Exploring the myths surrounding the COVID-19 vaccines in Africa: the study to investigate their impacts on acceptance using online survey and social media

Since its emergence in December 2019, the coronavirus disease 2019 (COVID-19) pandemic has threatened the world with high transmission, hospitalizations, and mortality rates [1]. Before the end of December 2020, the pandemic has led to the deaths of more than 1.6 million people across 223 countries around the globe. The whole world was waiting to arrive at an effective and safe vaccine and its strategies to combat the COVID-19 pandemic [2].

Progress in vaccine development was seen in December 2020 when a partnership between the Department of Health and Human Services and Department of Defense which has organized a public-private partnership called “Operation Warp Speed” reported 300+ COVID-19 vaccine candidates, of which 52 were in the phase of clinical evaluation and the remaining been in preclinical development [3]. Eventually, six vaccine candidates showed promising potential in their efficacy proceeded to the phase 3 large-stage clinical trials. Only three gained the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) Emergency Use Approval in the United States, Moderna, Johnson & Johnson’s Janssen, and Pfizer-BioNTech [4]. Novavax and AstraZeneca are in large-scale (phase 3) clinical trials in the United States [4]. AstraZeneca was approved by the World Health Organization (WHO) and used across the world. Sputnik V-Russia is approved in Central and South America, the Middle East, Central Europe, Africa, Asia, Russia, and Africa.

Vaccination of the global population aimed to promote individual immunity against the deadly virus and protect those unable to get vaccinated through “herd immunity” [5]. It is estimated that 55%–82% vaccine uptake is required to build herd immunity against the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) [6]. The COVAX Global Initiative was established to provide equitable access to COVID-19 vaccines across the world to higher-income and lower-income countries. The WHO, United Nations Children’s Fund, Coalition for Epidemic Preparedness Innovations, Access to COVID-19 Tools ACT-Accelerator, Gavi, the Vaccine Alliance, PAHO Revolving Fund, and the World Bank have delivered over 70 million doses to 126 countries, working with both governments and vaccine manufacturers [7]. The goal is to work with vaccine manufacturers to offer low-cost COVID-19 vaccines to countries. Inovio, Moderna, CureVac, Institute Pasteur/Merck/Themis, AstraZeneca/University of Oxford, Novavax, University of Hong Kong, Clover Biopharmaceuticals, and University of Queensland/CSL are part of the COVAX Initiative. The COVAX Initiative aims to supply 600 million doses to Africa to vaccinate at least 20% of the population. Contributing countries include France, Norway, Germany, Italy, New Zealand, Spain, Sweden, the United Arab Emirates (UAE), Canada, and the United States [7]. Some African countries are also getting vaccine donations from China, Russia, India, and the UAE. The African countries of Tanzania, Burundi, Burkina Faso, Central African Republic, Chad, and Eritrea are yet to receive COVID-19 vaccines [7].

Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance, stated that “the momentum we are witnessing behind this unprecedented global effort means there could be light at the end of the tunnel: a vaccine is our best route to ending the acute phase of the pandemic, and the COVAX effort is the best way to get there [8]. For higher-income countries, it represents a win-win: not only will you be guaranteed access to the world’s largest portfolio of vaccines, but you will also be negotiating as part of a global consortium, bringing down prices and ensuring truly global access. Signing up to the COVAX Facility gives each country its best chance at protecting the most vulnerable members of their populations—which in turn gives the world its best chance at mitigating the toll this pandemic has taken on individuals, communities, and the global economy. To make this end-to-end vision a reality, we need countries to make end-to-end commitments: funding research and development, signing up to the Facility, and supporting the COVAX Advance Market Commitment.”

Therefore, equal access to a COVID-19 vaccine is the key to beating the virus and paving the way for recovery from the pandemic. COVID-19 vaccination, in combination with prevention and control guidelines such as handwashing and masking-up, remains an important tool to stop the pandemic [9]. As recommended by experts, getting vaccinated will protect people and particularly people at increased risk of severe illness from COVID-19 [9].

Distribution complications and lack of health infrastructure and staff contribute to slow vaccination rates. Nine countries have administered less than a quarter of the doses they obtained, and 15 countries have given less than half of the doses [3]. However, despite public health importance, high mortality, vaccine hesitancy is rising globally due to myths surrounding the COVID-19 vaccines leading to lower than anticipated acceptance. They spread with ease due to social media and online platforms. This widespread misinformation, skepticism, and popularity of anti-vaccine movements toward the COVID-19 vaccination make global vaccination and herd immunity an even more difficult task [10]. “While we call for vaccine equity, Africa must also knuckle down and make the best of what we have,” said Matshidiso Moeti, regional director for WHO in Africa [3].

Previous studies indicate that people have various misconceptions and are likely to reject a newly developed vaccine for a detected disease [11]. The polio vaccine boycott in Nigeria prompted by distrust and fallacies which lead to a five-fold increase in the polio incidence in Nigeria between 2002 and 2006 is an example [12, 13]. Subsequently, a mass deworming program was rejected in Ghana due to misconception among community members [14]. Okunlola et al. [15] in 2020 highlighted some myths and misconceptions associated with the COVID-19 pandemic. Although a global survey done by the World Economic Forum in 15 countries showed high vaccination intentions in China (80%), the United Kingdom (77%), and the United States (nearly 70%), there remains robust and widespread movements and resistance to COVID-19 vaccination globally [16]. According to this same study, the number of people who agreed to take the vaccines dropped significantly in some countries, including South Africa and France [2]. Concerns ranged from possible side effects to the speed at which the vaccines were developed and more mysterious allegations that the vaccines contain a microchip for tracking purposes [2]. People also have a mixed feeling of whether the vaccines are safe, protect against the virus, and stop wearing masks after vaccination. Whereas others would accept the vaccines, others will not [17], which may be due to fears, worries, and surrounding misconceptions.

Deliveries of the COVID-19 vaccines in Africa started in February 2021, intending to supply 600 million doses to vaccinate at least 20% of the population under the COVAX Program [18]. It is necessary to identify some of the myths that influence people’s intention not to get vaccinated to effectively develop interventions and health education to promote a positive vaccination attitude and overall acceptance of the COVID-19 vaccines. A study commissioned by the African CDC on COVID-19 vaccine perceptions in 15 countries indicated a significant proportion of people had concerns around vaccine safety. On average, about 20% of respondents said they would not have a vaccine, but the proportion varied from below 10% in Ethiopia, Niger, and Tunisia to 41% in Democratic Republic of the Congo [19]. Assessing the knowledge, attitude and perceptions of respondents, and further education of the general public has proved effective in changing the risk perception of the populace and resulted in attitudinal changes that were necessary to reduce the epidemic disease burden [20]. Adequate monitoring of social media platforms to confirm and improve the quality of information delivered to the people is of prime importance. The present study explores the perceived myths about the safety of vaccines and the impacts of these myths on acceptance in Africa.

A total of 2,500 responses were included and analyzed for the study. Incomplete submissions such as respondents skipping specific questions and minor omissions were excluded and not considered part of the data analyzed. Almost two-thirds (61.3%) of the respondents were females, while 38.7% were males. Ages ranged from 18 years to 51 years and above, with the age group of 21–30 years forming most respondents (35.8%). Among the participants, 90.7% reported that they had attained high education, whereas 64.8% were employed. Approximately 40% of the respondents (980/2,500) were from West Africa, 665 Central Africans, 450 East Africans, 235 Southern Africans, and 170 North Africa participants. Table 1 presents the details of respondents on age, marital status, religion, education, and occupational status. Table 2 shows a statistically significant association between demographic variables such as gender, age, marital status, religion, high education attainment, occupation status, access to credible information, and the acceptance of COVID-19 vaccines or the vaccine’s acceptance dependent on these demographic variables.

Table 1
Demographic characteristics of the respondents

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Table 2
Association between selected demographic variables with acceptance of the coronavirus disease 2019 vaccines (n=2,500)

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Ten statements were presented to the respondents, and their responses to each of them are shown in Table 3. Agreement with these statements ranged from 8.8%–35.7%. The range in percentage of respondents who expressed “no idea (neutral stands)” with each statement was 12.4%–33.0%. The statements that a few respondents agreed with were that “since vaccines for the COVID-19 have been developed, we can make vaccines for the common cold, human immunodeficiency viruses (HIV) and others” (35.7%) and that “researchers rushed the development of the COVID-19 vaccines; therefore, it is not very effective and safe or cannot be trusted” (23.8%). However, most respondents debunked and disagreed with some of these myths. The majority (77.2%) did not agree that after getting the COVID-19 vaccines, one can stop wearing a mask and taking safety precautions. Consequently, 66.4% do not believe that the COVID-19 vaccine enters your cell and changes the DNA. Respondents who will accept the vaccine were more likely to disagree with statements 1, 2, 3, 4, 5, 6, 7, 9, and 10, whereas those who will not take the vaccine agreed (p=0.001). The present study also identified that certain myths about the COVID-19 vaccines do not influence acceptance shown in Table 4. The myth did not influence acceptance that since vaccines for COVID-19 have been developed, “we can make vaccines for other viruses such as the common cold and HIV [21].”

Table 3
Responses of Africans to the myths surrounding the COVID-19 vaccines

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Table 4
Potential influence of these statements and their impacts on acceptance of the vaccine

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Hesitancy to new vaccines, population confidence or willingness to vaccinate, and their blunt refusal may be as a result of misinformation about its safety or misconceptions which have gain ground on social media platforms [22, 23]. Anti-vaccine lobbyists and religious groups make use of social media and the internet to express and spread their lack of trust in the pharmaceutical industry, advocate against vaccination, and report the alleged risk of vaccination [24, 25]. These sometimes justify the myths surrounding the COVID-19 vaccines. Therefore communication, the internet, and social media are paramount to the determinants of vaccine acceptance, hesitancy, and levels of misconceptions.

The present-day study showed that only a tiny percentage of respondents agreed with the myths surrounding the COVID-19 vaccines suggesting only a minority of Africans held significant misconceptions about the vaccines. The study, however, also revealed that one-third of all the respondents (33.0%) neither agreed nor disagreed with the statement that the COVID-19 vaccines affected fertility later in life for women; this implies a lack of knowledge about the COVID-19 vaccines and fertility. It offers an excellent opportunity for stakeholders and health authorities to provide comprehensive information about the possible impact of the vaccine on fertility, pregnancy, and miscarriage. People need to consider the facts about the vaccines and what could happen if they develop COVID-19 symptoms during pregnancy. Couples have to be reassured that it is safe to become pregnant after the COVID-19 vaccination. The vaccine is not causing any change in infertility for women, and unvaccinated expectant mothers have an increased risk of severe illnesses from COVID-19. A study done by Gray et al. [26] in 2021 published in the American Journal of Obstetrics and Gynecology shows that the COVID-19 vaccines are safe and effective for pregnant and breastfeeding women and they also offer protection for their babies. The CDC, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists agree that the COVID-19 vaccine can be offered to pregnant women who are eligible [27, 28, 29].

For respondents who still have doubts and safety concerns, they should discuss the risks and benefits of the COVID-19 vaccination with their healthcare providers. There is no evidence that antibodies from the vaccines interfere with fertility or cause pregnancy problems.

We also found some skepticism about whether vaccines for the common cold, HIV, and other diseases can equally be produced since vaccines for the COVID-19 have been developed, which was the most common misconception (35.7%) the study revealed, or participants agreed on. However, it does not significantly affect acceptance. Again, public health authorities need to educate the general population on the logic behind developing the COVID-19 vaccine compared to other diseases. Each disease and the illnesses they cause have their unique challenges, which are different from one another.

Furthermore, respondents were also concerned that researchers rushed the development of the COVID-19 vaccines, and it is not very safe, effective, and trusted. Although the COVID-19 vaccines seemed to have had rapid development, 69 days to clinical trial once developed from laboratory and animal models [30]. The clinical trials that examined the vaccines’ safety and quality control were not rushed or compromised in any way, they used standard vaccine development stages, and they occurred in the United States, Europe, and China [31].

In the past, vaccine development was lengthier partly because of limited technology and resources.

The messenger RNA (mRNA)-based technology is a relatively easy, low-cost manufacturing process, synthetic, and quick to produce [32]. Allows the ability to streamline vaccine discovery and development and facilitate a rapid response to emerging infectious diseases, such as COVID-19 [33]. The technology employed to manufacture the mRNA COVID-19 vaccines was developed in record time because other researchers have been working on mRNA research for three decades [34]. The lessons from this strategy over time were applied for the development for use as COVID-19 vaccines [33].

Experts continuously monitor the safety and standards of the COVID-19 vaccines, scientists worldwide, and agency partners experts to ensure that the COVID-19 vaccines continue to be safe through the CDC, the National Institutes of Health, and the National Academies of Sciences, Engineering, and Medicine. The FDA regulates and approves vaccines in the United States. Vaccines undergo a rigorous review of laboratory, clinical, and manufacturing data to ensure the safety, effectiveness, and quality of these products. The European Medicines Agency (EMA) are the scientific evaluators, approvers, and monitors of vaccines in the European Union, The Medicines and Healthcare Products Regulatory Agency in the United Kingdom [35]. In Africa, Nigerian National Agency for Food and Drug Administration and Control and the South African Health Products Regulatory Authority utilize the FDA and EMA guidance [36].

The FDA Ghana utilizes an independent committee of experts, the Joint COVID-19 Vaccine Safety Review Committee, and an FDA Safety Monitoring Department [37]. It is common for new vaccines to be met with misconceptions and initial hesitancy. One of the considerable sources where African health institutions can give information about the benefits of the COVID-19 vaccines to the general population and recommendations is through social media. Although social media represent a rapidly evolving global environment for disseminating misconceptions, it can be used as a tool for designing an effective educational intervention. This will serve the purpose of increasing vaccine acceptance, addressing hesitancy, and tackling the problem of misinformation in Africa. In this study, the willingness to accept the COVID-19 vaccine among Africans was relatively high as 68% of the respondents expressed the intention to take it regardless of these misconceptions. Demographic profiles such as gender (p=0.001), age (p<0.001), marital status (p<0.001), religion (p=0.008), high educational attainment (p<0.001), occupational status (p<0.001), and access to regular information (p<0.001) were some factors highly associated with acceptance of the vaccine. These demographic characteristics were more likely to contribute to the acceptance of the vaccines or can be regarded as highly accurate predictors of acceptance (Table 5).

Table 5
Analysis of demographic characteristics to the 10 statements

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These findings corroborate the studies of Al-Mohaithef and Padhi [38] in 2020, who investigated the community determinants that influence COVID-19 vaccine acceptance in Saudi Arabia.

Health education interventions should target sociodemographic groups or areas in Africa that are identified as a priority to increase vaccine/health education, understanding, dispel misconceptions around vaccine safety and increase overall vaccine acceptance. Many people will need to accept and receive COVID-19 vaccines to achieve herd immunity, slow the spread and stop the pandemic in Africa. Globally, 150 doses have been administered per 1,000 people, but it’s about eight doses per 1,000 people in Africa. In South Africa, 67% of its population, 40 million people would need to be fully vaccinated to achieve her immunity by the end of 2021 [39]. Therefore, public health authorities across Africa must provide accurate information focusing on correcting the present study’s misconceptions, promoting positive attitudes, increasing safety awareness, and accepting the COVID-19 vaccines in vaccine campaigns.

The study reflects the views of African respondents on social media with internet access. There could be alternative opinions that were not represented.