In late 2020, ‘vaccine preparedness’ became an established goal of efforts to control the spread of SARS-CoV-2. Throughout the second year of the pandemic, vaccination moved to the forefront of global debate and policy. The remarkable speed and success of vaccine development for Covid-19 heightened the emphasis on ‘vaccinating the world’ as the way to attenuate its effects.
As the World Health Organization (WHO) now considers different scenarios for ‘living with’ Covid-19, vaccines have remained a cornerstone of strategic thinking. Experts weigh up gaps in knowledge that could give pointers to achieving lasting immune responses from vaccination, or inform the development of jabs that could also block viral transmission. Technological platforms are sought that could enable quick adaption of vaccines to new variants or that could ensure greater resilience to viral mutations.
In parallel, there has been a concerted effort from the WHO to ‘manage’ the so-called ‘infodemic’, with particular focus on vaccine confidence, and (dis)trust of science and public health authorities more widely.
The Pandemic Preparedness Project
The Pandemic Preparedness Project team, led by Melissa Leach and Hayley MacGregor, have recently published an article ‘Vaccine anxieties, vaccine preparedness: Perspectives from Africa in a Covid-19 era.’ This study forms part of a broader collaborative anthropological research programme on pandemic preparedness in Africa which started in 2019, involving research in global and regional settings, and in national and local sites in Uganda and Sierra Leone. The programme pivoted attention to Covid-19 in 2020. From 2021, as vaccination started to be discussed and then implemented in the study countries, this became a further focus of fieldwork and analysis.
Our research offers new insights into the idea of ‘vaccine preparedness’ and related concerns about vaccine uptake and confidence. Global debate has largely focused on questions of supply and global injustice in vaccine distribution, particularly with respect to African countries. At the same time, vaccine demand and uptake are seen to be threatened by hesitancy, often attributed to an increasingly globalised anti-vaxx movement and its propagation of misinformation and conspiracy, now reaching African populations through a social media ‘infodemic’.
Underplayed in these debates are the socio-political contexts through which vaccine technologies enter African settings, and the crucial intersections between supply and demand. Vaccine uptake is contextually driven, and ideas about the body and vaccines are filtered through national politics and interpretations of a wider geopolitics.
To explore this, we use a ‘vaccine anxieties’ framework. This allows us to consider the socially embedded reasons why people want or do not want Covid-19 vaccines, and how these intersect with the dynamics of vaccine supply, access and distribution in rapidly unfolding epidemic situations. Our accounts from local and national settings in Uganda and Sierra Leone showed that different layers of experience coalesce to generate positive and negative anxieties.
A snapshot of the issues from our Uganda fieldwork
In Uganda, people in our fieldsite suspected politicisation of Covid-19 prior to the arrival of vaccines. The first year of Covid-19 saw little disease on the ground but quite brutal enforcement of restrictions by a government seeking to suppress opposition and gain re-election in early 2021.
The arrival of vaccines from China led to speculation about corruption and Ugandan government deals, with questioning in this context of the quality of the vaccines allocated to teachers in a campaign of mandatory vaccination. There was also speculation about the different vaccines being supplied. Astra Zeneca vaccines supplied through COVAX raised concerns: the safety of the vaccine was questioned as people reflected on why EU regulators were suspicious of this product.
The US also donated unused Astra Zeneca vaccine to Africa after it was not deployed in the US – prompting social media comment that inferior vaccines were being dumped in Africa. Similarly, the specific Astra Zeneca supplies had been manufactured by the Serum Institute in India and raised additional concerns when some European countries indicated that travellers who had received this product would not be considered vaccinated for travel purposes. The more severe Delta wave in mid-2021 brought rising fear of Covid-19 in Uganda and an increase in those wishing to get a vaccine, in a context of limited supplies and challenges to equitable internal distribution.
This snapshot of Uganda points to the multi-layered nature of anxieties that emerged from our research. Though contextually different, in both Uganda and Sierra Leone, vaccine anxieties related not only to bodily understanding but also political relations and geopolitical positioning. Our analysis reveals how anxiety is generated by wider contextual factors which are multiple and shifting. Similarly, the urgency to get a vaccine or not changes as circumstances change and with waves of infection and new variants.
A new conceptualisation of ‘vaccine preparedness’
Whilst it is easy to dismiss negative comments about vaccines as ill-founded, misguided misinformation and conspiracy – part of an infodemic – it is also the case that they often reiterate longstanding concerns about vaccination in Africa and globally; and they have been given new life by the specific supply issues around Covid-19. The cases of Uganda and Sierra Leone reveal that people’s anxieties about Covid-19 vaccines – both negative worries, but also positive desires for the vaccines – are embedded in often sophisticated understandings and reflections that make sense amidst their social and historical contexts and experiences.
In this light, we need a new conceptualisation of ‘vaccine preparedness’ to become a central part of global health and emergency policy and planning. This must move beyond existing WHO notions of ‘vaccine readiness’ to address the longer-term structural, social and political relations in which vaccine delivery and distribution are embedded. We need to move beyond narrow assumptions about vaccine demand or hesitancy, and address also the real anxieties embedded in bodily, social and wider political experience.