the World Health Organization Regional Office for Africa.^[4] Current efforts to accelerate catch-up of routine childhood vaccination have concentrated on supply chain problems, travel limitations and other COVID-related disruptions. This latest study shows that we need to start building confidence in the concept of vaccination as a safe and life-saving public health measure. However, as Wiysonge points out, the study not only shows that there is more to catch-up than logistics, but also that the detailed data collected can help health authorities identify specific regions where they will have to make direct and focused efforts to restore trust in vaccines. Mistrust in vaccines is not new, and misinformation is as old as the concept of vaccination itself. We, as health professionals, need to ensure that we use this information wisely and listen carefully to community and individual concerns if we come across vaccine hesitancy in any setting. Routine childhood immunisation saves millions of lives. Let's get it up to the correct levels again.

Bridget Farham

Editor

ugqirha@iafrica.com

References

1. World Health Organization. Tuberculosis deaths and disease increase during the COVID-19 pandemic. Geneva: WHO, 2022. https://www.who.int/news/item/27-10-2022-tuberculosis-deaths-and-disease-increase-during-the-covid-19-pandemic (accessed 19 June 2023).         [ Links ]

2. United Nations Children's Fund. New UNICEF report shows 12.7 million children in Africa missed out on one or more vaccinations over three years. Johannesburg: UNICEF, 2023. https://www.unicef.org/esa/press-releases/new-unicef-report-shows-127-million-children-africa-missed-out-one-or-more (accessed 19 June 2023).         [ Links ]

3. De Figueiredo A, Temfack E, Tajudeen R, Larson HJ. Declining trends in vaccine confidence across sub-Saharan Africa: A large-scale cross-sectional modeling study. Hum Vacc Immunotherapeutics 2023;8:2213117. https://doi.org/10.1080/21645515.2023.2213117        [ Links ]

4. Makoni M. In Africa, doubts about vaccines grew during the pandemic, survey finds. Science, 12 Jun 2023. https://www.science.org/content/article/africa-doubts-about-vaccines-grew-during-pandemic-survey-finds (accessed 19 June 2023).         [ Links ]