COVID-19 vaccines roll-out face hesitancy, anti-vax campaign

World champion sprinter Yohan Blake had just raced across a track at a meet in Jamaica when he made his position clear: He would rather miss this summer’s Tokyo Olympics than get a coronavirus vaccine.

“I am not taking it,” he told The Gleaner, a daily newspaper on the island. “I don’t really want to get into it now, but I have my reasons.”

Blake’s reluctance to get a shot to protect himself from the virus that has overwhelmed hospitals in his country underscores a challenge facing health officials across Latin America and the Caribbean as inoculation campaigns get underway: resistance to getting the vaccine.

“His position unfortunately is not that uncommon in many segments of our population,” Jamaica Health Minister Christopher Tufton said of Blake, considered the second fastest man in the world after Usain Bolt. “The difference, of course, is that he is a national talent and therefore carries influence, especially among the younger population.”

As the first vaccine shipments from a United Nations-backed initiative known as COVAX begin arriving in the region, a year after the first infections were confirmed and months after the United States and the United Kingdom began inoculating their citizens, governments are quickly realizing that the race to controlling the deadly pandemic is strewn with distrust, conspiracy theories, and an anti-vaccine campaign growing in strength.

Research by Florida International University’s School of Communication and Global Health Consortium shows that while access to a COVID-19 vaccine remains an overwhelming concern for most citizens in the region, who have been watching wealthier nations immunize their populations, hesitation over taking one persists.

“The anti-vaccine movement from Europe and the United States is gaining traction in Latin America,” said Maria Elena Villar, an associate professor of communications at FIU. “You’re starting to see an increase in that kind of messaging, often referring to content that was originally from the U.S. and Europe. It’s something to watch and to try to mitigate before it gets worse.”

Like in the United States, citizens are questioning the science and the rapid speed at which vaccines have been developed and given emergency approval. Others have doubts about the long-term effects. Then there is distrust of authorities.

How people across the region feel about their governments, tasked with administering the vaccines, has been a complicating issue throughout the pandemic. It has influenced everything from accepting the existence of COVID-19 to following mitigation efforts like mask wearing to now vaccine response.

Around the globe, leaders have peddled unproven cures and even denial of the virus. In December, Brazilian President Jair Bolsonaro left citizens baffled when he cautioned them that his government won’t be responsible if the Pfizer-BioNTech vaccine turns people into “crocodiles” or make women bearded as a side effect.

“Maintaining the population’s trust in immunization is critical at all times…especially during the rollout of a new vaccine,” said Dr. Sylvain Aldighieri, incident manager with the Pan American Health Organization, the Americas office of the World Health Organization.

Distrust, skepticism as misinformation spreads

In Venezuela, people’s trust in the vaccine is often intertwined with their political views. While many people have been posting on social media about wanting access to the shot, on the streets of Caracas, where people are often seen walking with masks hanging from their chins, distrust and skepticism are everywhere.

Critics say President Nicolás Maduro has helped fan the flames of doubt. In January, as Venezuela scrambled to get access to a COVID-19 vaccine, Maduro went on live television and promoted what he called a cure for the virus: the drug Carvativir. The oral solution is derived from the herb thyme, long used in traditional medications.

Maduro described Carvativir as “miracle drops of Jose Gregorio Hernandez,” a 19th century Venezuelan doctor who was beatified by the Roman Catholic Church last year.

For many Venezuelans, the message resonated as a joke. Then came news that the country would be relying primarily on Russia’s Sputnik-V coronavirus vaccine, which has not been approved in countries like the United States or by the World Health Organization.

Though a recent study indicates that the Russian vaccine is highly effective, some remain skeptical of getting a shot in the arm as Venezuela’s access to other vaccines approved through COVAX remains in limbo. The country’s government and opposition have been sparring over how to make a required $18 million down payment.

Orlando Pérez, 60, a motorcycle driver who used to be a forensic assistant at a morgue before the South American nation’s severe economic retraction, said stories have been circulating in his central Caracas neighborhood about the vaccine killing the elderly, frightening both of his elderly parents. His father in particular has been trying hard to not make it seem that he is old enough to be on the priority list for a dose.

“My father is 100 years old now, my mother is 96. Before they were feeling a bit down. But now that they have been told that the elderly are being vaccinated, and they are being killed, he is now active,” Pérez said about his dad. “He goes out to the street, he walks— everything.”

Others doubt the existence of the virus at all, or no longer believe that it poses a serious threat. In Catia, a working-class neighborhood where Ciro Zambrano lives, some people along the busy main square no longer wear a mask and police officers have stopped enforcement.

“I have not had that [coronavirus]. Neither has my family,” Zambrano, 55, said as he waited in line for cooking fuel among pro-government supporters.

A shoemaker, whose business was also hurt by the economic crisis, Zambrano said he’s especially skeptical of the Russian vaccine.

“I would never get that vaccine,” he said. “It scares me.“

Across the Caribbean Sea in Antigua and Barbuda, Lionel Walker also had his doubts, worried about introducing what he likened to “a foreign body” into his arm. But he changed his mind after considering his age, 67, and his potential exposure to the virus: He and his wife run a guest house for tourists, which means they are not completely shielded from the outside world.

“I said ‘Look, if it’s going to keep me out of the hospital, I think I would rather take my chance with the vaccine,” said Walker, who recently received his first shot.

Walker said his decision was solidified when his 51-year-old nephew ended up on a ventilator after contracting COVID-19. He’s been hospitalized for more than three weeks.

“His lungs have been severely compromised because of COVID and if I were in his position in the hospital, I would be dead,” said Walker.

Throughout the region, concerns have also arisen over which manufacturer’s shot is best and who is getting access to the most highly effective ones to reduce transmission. One of the more widely distributed shots, the Oxford-AstraZeneca vaccine, has about a 70% efficacy rate, which studies show prevents serious illness, but is lower than others in use.

Questions over how well it works for older people have only added to skepticism and confusion, which recently reached the shores of Antigua.

The country’s prime minister, Gaston Browne, had promised he would be one of the first to take a jab in the arm when a vaccine became available. Later it was revealed, however, that Browne had secretly been vaccinated three weeks earlier with a Moderna vaccine shot rather than AstraZeneca, which recently became available for the population through a donation from India.

PAHO has said that AstraZeneca “is similarly effective” as all of the other vaccines, meaning it performs just as well in the real world and should be used to protect those who are more vulnerable to the disease. Still, Antiguans aren’t happy. Many accused the prime minister of providing an inferior shot for the general population.

“A leader ought to be leading his troops into the same danger that he is going into,” Walker said about Browne. “He took a different vaccine than the one most of his citizens will be exposed to. I am very disappointed.”

Over 50 million infected in Latin America, Caribbean

This time last year, Argentina, Chile and Ecuador were reporting their first COVID cases. Since then, more than 1.2 million people have died from the disease and more than 52 million have been infected throughout the Americas, which includes the U.S. and Canada.

In many places, cases and deaths are starting to show a decline, but in several countries, including most notably Brazil, patients are still overwhelming hospitals, filling up beds in intensive care units.

Though some countries have secured initial doses of vaccines through bilateral arrangements and donations from India and Israel, which provided 5,000 doses each to Honduras and Guatemala, most countries in the region are getting doses through the COVAX Facility. An estimated 28.7 million doses are expected to be delivered to countries between now and May — far less than the estimated 500 million people the Americas will need to immunize to contain the pandemic.

So far more than 113 million people in the Americas have been vaccinated against COVID-19, with the U.S. leading in the percentage of individuals who are fully vaccinated. One country in Latin America that is outpacing its neighbors is Chile, which has sourced vaccines from several places and administered more than 6 million doses and set a goal of delivering at least one dose to 15 million people by the end of June.

The success of the country’s vaccination campaign can be attributed in large part to its high income, said PAHO Assistant Director Jarbas Barbosa. He noted that most countries in the region lack the resources to enter into their own bilateral agreements with vaccine manufacturers. Chile also has a robust primary healthcare system, a national immunization registry and experience in conducting mass immunization campaigns.

“They have smartly used the resources they have to carry out bilateral agreements with some manufacturers,” Barbosa said. “Chile has several options to access a vaccine but I do not think these same conditions are true for other countries.”

While there is wide acceptance for vaccinating children in Latin America and the Caribbean against ailments like polio that were eradicated through inoculation years ago, PAHO public health experts have said the rollout of a new vaccine comes with specific challenges.

“What we are facing is misinformation about COVID-19 vaccines that has been circulating even before the vaccines were available,” Aldighieri said. “So our main objective is to correct this misinformation with clear messages on how the vaccine is crucial to decrease the number of hospitalizations and the number of deaths.”

PAHO has asked countries and governments to prepare their populations to receive inoculations by prioritizing who will be first in line, and adapt communications to encourage vaccination. The regional health agency is also trying to get a better grasp on the hesitancy issue and currently has several ongoing studies. The organization is especially concerned about perceptions among minority groups, including the population of Afro-descendants and indigenous communities.

“The reasons for hesitancy are often very complex; context specific and sometimes culture specific,” Aldighieri said. “We have to work with countries and partners to understand why people may not be motivated or willing to accept or seek vaccination.”

Dr. Lauré Adrien, the director of Haiti’s Ministry of Health, said officials have put together a task force whose central challenge will be helping the ministry figure out how to convince a population to take a vaccine to protect against a disease it doesn’t believe in. Stigma, distrust of the government and a lack of high hospitalizations and deaths have many Haitians unconvinced COVID-19 is real and dismissing it as “a little fever.”

Lines in Barbados, photos in Puerto Rico

Two places that are seeing success with vaccination efforts are the U.S. territory of Puerto Rico and the island of Barbados. In both places, success has been pinned to aggressive messaging campaigns.

In one campaign in Barbados, for example, the public was asked to choose between two masks: A regular face mask to protect against COVID and another used by patients on a ventilator. As the country began vaccinations, the message featured individuals who had taken the vaccine and are now keeping a loved one safe.

The result has been a growing demand for the vaccine, with motorists waiting in long lines to get a jab. As of March 11, the country had vaccinated over a quarter of its population, administering 50,621 doses in just over a month. The first vaccinations were distributed to front-line workers, including those in the tourism sector, as well as vulnerable populations like the elderly and those with preexisting conditions.

In an address to the nation, Barbados Prime Minister Mia Mottley called it “a commendable start for a country that really did not have a lot in place for a vaccination program.”

Dr. Iris Cardona, director of the Puerto Rico Department of Health’s vaccination program, attributes the strong interest in Puerto Ricans getting vaccinated partly to a campaign in which health professionals posted photos of themselves getting the COVID-19 vaccine and promoted immunization on their social networks. Puerto Rico has thus far administered at least one vaccine dose to 15.2% of the population, below the mainland U.S. average but above most in the Americas.

“It was very successful. We had nurses, technologists, pharmacists, and doctors getting vaccinated, getting photographed, sending a message through all social networks,” she said.

When the next vaccination phase opened for first responders, officials observed the same phenomenon playing out on social media.

“We could say it perhaps became viral,” she said.

Lilliam Rodríguez Capó, president of vaccine coalition VOCES, said that aggressive education campaigns and vaccine drives through programs such as theirs have also made Puerto Ricans receptive to the vaccine. VOCES helped the island achieve among the highest rates of immunization against the human papillomavirus (HPV) through vaccination in the United States years ago.

Aldighieri believes it is key for health ministries to provide real-time information, especially by showing examples of successful vaccination campaigns in various parts of the world.

None of this is lost on Tufton, Jamaica’s health minister, who noted that the last large-scale vaccination campaign in the country, for HPV shots, had less than 40% acceptance despite the vaccine being provided for free and promoted by medical groups as protecting girls from a deadly cancer.

After initially keeping the coronavirus under control, the country is reporting an average of 297 new infections a day. Its highest daily average was reported on February 20. Hospitals are overrun and the government is opening up several field hospitals. There are more than 28,270 infections and 463 coronavirus-related deaths.

Earlier this month, officials reimposed lockdowns, required visitors to present a negative COVID-19 test taken 72 hours before arrival, temporarily banned funerals and burials, and required work from home for public sector employees. On average, one person infects 1.3 individuals, Tufton recently told the nation, adding that the images of Jamaicans on oxygen tanks scare him.

To address hesitancy, he said, the ministry is hoping to use healthcare workers, such as doctors and nurses, to help with community outreach. He also plans to seek endorsements from social media influencers and other popular personalities to help.

“Our response must include getting Jamaicans to understand that these vaccines are not dangerous, and more importantly, can be of significant benefits to the individuals and the society,” Tufton said.