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By Dr Masimba Mavaza
While the rapid development of vaccines against COVID‑19 is an extraordinary achievement, successfully vaccinating the global population presents many challenges, from production to distribution, deployment, and importantly, acceptance.
Trust in the vaccines is vital, and is critically dependant on the ability of governments to communicate the benefits of vaccination, and to deliver the vaccines safely and effectively.
The government plays a greater role in promoting confidence in the effectiveness and safety through effective communication, as well as trust in their ability to procure and distribute them efficiently and equitably.
While a larger part of the population holds strong anti-vaccination views, hesitancy about COVID‑19 vaccination is evident in many countries not only Zimbabwe. Recognising that vaccination campaigns of the magnitude needed are unprecedented, government actions to garner trust will be essential to their success, and to the emergence of more resilient society after the crisis.
Zimbabwe government has gone past a four million mark with great focus on the ten million soon. Average number of new infections reported each day in Zimbabwe falls by more than 1,200 over the last 3 weeks, 52% of its previous peak. COVID-19 infections are decreasing in Zimbabwe, with 324 new infections reported on average each day. That’s 14% of the peak — the highest daily average reported on July 15.
There have been 123,320 infections and 4,320 coronavirus-related deaths reported in the country since the pandemic began.
Zimbabwe has administered at least 3,958,174 doses of COVID vaccines so far. Assuming every person needs 2 doses, that’s enough to have vaccinated about 13.5% of the country’s population.
While the development of COVID‑19 vaccines has been an extraordinary success, vaccinating most of the global population is an enormous challenge, one for which gaining – and maintaining – public trust in COVID‑19 vaccines and vaccination will be as essential as the effectiveness of the vaccines themselves. Moreover, the experience with COVID‑19 will likely shape confidence in other vaccines making it even more important to build confidence at this time.
Trust in vaccination, and in the ability of governments to communicate, and to successfully deliver a vaccination programme, is critically dependent on:
the extent to which the government can instil and maintain public confidence in the effectiveness and safety of the vaccines;
Given the speed at which COVID‑19 vaccine development has taken place it is important for governments to emphasise that no developmental or regulatory corners were cut in the process, as: development was facilitated by extensive prior research, unprecedented levels of international collaboration among researchers, and massive public investment in R&D and manufacturing capacity; and
approval processes were accelerated, in part through procedures that allow the acceptance of more preliminary evidence in circumstances of public emergency; and with COVID‑19 products accorded the highest priority by regulators.
Successful vaccination campaigns also require governments to partner and support community organisations to conduct extensive and well-managed community engagement. A thorough understanding is needed of different populations’ specific concerns, prior experiences both with vaccination and the health system in general, religious and/or political affiliations, and socio-economic status. It is also important to ensure that government actions are open to public scrutiny, and that public institutions engage with the population.
We must remember that fairness is a hallmark of human behaviour that underpins social cohesion and trust. Governments must therefore manage public expectations and explain why it is fair that particular population groups within a country are not allowed to meet without vaccination.The most important ingredient in all vaccines is trust. Our parents trusted clinics who gave us jabs for flue jabs for polio and so many ailments.
There is broad agreement within the global scientific community that the most effective way to defeat the COVID‑19 pandemic is through the mass vaccination of populations around the world. The development of vaccines for COVID‑19 has been a powerful demonstration of how substantial public funding, intense focus, and unprecedented levels of scientific collaboration can help spur innovation to address global public needs in a very short time. However, the approval and rollout of vaccines does not herald the immediate end of the health crisis, as attaining herd immunity will require the vaccination of a very substantial proportion of population, and is therefore a major challenge.
To succeed in the government’s effort to immunise billions of people as rapidly as possible, civic organisations including churches need to give priority to addressing issues of trust – trust both in vaccines, and in the institutions responsible for the vaccination endeavour. They need to promote confidence among the public in the effectiveness and safety of the vaccines, as well as in the capacity of governments to manage the logistical challenges competently.
Despite the efforts put by the government of Zimbabwe we still have several civic organisations who have exhibited increasing levels of distrust in government capacity to handle the crisis and implement coherent policies This has resulted in declining compliance with public health-related rules, and increasing scepticism about long-term economic recovery. More broadly, the pandemic has triggered widespread disinformation that has undermined both understanding and acceptance of science and public policy and this extends to the issue of vaccine acceptance. Despite widespread recognition that COVID‑19 is a critical issue to people all around the globe, many remain unwilling to be vaccinated.
However, by the end of May 2021 an average of 60% of the population across zimbabwe indicated willingness to be vaccinated. This was reflected in the number of those vaccinated and those queuing for vaccine.
Not surprisingly, trust in the safety of vaccines has also been seriously tested by recent reports of rare, but serious, adverse events with a probable causal link to the Christian and other religious groups.
Both the safety signal, and the different mixed sermons on the vaccine have undermined public confidence. That said, there is also evidence to suggest that as more people are vaccinated, more will be inclined to accept vaccination. While this may to some degree indicate a gradual dissipation of initial fears about the safety of novel vaccines it may also reflect that being vaccinated gradually becomes normative, and is increasingly accepted as the path out of restriction and confinement.
Trust in vaccines must also be complemented by trust in the institutions responsible for vaccination. Lack of acceptance of vaccination may derive from previous failures of health systems and public institutions to serve certain population groups effectively and engender their trust. In general, trust in institutions is critical for the effective functioning of society and acceptance of public policy, and particularly so during a crisis.
Trust is defined as one’s belief that another person or institution will act in accordance with one’s expectations of positive behaviour by others and institutional trust is recognised as a key measure of government performance.
Overall, the success of vaccination campaigns will largely be influenced by the extent to which people trust the effectiveness and safety of the vaccines, the competence and reliability of the institutions that deliver them, and the principles that guide government decisions and actions.
Zimbabwe is now facing problems of several religious leaders and labour movements who are attacking vaccination campaign labelling it a mandatory satanic agenda.
We should appreciate that mandatory vaccination, including for COVID-19, can be ethically justified if the threat to public health is grave, the confidence in safety and effectiveness is high, the expected utility of mandatory vaccination is greater than the alternatives, and there must be penalties or costs for non-compliance.
Penalties or costs could include withholding of benefits, imposition of fines, provision of community service or loss of freedoms. We must know that under conditions of risk or perceived risk of a novel vaccination, a system of payment for risk in vaccination may be superior.
The government must never be forced under pressure by religious groups to abandon an exercise which saves lives. There is a large body of literature on the justification for the use of coercion in public health and infectious disease in particular. Mandatory vaccination is typically justified on Public health grounds and to avoid harm to others.
We must appreciate that the sole ground for the use of state coercion and restriction of liberty is when one individual risks harming others.The most prominent arguments from bioethicists appeal to preventing harm to others. Vaccination will likely be part of a multi-faceted public health response to the future emergence of a pandemic illness. In addition to other measures designed to respond to and control a pandemic, such as surveillance, communication plans, quarantine, and disease treatment, deployment of effective vaccines has the potential to protect lives and limit disease spread.
Not all disease threats, however, have a corresponding vaccine, and for those that do, there are significant challenges to their successful use in a pandemic.
Vaccination is the most important thing we can do to protect ourselves and our children against ill health. They prevent up to 3 million deaths worldwide every year.
Since vaccines were introduced in Zimbabwe diseases like smallpox, polio and tetanus that used to kill or disable millions of people are either gone or seen very rarely.
Other diseases like measles and diphtheria have been reduced by up to 99.9% since their vaccines were introduced.
However, if people stop having vaccines, it’s possible for infectious diseases to quickly spread again.
The World Health Organization (WHO) has listed vaccine hesitancy as one of the biggest threats to global health.
Vaccine hesitancy is where people with access to vaccines delay or refuse vaccination. To beat COVID-19, Zimbabweans will need to embrace an ethics of responsibility—recognizing that freedom has limits when it comes to keeping others safe, and taking actions that protect one another.
So the closure of churches and other public areas is in the best interest of those around you. There is a strong case for making any vaccination mandatory (or compulsory) if four conditions are met: 1. That there is a grave threat to public health
2. That the vaccine is safe and effective
3. Mandatory vaccination has a superior cost/benefit profile compared with other alternatives
4. The level of coercion is proportionate.
Each of these conditions involves value judgements.
Grave threat to public health
So far, there have been over 3 million deaths attributed to COVID-19 globally and thousands in Zimbabwe.
As a nation Zimbabwe must take a position to protect its people. It is humane enough to save the people a warn them of the dangers of COVID. COVID must not keep us down. If we are not vaccinated get a jab now we are in a pandemic quagmire.
Be responsible serve a-life.