Measles outbreaks are flaring up worldwide. Before the coronavirus (COVID-19) pandemic, spikes in measles outbreaks were mainly attributed to two key factors: infrastructure and junk science. In less affluent regions, inadequate healthcare infrastructure and resources impeded vaccine deliveries. Meanwhile, in more affluent areas, some parents refused to vaccinate their children based on junk science and myths. Despite the complexities of the conflicting positions, the former could be addressed with increased funds and resources, while the latter can be managed with the dissemination of factual scientific evidence. In the wake of the pandemic, there is a new and potentially dangerous wave of vaccine hesitancy. This unwelcome wave is fueled by a series of miscalculated steps and distrust, and neither money nor hard science may be enough to remedy its consequences.
On March 11, the World Health Organization (WHO) declared the COVID-19 outbreak a global pandemic. This infectious disease, caused by a novel strain of the coronavirus, had been spreading, first undetected, then identified but understated for at least three months. Arguably, health officials and government leaders were hesitant to react swiftly due to the novelty of the disease. Their hesitance, however, allowed ample time for the emergence of an insidious infodemic. Similar to the 1918 influenza pandemic, some viewed COVID-19 as a ‘bad flu’ while others predicted an incidence recession in April with the arrival of warmer months. These rampant rumors, devoid of evidence, encouraged lackadaisical behavior among many and raised a false sense of hope surrounding African lineage and COVID-19 immunity. Tragically, a race-based medical presumption surfaced with grave semblance to African Americans’ “supposed” immunity during the 1793 Yellow Fever epidemic. Within days of the WHO pandemic declaration, 48 of 54 African countries, most with warm climates, had confirmed local cases of COVID-19. While the devastation of COVID-19 revealed systemic racial discrepancies in more affluent countries, families in economically ravaged regions were left to deal with the resurgence of familiar devastating infectious diseases such as diphtheria, cholera, and measles, in addition to the pandemic.
On April 1, two French doctors in a discussion on COVID-19 vaccine trials, casually suggested that the vaccines be tried first in Africa, “… where there are no masks, no treatments, no resuscitation? a little bit like it’s been done for certain AIDS studies… because they are highly exposed and don’t protect themselves?” Desperate attempts to salvage the situation included a tweet insinuating that the message had been taken out of context, with no reasonable explanations provided. These actions resulted in a well-deserved backlash from renowned African athletes, including Didier Drogba and Samuel Eto’o. Despite a belated apology, the damage had already been done. A seed of distrust had been sown in the minds of many African parents.
This year, five WHO regions were slated to eliminate measles. This milestone requires a critical immunity threshold between 93-95%. In a recent report on mass immunization efforts in the Democratic Republic of Congo, the impact of said distrust was evident. Health volunteers ready to resume inoculations, which had been temporarily suspended due to the pandemic, were faced with a new challenge. Parents refused to vaccinate their children because they were convinced that the vaccines were not for measles. The public health team had overcome diverse barriers and months of work to get to these communities, only to find out the vaccines were no longer wanted. After hours of cajoling, approximately 16,000 children were vaccinated. 88% of the eligible group and 5% short of the lower immunity threshold.
In efforts to contain the spread of COVID-19, mass vaccinations were halted globally. As a result, over 80 million children are now living without the benefits of safe and effective vaccines. As restrictions ease globally, lifesaving immunization campaigns will quickly resume, but the repercussion of distrust may take longer to heal. A critical step the health care sector must take is to reestablish the trust. This action should include implementation of educational programs designed to address these interrelated issues – the importance of vaccinations and trust in the system. These messages must be sustained and targeted in order to capture the attention and agreement of the authorities, the payers and most importantly the people. To act now is to save millions of lives.