The G7 has promised to donate 1 billion Covid vaccine doses by the end of 2021. However, in South Sudan, COVID restrictions, aid cuts and comments by European leaders have shattered trust in public health advice and encouraged vaccine hesitancy. Despite the rhetoric, donating vaccines while cutting aid may prove meaningless

Diing Akoi, Abraham

Pendle, Naomi

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LSE Research Online

Naomi Pendle Abraham Diing Akoi June 15th, 2021Cutting aid will increase distrust in Africa’s COVID-19 vaccine rollout0 comments | 7 sharesEstimated reading time: 5 minutesThe G7 has promised to donate 1 billion Covid vaccine doses by the end of 2021. However,in South Sudan, COVID restrictions, aid cuts and comments by European leaders haveshattered trust in public health advice and encouraged vaccine hesitancy. Despite therhetoric, donating vaccines while cutting aid may prove meaningless.As the G7 gathered in Cornwall, UK in June 2021, press headlines and humanitarian lobbyists werepushing for high-level commitments to provide COVID-19 vaccines to the world’s poorest countries.Undoubtedly there is a heavy humanitarian burden to help those countries that cannot afford thevaccine; real-world data is making it increasingly clear that vaccines make the disease less deadlyand save lives. Recent months have also shown that variants quickly spread globally, and that areduction in transmission through the vaccine is a major way to stop the emergence of new ones.Many people in the poorest countries around the world are eager to receive a COVID-19 vaccine.There are reports of people sleeping outside clinics in Uganda overnight in hope of receiving them.Yet, if we do want to vaccinate the entire world, providing vaccines is not enough. In many contexts,there is considerable vaccine scepticism and we need to build trust in public health so that peoplewill not refuse them.In a recent study in South Sudan, it was clear that COVID-19 restrictions in the  rst year of thepandemic have resulted in a loss of trust in governments, UN agencies, humanitarians andbiomedical advice. The study was funded by the East Africa Research Fund of the UK’s Foreign,Commonwealth and Development O ce, and included detailed interviews with people across SouthSudan. The research highlighted that trust had fallen because South Sudanese did not share thesame priorities as these powerful actors, and because COVID-19 restrictions had caused muchharm.In South Sudan, people have longstanding experience of recognising and dealing with epidemics.But like in many of the world’s poorest countries, the lack of COVID-19 testing has made the virusinvisible. Across much of the country people do not believe there have been COVID-19 deathslocally; the lack of testing means that few deaths have been con rmed as resulting from the virus.Plus, in South Sudan, the lack of medical access means high mortality among the elderly is notunusual.Furthermore, people in South Sudan have to survive myriad other troubles – troubles they know cankill them. They face deadly armed con ict, other epidemics and severe food insecurity that hasreached famine levels in some places. Mothers have to face choices between buying grain to feedtheir children or buying soap.In this context, the enforcing of COVID-19 restrictions highlighted to South Sudanese how muchmost people’s priorities and concerns differed from those of national and global leaders. Theserestrictions failed to re ect South Sudanese priorities and caused economic and social harm. SouthSudanese have also experienced a decline in non-COVID-19 aid programming, making it moredi cult for them to confront the struggles of hunger and con ict. For many, the COVID-19 pandemichas made starkly visible the world’s inequities. It was only the world’s richest people and populationsthat had the ability to be concerned by this health concern. Some South Sudanese racially codedCOVID-19 as the ‘white man’s disease’.Receiving vaccines in South SudanThe week in June 2021 when the G7 met in the UK was the same week that the  rst COVID-19vaccinations arrived in Bor – a town in South Sudan that has seen episodes of extreme con ict inrecent decades, including large-scale battles that targeted civilians in the country’s recent war. InJonglei State (the state in which Bor is the capital), in recent months there have been deadlycon icts and famine-level hunger.Wariness about UN and humanitarian public health advice, and mistrust of government, haveclouded the virus and vaccine perception. People in Bor do not view the virus as dangerous becausethey see more deaths from con icts and other diseases.One woman we interviewed has recently moved to Bor because unknown gunmen made itimpossible for her to remain safely in her village. Her son was abducted and her husband was killed.In her words:‘the virus could have not abducted my boy and killed my husband … So, those who talk about thevaccine do not understand what we are going through. Where is the so-called government? Theonly people who should worry about virus are the rich not us the poor, the ordinary peoplebecause we have nothing to lose.’There is also scepticism about the vaccine. Internet access via mobile phones is widespread in thecountry, and many South Sudanese learnt about the global pandemic as soon as it hit globalheadlines, continuing to watch as the virus has spread and vaccines have been rolled out. Butscepticism has not been helped by European leaders playing political games and, in March 2021,provocatively and seemingly arbitrarily restricting vaccine use domestically.A COVID-19 vaccination poster in Bor, South Sudan, June 2021. Credit: Abraham Diing Akoi.The  rst AstraZeneca vaccines arrived in South Sudan in the last week of March 2021. The sameweek Germany restricted the use of the same vaccines in under 60s at home. The result has beenthat many South Sudanese feared that Europeans were dumping on Africa dangerous products.Some people in Bor highlighted that the South Sudan government does not have the capacitythemselves to regulate the safety of vaccines, providing grounds to mistrust it. Others even fearedthat these Europeans were conspiring with their own government to harm them through the vaccine;the government had attacked them through military campaigns and was now, apparently, attackingthem via medicine.In Bor, scepticism about the vaccine increased as it became prioritised over issues considered moredeadly. In Bor, a local medical o cial described how there has only been one con rmed death fromCOVID-19 in the hospital, and another in the UN compound. Even health workers struggle to knowwhether people have died from COVID-19 as they have no access to testing. Therefore, people havequestioned the government’s motive given the vaccine rollout has been quick but a response to helphundreds of people dying from malaria and pneumonia and during childbirth has been slow. Onewoman we interviewed owns a small tea shop in Bor, with plastic sheets for walls and mud for a oor. In 2020, large  oods in the town swept away many houses; she stated that ‘my house waswashed away by the  ood, and me and my children are squatting in an open space in the town. Whyshould I care about virus or vaccine?’Not only are individuals refusing the vaccine, but some community leaders are discouraging uptakeand having the vaccine is now associated with social condemnation. For example, during aninterview with one o cial in the state Ministry of Health in Bor, he explained that he had not beenvaccinated as his wife refused to allow him. She argued that she was still a young wife and that shedeserved to have a healthy husband. She had heard the vaccine was dangerous and did not want hishealth affected.It is increasingly clear that COVID-19 vaccines will save millions of lives and allow the easing ofrestrictions. South Sudanese will be safer if they accept to take the vaccine. Yet, the  rst year of thepandemic has shattered trust in government and UN and humanitarian health advice. Thisunderstandable lack of trust is now shattering people’s likelihood of staying safe.In Juba, where COVID-19 is more visible, there has been much fear about COVID-19 and less vaccinehesitancy. Even in Bor, despite largescale reservations, hundreds have come forward, especiallygovernment o cials and humanitarian workers. Some local people are coming if their relativesabroad, who live as refugees (or now citizens) in the UK, the US and Australia, have convinced themof its safety.In South Sudan, the UK has spent substantial overseas development aid on supporting local peaceprocesses and on providing food to prevent famine mortality. Taking these South Sudanesepriorities seriously alongside vaccine distribution is one way to develop trust and sympathy. Yet atthe G7 meeting, overseas aid cuts by the UK government have not been reversed, threatening tofurther undermine trust when global health needs it most.Photo: Foreign Secretary Dominic Raab bilateral with Naledi Pandor. June 2021. Picture by SimonDawson / No 10 Downing Street. Licensed under CC BY-NC-ND 2.0.About the authorPosted In: COVID-19 | Health | International Affairs | RecentDr Naomi Pendle is a research at the LSE Firoz Lalji Centre for Africa focussed on publicauthority, patterns of violence and local governance particularly in South Sudan. Naomi hasadvised the UK and US governments and researched for the ICRC.Naomi PendleAbraham Diing Akoi is a researcher at the LSE Centre for Public Authority and InternationalDevelopment at the Firoz Lalji Institute for Africa. He began his formal education in KakumaRefugee Camp, Kenya, and graduated from LSE with a Masters in Development Studies. Heremains part of the PfAL network at LSE.Abraham Diing Akoi

Cutting aid will increase distrust in Africa’s COVID-19 vaccine rollout

http://eprints.lse.ac.uk/111077/1/Africa_2021_06_15_cutting_aid_will_increase_distrust.pdf

Cutting aid will increase distrust in Africa’s COVID-19 vaccine rollout

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