Yellow fever vaccine hesitancy blamed on elites and mistrust

Yellow fever mass vaccination campaign has unmasked the rise in vaccine hesitancy in the country, a vice health experts warn could increase risks of outbreak of vaccine-preventable diseases.
Following the April 2 start of the mass vaccination against yellow fever, a contagious disease which the World Health Organisation (WHO) says is endemic in Uganda, a growing number of parents—many using social media to express their views—are saying they don’t trust the vaccine, its safety and the motive behind the campaign.

However, data from the Health ministry also indicates that there is a general increase in the number of children who have never gotten other essential vaccines.  
Dr Ombeva Malande, a vaccinologist at the ministry’s Uganda National Expanded Programme on Immunisation (Unepi) told Sunday Monitor on Friday that hesitancy has increased during and after the Covid-19 pandemic. He said the increase is “due to wider internet access post-[pandemic]”, adding that the vaccines are safe and there is no ill motive behind the government vaccination campaigns.

The access has exposed many people to misinformation, disinformation and conspiracy theories, amid other useful and enlightening information.   
Former presidential candidate Joseph Kabuleta has been running campaigns on social media, majorly X (formerly Twitter), advising people to be cautious about the Covid-19 vaccines. He has now shifted focus to Yellow Fever vaccines, with many of his followers offering support.

“Dear head teachers, parental consent is 100 percent necessary for the Bill Gates Yellow Fever vaccination. If you force it on learners, and adverse side effects start (as they surely will) you will face the wrath of legal fees alone. Be warned!!” he wrote in one of the posts.
Without sharing the link to the report showing the alleged side effects, he claims the yellow fever vaccine is associated with about half a dozen health problems including organ failure.

However, Dr Malande insisted that the “vaccine is safe”. 
“For a year now, it was already rolled out in a routine immunisation programme for children aged nine months. Babies have been getting it as part of routine immunisation,” he said.
“We want to catch up with the rest of the population. It’s the same vaccine and manufacturer we have used for years, Sanofi Pastuer’s Stamaril. And it’s from France ... not from America or Bill Gates, as some are saying,” he added.

‘No need to fret’
The vaccinologist added the campaign and vaccine are funded by “Uganda as a country; not Bill Gates or some agenda.”
He told Sunday Monitor thus: “It’s your taxes paying for it. It is safe. Even if you got it previously and got it again, it’s safe. Only people confirmed to be allergic to eggs won’t get it, and elderly above 60 years, breastfeeding mothers of infants below nine months and pregnant mothers. The rest should get the vaccine, [those] aged nine months to 60 years.” 
The campaign is running from April 2 to 8 in designated vaccination centres in many districts of the country. 

According to the Health ministry, one shot of the vaccine offers lifetime protection. “And when you want to travel, that white card is enough to show to a yellow fever card issuing centre and they give you the yellow card. You won’t be able to travel to any country without yellow fever evidence of vaccination. Vaccines save lives,” he added.
According to information from WHO Uganda, the yellow fever “vaccination is being done with support from the WHO, Eliminate Yellow Fever Epidemics (EYE) Strategy, Gavi and Unicef.”

Elites shun jabs
Prof Winstons Muhwezi, a behavioural scientist and director of research at Advocates Coalition for Development and Environment (ACODE), told this publication earlier that the hesitancy for vaccination is high among educated people.
“Generally, I think younger and more educated people like to question everything brought by the government, this is good for someone who is educated, but it can also be counterproductive,” he said.  

According to information from the website of the French drugmaker Sanofi (https://www.sanofi.com/assets/countries/singapore/docs/Stamaril-SG-0222.pdf), the safety of STAMARIL in paediatric population has been studied through a clinical study performed in 393 toddlers aged 12 to 13 months which received STAMARIL and placebo concomitantly.

“The following most frequently reported adverse reactions specific to the paediatric population were reported as “very common”: irritability (34.7 percent), appetite loss (33.7 percent), crying (32.1 percent) and drowsiness (22 percent),” the information reads.
“The other adverse reactions reported in toddlers were also reported from studies in the general population: Injection site pain (17.6 percent), pyrexia (16.5 percent) and vomiting (17.1 percent) were reported as “very common” in toddlers.

“Pyrexia (fever) and vomiting were more frequently reported than in the general population. Injection site reddening (9.8 percent) and injection site swelling (4.4 percent) were reported as “common” in toddlers, like in the general population, however with significantly higher frequencies compared to the general population,” information from Sanofi reads further.

‘Yellow fever vaccine safe’
According to information from the WHO, vaccination is the most important means of preventing yellow fever. “Side-effects from the yellow fever vaccine are rare,” information the WHO website reads.

“The yellow fever vaccine is safe, affordable and a single dose provides life-long protection against yellow fever disease. A booster dose of yellow fever vaccine is not needed. The vaccine provides effective immunity within 10 days for 80–100 percent of people vaccinated, and within 30 days for more than 99 percent of people vaccinated,” the WHO adds.
Dr Yonas Tegegn Woldemariam, the WHO representative in Uganda, said “yellow fever is endemic in Uganda with frequent outbreaks in various parts of the country”.

“The yellow fever vaccine is safe and effective. I encourage all parents and caretakers to ensure their child receives the vaccine. Adults need to take it as well. It saves lives,” he added.
Dr Diana Atwine, the permanent secretary of the Health ministry, on the other hand said the population increase and the reduction of under-five mortality which was reported in the Uganda Demographic and Health Report 2022 “was because we prioritised vaccination”.

“If we don’t vaccinate people, we shall see more people getting sick, children dropping out of school etc. We want to reduce the disease burden of our country,” she said.
She added: “We can only do that if all of us realise we have a common enemy and realise that infectious diseases are prevalent. We need to embrace prevention. Vaccination is a prevention measure.”

Unvaccinated children increase
Before the launch of the yellow fever vaccination campaign, a report presented by Gavi Zero Dose Learning Hub in Uganda last week indicated that the number of zero-dose children (those who have never been vaccinated with a routine vaccine), had almost doubled in the last two years from 55,000 in the year 2021 to 96,000 in the year 2023.
The Learning Hub in Uganda is being implemented by the Infectious Diseases Research Collaboration, PATH, a global health organisation, and Makerere University School of Public Health, with support from Gavi, a global vaccine alliance.

While presenting the report, the technical advisor for vaccines and immunisation at PATH, Ms Jackline Anena, said they were based on the data from the Health ministry’s District Health Information Software 2 (DHIS2).
“From 2020, were at 142,000 for the zero-dose children, in 2021, there was a significant reduction in these numbers [to 55,252] but in 2022 and 2023, there seems to be an increase in the number of zero-dose children,” Ms Anena said while presenting the report on March 27 in Kampala.  

According to the figures, in 2022, the number of zero-dose children increased to 75,952 and it continued to rise to 96,072 in 2023.
Ms Anena, who is the technical advisor for vaccines and immunisation at PATH, observed that the rise in the number of elites who are anti-vaxxers could further affect immunisation coverage in the country.

“The number of vaccines being introduced is increasing and so there is hesitancy. We have the anti-vaxxers coming up. Those are very learned people, they are elites,” she said.
“They review vaccines, do their study and come up with their evidence to fight, so with new vaccines coming in, we have more and more hesitancy challenges. So we need to think through and prepare as we introduce the vaccines,” she added.

The other factors researchers said were affecting vaccine uptake were challenges in vaccine delivery, vaccine stockouts, inconsistency in outreaches, limited sensitisation, cultural beliefs and distance to health facilities.
Dr Rita Atugonza, deputy manager for the Immunisation Programme at the Health ministry, supported the findings.

“Like most countries, we have seen tremendous improvement in our immunisation coverage over the past 20 years and we were even able to maintain that momentum during the pandemic. However, in 2022, we started to note a decline in our coverage,” she said.

She said although nationally the immunisation coverage is at around 92 percent, many districts have coverage of less than 80 percent.
“What zero-dose and under-immunised represent is outbreaks like measles. The data is beginning to show that we have these children because we are beginning to have these outbreaks. A child with measles may experience severe complications and these are also children who are likely to die before they turn five years and they are also more likely to be exposed to tuberculosis,” she said.

Way forward
Dr Immaculate Ampaire, the former deputy manager of Unepi, said before Covid-19 the ministry was already fighting anti-vaxxers in the country. Dr Ampaire said the government should amplify community engagement and increase the feeling of responsibility among Ugandans to address resistance. 
“We also need a clear framework for accountability and sense of ownership for this country,” she said.