COVID-19 Vaccine Hesitancy in Africa and Asian Continent: A Comparative Study Between Nigeria and Nepal

Introduction

The severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) was named by the International Committee on Taxonomy of Viruses (ICTV). This same virus was named 2019-novel coronavirus (2019-nCoV) by World Health Organization (WHO) and later coronavirus disease 2019 (COVID- 19). The WHO later declared the outbreak a pandemic and a Public Health Emergency of International Concern (PHEIC) [1].

This disease is linked with a cluster of respiratory infections in the Hubei province of Wuhan, China [2], and has since become a global pandemic. To date, more than 623 million cases of COVID-19 have been reported on the John Hopkins University Coronavirus Resource Centre (JHUCRC) database, with over 6.4 million deaths globally [3, 4].

To curtail the continual health and economic effects caused by SARS-CoV-2, many therapeutic strategies were proposed and implemented. These strategies include pharmaceutical intervention such as mask-wearing, social distancing, and quarantine as well as other non- pharmaceutical intervention which employs SARS-CoV-2 control at the community level [5]. Of all these interventions, the use of vaccines has proven effective in the control as well as in the prevention of SARS-CoV-2. Vaccines such as Johnson’s Janssen COVID-19, AstraZeneca, Moderna, and Pfizer/BioNtech are among the few vaccines that received very high global recognition and have long been accepted in many different countries including Nigeria and Nepal. Among these countries, vaccine hesitancy has been identified as a serious concern affecting the implementation of the SARS- CoV-2 vaccination Programme.

In Nepal, there are more than 1000 Covid-19 cases with 12,018 deaths thus far. Even with just about 3000 active cases so far, Nigeria has recorded a total of 265,816 confirmed cases of COVID-19 out of over 5 million samples tested with 3,155 deaths as of October 2022 [6].

Vaccination programs are currently ongoing against COVID-19 across different countries in the world. The least vaccinated countries are African countries, including Nigeria, even with the proven data with regard to vaccine safety and efficacy [7]. With more than 12 billion doses of vaccines administered globally [3], only about 80 million doses were administered in Nigeria out of a total population amounting to 200 million [8]. While in Nepal with a population of approximately 30 million people, about 58 million doses of vaccines have been administered and approximately 93.32% of the entire country’s population receiving at least a single dose [3, 9]. In Nigeria, a BBC news publication reported that only 3% of the entire population has received a full course of the COVID-19 vaccine, which is regarded as a very low rate compared with other African countries like South Africa (24%) [10].

There are still worries about vaccine efficacy and safety as part of the COVID-19 vaccine challenges both in Nepal [11] and Nigeria [12]. Therefore, more Randomized controlled trials are required to validate the efficacy of the vaccines. Vaccine hesitancy is one of the challenges of COVID-19 vaccination programs in Nigeria. Different studies have reported a high level of Vaccine hesitancy even among the elite class. The studies conducted by Uzochukuwu, et al. [13] among students and staff in Nigerian tertiary institutions have further explained this notion. The problems of vaccine hesitancy are attributed to mainly safety issues, problems of accessibility to vaccination centers especially by the rural residents, as well as misinformation about vaccines from social media [14]. Ilyasu, et al. [12] have identified insufficient information, distrust, fear of long-term effects, and rumors on the possible problems of infertility issues as relates to covid-19 vaccination as the four top bases for vaccine hesitancy in Northern Nigeria [12, 15]. However, despite the existing high levels of vaccine hesitancy against covid-19 amongst the educated class, the high levels of this hesitancy in Northern Nigeria as obviously evident publicly, might not be unconnected with the existing high poverty levels as well as a high illiteracy rate in this region. More so, vaccine hesitancy can negatively affect the implementation and achievement of a successful global vaccination campaign [16].

This study identified the problems of COVID-19 vaccine acceptance in both Nigeria and Nepal, and highlight the differences in both the two countries containment strategies, along with some possible solutions to the problems.

Origin of Covid-19

Covid-19 which is caused by SARS-Cov-2 was first detected in 2003. To date, this disease has contributed to the high level of morbidity and mortality caused by infectious diseases at a global scale. The first Covid-19 cases in humans were reported in Wuhan City, China in December 2019 [1, 8]. This virus was thought to have emerged in wild and jump from bats to humans, through other animals or directly from bats. Early genomic comparison carried out by Zhou, et al. [17]. Reported that the genome of the 2019-nCoV is 96% similar to that of a bat coronavirus. But a recent research conducted by Pekar et al. stated that the SARS CoV-2, just like other coronavirus emerges likely from multiple zoonotic occurrences [4, 18].

A team of international Scientists co-lead by Dr Peter Ben Embarek anf Professor Liang Wannian was convened by WHO to study the origins of SARS-CoV-2 and it was reported that there was widespread contamination with SARS-CoV-2 in Wuhan, China at the Huanan market but the actual source of contamination could not be identified. The team also assessed several laboratories in Wuhan to check the possibility of a Laboratory incident that could lead to the virus entering the human population, however, they reported that a laboratory leak is unlikely to have occurred [19].

Approved Covid-19 Vaccines in Nepal

A total of 44 different vaccines have been approved for use by at least one national regulatory authority out of which 11 vaccines are in WHO’s emergency use listing. So far, the Department of Drug Administration (DDA) has approved nine vaccines for Emergency / conditional use in Nepal, these vaccines are Pfizer, AstraZeneca, Janssen, Moderna, Gamaleya, Sinopharm, Sinovac, BBIL, and Covishield [20].

The Department of Drug Administration (DDA) serves as the regulatory authority in charge of regulating the registration of drugs and vaccine candidates in Nepal [21]. The first vaccine to be approved by DDA is ChAdOx1 nCOV-19 (Covisheild), a vaccine developed by the University of Oxford and pharmaceutical giant AstraZeneca and supplied by Serum Institute of India. After a month, Sinopharm’s BBIBP- CorV received approval on February 17, 2021, becoming the second vaccine to be approved for Nepal [22]. On September 15, 2021, Moderna-Spikevax, an RNA-based vaccine received approval, bringing the country’s total number of licensed vaccines to nine (Table 1).

Approved Covid-19 Vaccines in Nigeria

As of 7th October 2022, a total of seven vaccines have been approved for use against Covid-19 in Nigeria [21]. These include Sinopharm (Beijing) Covilo, Oxford/ AstraZeneca formulation, Oxford/AstraZeneca Vaxzevria, Janssen (Johnson & Johnson) Jcovden, Gamaleya Sputnik V, Pfizer/BioNTech Comirnaty and Moderna Spikevax [6].

Problems of Covid-19 Vaccine Acceptance in Nigeria

Concerns with vaccination safety and uncertainty pose the biggest threat to the COVID-19 vaccine’s acceptability in Nigeria. Due to safety concerns sparked by reports of blood clots and deaths associated with the vaccine in the United States and some European nations like Austria, Lithuania, Italy, Luxembourg, Norway, Estonia, Latvia, Malawi, Denmark, Iceland, Sierra Leone, and Chad, many other African countries were hesitant to vaccinate their citizens with the Oxford/ AstraZeneca COVID-19 vaccines [23]. In certain African countries, particularly Nigeria, that started the vaccination program, this also led to poor vaccination rates even among medical professionals and some susceptible educated people. In addition, many African nations lack the systems and capacity to document and monitor reports of unexpected and infrequent side effects in vaccination recipients; this raises questions about vaccine safety and discourages individuals from obtaining the shots. For instance, the results of a sizable study on perceptions of the COVID-19 vaccine in Uganda, Tunisia, Niger, Malawi, Burkina Faso, Morocco, Ethiopia, Côte d’Ivoire, the Democratic Republic of the Congo, Nigeria, Senegal, South Africa, Sudan, Kenya and Gabon by the Africa Center for Disease Control showed that the majority of respondents had concerns about the safety of the vaccine [15]. The majority of respondents from Ethiopia, Niger, Tunisia, and the Democratic Republic of Congo, in contrast, flatly refused to receive the vaccination. Additionally, issues with false information and superstitious beliefs that have surfaced since the start of the pandemic in some African nations and around the globe, as well as unproven theories about the manufacture of the COVID-19 vaccines that are circulating on social media, are posing a threat to the uptake of the vaccines in the world and Nigeria, especially in rural communities.

Solutions to the Problems of Covid-19 Vaccine Acceptance in Nigeria

In other to create a successful vaccination program in Nigeria, measures to overcome these problems must be implemented promptly and continuously. In other to ensure uninterrupted vaccine procurement, storage, transit, distribution, and administration to intended people, a vaccination program must be adequately planned at the national level. This was impressive and produced positive results early in the vaccination exercise, as evident in Ghana and Angola, which vaccinated their targeted populations very early [7]. Before the COVID-19 vaccination program began in Africa, the majority of the continent’s nations revealed pre- planned outlines of how and when the vaccinations would take place. Planning for the succeeding phases is essential as the vaccination exercise advances, in other to replicate the outstanding outcomes attained early in the first phase and to address the errors noted in the ongoing first phase [15]. The standard storage facilities for vaccines to assure safety and sustain efficacy, as well as the lack of appropriate vaccines at vaccination stations, are some of the major obstacles to meeting the goals of vaccination exercise. To retain the efficacy and safety of the vaccine doses before administration, African nations must invest more in cold chain facilities to store more important vaccines for the vaccination program in the second phase [6, 8]. There should be enough cold chain logistics in place to maintain the vaccinations that will serve the target and intended populations because the second phase of the vaccination exercise will involve greater populations than the first phase. Additionally, using well- known people, respectable individuals, and national heroes to spread vaccine-promotional messages may increase public acceptance of vaccines. Additionally, by providing additional people and material resources necessary to address COVID-19 vaccine hesitancy in Nigeria, strong intra- and inter-sectoral cooperation would aid in improving the acceptance and uptake of the COVID-19 vaccines [1, 23]. The public health system may be strengthened by the inclusion of the COVID-19 vaccine in the normal vaccination schedule and as a requirement, which would also serve to promote and increase the COVID-19 vaccine’s acceptance while also enhancing the general wellbeing of everyone living in Nigeria.

Problems of Covid-19 Vaccines Acceptance in Nepal

In 2019, the WHO reported covid-19 vaccine hesitancy as one of the top ten problems affecting the global effort in the containment of Covid-19. The WHO defines vaccine hesitancy as a “delay in acceptance or the complete refusal to get vaccinated even though vaccination services are readily available” [24]. Among different countries in the globe, the rate of vaccine acceptance varies significantly with no specific trend [23, 25, 26]. In earlier research, Indonesia (93.3%), Malaysia (94.3%), China (91.3%), and Ecuador (97%), had greater (>90%) vaccination acceptance rates [27, 28, 29, 30, 31, 32]. While the Democratic Republic of Congo, Jordan, and Kuwait reportedly had a low acceptance rate of 27.7%, 28.4%, and 23.6% respectively [31, 32]. According to research conducted in Indonesia, when effectiveness dropped from 95% to 50%, the acceptance rate dropped from 93.9% to 67% [29]. One multi-country study found that Nepal having a score of 74%, has the highest acceptance rates among the Southeast Asian nations [33].

According to a study conducted in Nepal, a total of 8.8% of respondents refused to be administered the covid-19 vaccine, while a similar study reported a vaccine hesitancy rate of 6.3% in phase 1, and later reduced to 1.7% in phase 2 which was before and after the drug was approved by the national regulatory body respectively [34, 35]. Similarly, a study of 1196 people found that only 2.6% of them refused vaccination [36]. The lower refusal rate in these studies may be because the majority of participants in this survey were highly educated, had a medical background, and were economically stable. However, many studies found that the main reason behind the refusal of most people to get vaccinated was a major lack of confidence in the entire vaccination program, concern about their safety as well as the side effects which are likely to follow after the vaccination. These problems are further explained in detail below;

Conclusion

In both Nepal and Nigeria, vaccine hesitancy has been identified as a serious problem affecting the successful implementation of the Covid-19 vaccination Programme. With more than 12 billion doses of vaccines administered globally, only about 80 million doses were administered in Nigeria out of a total population amounting to 200 million. While in Nepal with a population of approximately 30 million people, about 58 million doses of vaccines have been administered and 93.32% of the population received at least one dose. There are still worries about vaccine efficacy and safety as part of the COVID-19 vaccine challenges both in Nepal and Nigeria. These problems are known to be much in Africa with Nigeria as one of the countries having high vaccine hesitancy levels. However, despite the problems of vaccine hesitancy in Nepal, the number of administered Covid-19 vaccines had increased significantly far greater than that of Nigeria. More so, the total number of approved Covid-19 vaccines in Nepal is far greater than that of Nigeria, perhaps this might be among the contributing factors behind the higher number of populace covered in the vaccination program. In order to create a successful vaccination program in Nigeria, measures to overcome the problems of vaccine hesitancy, and easy access to available vaccination centers among other problems must be addressed. More so, for uninterrupted vaccine procurement, storage, transit, distribution, and administration to intended people, a vaccination program must be adequately planned at both the national and local levels.

Ethics Approval and Consent to Participate

Not applicable

Consent for Publication

Not applicable

Availability of Data and Material

All data generated or analyzed during this study are included in this published article.

Competing Interests

The authors declare that they have no competing interests.

Funding

Not applicable.

Authors Contributions

IR coined the whole research idea, perform a preliminary literature search, was a major contributor to drafting the paper, and proofread the entire manuscript. ASU contributes to coining the research idea, performing literature searches and downloads, and contributing to the writing and proofreading of the final manuscript. UG contributes to coining the research idea, performing literature searches and downloads, and contributing to writing the final manuscript. UG contributes to coining the research idea, performing literature searches and downloads, and contributing to writing the final manuscript. RP contributes to coining the research idea, performing literature searches and downloads, and contributing to writing the final manuscript. AM contributes to coining the research idea, performing literature searches and downloads, and contributing to writing the final manuscript. All authors read and approved the final manuscript.

Acknowledgements

We wish to appreciate the management of Skyline University University Library under the leadership of Mr. Musa Muhammad for providing us with the Needed liliteratures well as scholarly guidance.

Authors Information

Ismail Rabiu, is from Nigeria, having a BSc in Microbiology and MSc degree in Medical Microbiology, with a PhD in View. His passion for excellence, and wide reading habit made him break the long-standing record where he finished at the top of his class with Distinction during his graduate studies at Bayero University Kano. His motivation to learn novel techniques made him undergo different training on Infectious disease and Antimicrobial resistance with the Bloomberg School of public health and the United State Agency for International Development under the Global e-health learning. All these have provided him with skills in infectious disease Epidemiology and sustainable control strategies. His research interest cut across areas of Medical Microbiology, Epidemiology, and Public Health Microbiology. At present, He is a faculty, in the Department of Microbiology, at Skyline University Nigeria. He holds the credit of being among the youngest faculties that implemented flip teaching and peer-based learning as novel teaching methodologies.