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COVID-19 vaccines: from rejection to shortage, how Côte d’Ivoire became a model for managing vaccine hesitancy

In February 2021, Côte d’Ivoire’s efforts to vaccinate its population in order to save lives and stem the spread of the coronavirus were being stymied by a wave of misinformation and a low level of public acceptance of the vaccine.

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A man being vaccinated against COVID-19 at the vaccination center in Treichville, Abidjan, Côte d’Ivoire. © Erick Kaglan, World Bank.

 

One month after Côte d’Ivoire’s vaccination campaign was launched with much fanfare, the great enthusiasm generated by the delivery of 504,000 doses of the AstraZeneca vaccine on February 26, 2021, quickly gave way to major concerns due to very low vaccine acceptance rates among the target population. By March 30, only 40,153 doses had been administered in Côte d’Ivoire. The following week, the National Security Council, chaired by Ivorian President Alassane Ouattara himself, decided to expand access to the COVID-19 vaccine to all Ivorians over the age of 18 in order to boost vaccination rates. Yet, little had changed, and vaccine mistrust remained widespread in Abidjan, where far-fetched rumors were spreading like wildfire on social media.

Yopougon a neighborhood of rumors

“Yopougon is a neighborhood of rumors; here we believe more in word of mouth.” As in most of the rest of the country, in Abidjan’s largest district, which has more than a million inhabitants, “rumors are more powerful and spread faster than appeals from the authorities. After several weeks of refusal, then hesitancy, Olga Gneppa, a shopkeeper in Yopougon and a mother of five children, finally decided to get vaccinated.

But not many were choosing to follow in Olga’s footsteps. While vaccination centers in the capital and its environs were capable of serving up to 300 people in a day, they were struggling to vaccinate 20 per day. In total, the 60 or so centers were only vaccinating 2,000 people per day. At that rate, many vaccine doses were likely to expire and end up in the garbage.

This was a far cry from the health authorities’ goal of vaccinating 10 million people, or 40% of the population, by the end of the year and 57% by December 2022. “We were told that the COVID-19 vaccine would cause blood clots and kill us, but now that the minister has come to explain it to us, we understand that this was all untrue.” Olga Gneppa.

Kill the rumors or lose the battle

In mid-April, Minister Pierre Dimba, who had just been appointed Minister of Health, made the same observation: fake news is spreading on social media, discouraging people from getting the vaccine and undermining the vaccination campaign in Côte d’Ivoire. For his part, Professor Mamadou Samba, Director General of Health, kept repeating the same reassuring scientific facts: “We have not recorded any cases of serious side effects from the AstraZeneca vaccine. This vaccine is very safe and is being used in many countries.” But he was confronted by a wall of mistrust that had been built up in working-class circles and even among young professionals, although they were expected to be relaying awareness messages to the general public.

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In the immediate future, tens of thousands of Ivorians had to be convinced of the effectiveness of the vaccines and, above all, the wild rumors about the harmful and even fatal side effects of the AstraZeneca vaccine had to be squelched. Minister Dimba began holding conversations with key players at the national level and with international organizations, and enlisted as many people as he could to get the word out, including social media influencers, religious and community leaders, and local elected officials. For Pierre Dimba, “the survival of our population is at stake and by stepping up vaccination campaigns in markets and places of worship, we hope to quickly reach the goal of vaccinating nearly six million people throughout the country.”

The government has also begun expanding the vaccination campaign in the rest of the country. It has deployed mobile clinics—large medically equipped buses that travel to the busiest areas to educate, mobilize, and vaccinate people. This new strategy requires significant financial and logistical resources, and for this Côte d’Ivoire can count on an important partner.

© Erick Kaglan, World Bank.
The awareness-raising campaign launched by the government to address low vaccine uptake among the population has enabled Côte d’Ivoire to boost vaccination rates.
© Erick Kaglan, World Bank.

An international leader in the fight against COVID-19

In April, the World Bank, which had already committed more than $75 million to the fight against COVID-19 in Côte d’Ivoire, provided a further $100 million in funding to the Ivorian government through the International Development Association (IDA). The goal is to facilitate the acquisition of new vaccines against COVID-19 and reinforce the national vaccination campaign in order to limit the spread of coronavirus.

This additional funding, which is part of the COVID-19 Strategic Preparedness and Response Project, is intended to enable Côte d’Ivoire to diversify its vaccine supply sources, ensure effective deployment at the national level, and support awareness-raising efforts. It has made it possible to cover the logistical costs and scaling up the campaign, in particular through the roll out in the country’s 113 health districts and the operation of 12 mobile clinics in Abidjan.

At the same time, the World Bank’s health and communication specialists are working alongside government teams to bolster the community mobilization campaign and step-up communication about the vaccine. As a result, after four weeks, Côte d’Ivoire was able to increase the number of people vaccinated from 2,000 per day to more than 20,000 in the following weeks.

Demand soared, making Côte d’Ivoire an international model for successful management of the antivax movement. “Now, our center is overrun in the morning and we vaccinate at least 300 people a day,” says Dr. Adèle Telly, head of the COVID-19 center at the Treichville sports center. As of early July, the country had more than 300 fixed and mobile vaccination sites.

But while the awareness-raising campaign is bearing fruit and demand for vaccines is rising, the government has had to grapple with vaccine shortage and overall limited supply on the continent.

Vaccines today, not tomorrow

Although the situation varies across Africa, on average, less than 3% of the African population is vaccinated. This situation is “unacceptable and must change,” said Axel van Trotsenburg, the World Bank’s Managing Director of Operations, when he visited the mobile clinic in the Adjamé Forum market, a large open-air shopping center in downtown Abidjan.

“We have intensified our support and are deploying needed financing to help enable African countries to contain the pandemic and rebuild economically and socially,” added van Trotsenburg ahead of a July summit of African heads of state for the replenishment of IDA, the main source of financing for development and for the fight against the COVID-19 pandemic in Africa. The World Bank has made $20 billion in financing available to low- and middle-income countries to purchase and distribute COVID-19 vaccines, tests and treatments and to strengthen their immunization systems.

This funding is part of the broader response to the pandemic by the World Bank Group, which is currently helping more than 100 countries to strengthen their health systems, protect the poorest households, and safeguard jobs and livelihoods for the hardest-hit populations.

Recently, the African Union, working closely with the World Bank, took the lead in negotiating on behalf of the African countries with Johnson & Johnson to produce 400 million doses of vaccine for the continent with the goal of vaccinating 40% of the population by the end of this year and 60% by June 2022. Early September 2021, 100,800 first doses have already been shipped to Cote d’Ivoire.

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This article was first published by The World Bank on 7 September 2021

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