This article, in which reporting was supported by the International Women’s Media Foundation’s Global Health Reporting Initiative: Vaccines and Immunisation in Africa, focuses on the issue of hesitancy surrounding Covid-19 vaccines and what stakeholders are doing to address the problem. RICHARD CHIROMBO writes.

Save for the pungent smell of medical drugs and the random shrill of under-five children, the other notable feature at St Peters Community Hospital in Likoma District is a disturbing hush on what is supposed to be a Covid vaccination site.

The lack of activity cannot be attributed to lack of health-seeking behaviour for, as recently as November 13 2015, some community members in Likoma District took Central Government officials to task over the residential area of the district’s most senior medical officer, officially known as District Health Officer, who was staying in another district, Nkhata Bay, another Northern Region district, instead of being stationed at Likoma.

Likoma residents made so much noise that the Ministry of Health was forced to act in their favour.

The lack of activity can, also, not be attributed to the fact that, according to the Malawi Population and Housing Census, the district is the smallest in Malawi with 14,527 people.

“People are simply suspicious of Covid-19 vaccines and do not want to be hoodwinked by the government machinery, which seems hell bent at cowing us into submission,” says 42-year-old Samantha Patani Njazi, who claims to be visiting the island district from Mzuzu City.

True to her words, people seem to be flocking in droves to the health facility for other services.

District health officials are trying their best, though, as they mobilise people to get vaccinated for Covid.

Likoma District Health Office spokesperson Gracewell Mathewe indicates that they have been moving door-to-door and offering mobile services in a bid to ensure that the district meets its Covid vaccination target.

“Door-to-door [outreach activities] and mobile [services] are more effective [than other outreach activities]. Of course, we need to train more vaccinators to conduct vaccination sessions,” he says.

As of Friday last week, the district had 607 fully vaccinated people, against health officials’ target of 9,235 eligible people.

However, the district puts the number of people who got one dose of, for instance, Oxford- AstraZeneca, at 649.

Four hundred and eighteen people got two doses of Oxford- AstraZeneca vaccine, with a further 189 people getting a dose of Johnson & Johnson (J&J). With J&J, one dose is enough.

It is clear, however, that, even for a district as small as Likoma, giving people the right message to get vaccinated for Covid remains a challenge, exposing how deep-rooted the problem of Covid hesitancy is in the country.

It is the same case in the Southern Region district of Mangochi, where signs of hesitancy are self-explanatory.

The lakeshore district has a population of 1,148,611 people and has one of the highest levels of illiteracy in Malawi.

Mangochi District Health Promotion Officer Harold Kabuluzi puts this in perspective.

“Our vaccination target is 586,988. The number of people that have received the first dose of Oxford-AstraZeneca is 34,513 while 6,471 people received the second dose of Oxford- AstraZeneca vaccine. 21,522 people received J&J,” he says.

This is despite that the district has 46 vaccination centres in its bid to reach out to many people.

“We are also conducting village-to-village campaigns. Health Surveillance Assistants (HSAs) also visit markets and homes to disseminate Covid- 19-related messages apart from having static clinics where people who visit health facilities can also get vaccines,” Kabuluzi says.

One of the residents, 28-year-old Saidi Mohammed, says Covid-19 “is a disease of the imagination” because he has never heard of anyone with Covid-19 symptoms in the vicinity.

“If they talk about coughing, we always cough at some part of the year and this is not new. This Covid business is just that; a business opportunity for some people. I do not think I will get inoculated for Covid anytime soon,” he vows.

However, others, notably 32-year-old Puna Issa, who is a mother of two, thinks otherwise.

“I got vaccinated for Covid-19 because I understand that, due to our extended family system, there will be many people who will suffer when I succumb to Covid- 19-related illness. If, Allah forbid, I were to die, who would take care of my children? I do not want to gamble on health issues,” she says.

As people dilly dally to make the decision of whether to get vaccinated, health officials are keeping their fingers crossed that there will be a change of heart.

“It’s very sad to see that, up to now people, have not accepted the Covid-19 vaccine even though various partners have been raising awareness on the importance of the vaccine,” Kabuluzi indicates.

As is the case in Mangochi District, in Nachiola Village, Traditional Authority (T/A) Chimutu in Lilongwe Rural, divisions often come to the surface when the issue of coronavirus is introduced.

Twenty-two-year-old Michael Malizani says he only got vaccinated for Covid-19 on January 16 2022, when he heard that one of his family members were admitted for Covid-19 in Johannesburg, South Africa, where he works in a shop.

Fortunately for healthcare workers there, the situation is improving as people turn up to be vaccinated at Chiwamba Health Centre.

Some non-governmental organisations, notably Oxfam, have been working in four T/ As namely Chimutu, Njewa, Tsabango and M’bwatalika in their bid to increase Covid vaccine uptake in Lilongwe Rural, which has the largest population in Malawi [at 9.3 percent of the national population].

Among other strategies, HSAs such as Reuben Kam’madzi disseminate Covid-19 vaccine-related information.

“Where community members complain that the distance to the health centre is long, we go right where they stay to administer Covid vaccines,” he says.

Chiwamba Health Centre in-charge Patience Ganunga cites misinformation as one of the factors fuelling the problem of Covid-19 hesitancy.

“False stories about Covid vaccines scare people. There are people who wrongly believe that they will die once they get vaccinated for Covid-19,” she says.

According to Health Minister Khumbize Kandodo Chiponda myths around Covid-19 vaccines have been frustrating health officials’ goal to vaccinate as many people as possible.

“Some people have been spreading false messages that Covid-19 vaccines interfere with hormones and that they also make people infertile. All these are lies,” Kandodo Chiponda assures.

Head of Malawi’s Expanded Programme on Immunisation Mike Chisema acknowledges that there is a need for huge investments in public sensitisation.

He indicates that, when some doses of Oxford-AstraZeneca vaccine were about to expire on December 31 2021, health officials spent K700 million [about US$850,000] just to ensure that people got the right message and got vaccinated.

Thanks to that investment, no Covid-19 vaccine dose was destroyed after December 31 2021, unlike the situation earlier in the year, when Malawi became the first country in Africa to destroy over 19,000 doses of Oxford- AstraZeneca vaccine.

Secretary for Health Dr Charles Mwansambo indicates that technical teams on immunisation are analysing the possibility of introducing Covid-19 booster shots in line with World Health Organisation’s recommendation.

“Some people are of the view that not much of the population is vaccinated at the moment and that, as such, we should not over-protect the five percent of people that have been vaccinated while leaving out about 95 percent of the population unprotected.

“However, we, as a ministry, cannot stand in the way of those that want booster shots,” he said.

A total of 1.8 million doses have been administered in the country so far.

Kamuzu University of Health Sciences-based psychologist, Professor Chiwoza Bandawe, says misconceptions around Covid-19 issues have created a situation where some people are not certain about themselves and others.

He says, as such, the Covid-19 scourge has created a “second pandemic” in society, resulting in rising cases of stress, anxiety, depression and substance use, an expert has said.

“We have to address the problem of conspiracy [theories] around coronavirus,” he says.

It is a view which Medical Society of Malawi President Dr Victor Mithi shares, urging people to trust science.

He says reluctance to go for Covid-19 vaccines could lead to a situation where, one day, the public healthcare service delivery system may be overwhelmed with Covid-19 patients or even collapse.

As at now, however, Covid-19 is creating a third pandemic within a pandemic; hesitancy—an awkward problem.