he development of vaccines is considered one of the most significant advancements in modern medicine. Since the 18th century, vaccines have saved millions of lives, significantly improved quality of life, and promoted overall wellbeing of populations. The ultimate goal of vaccines is to protect individuals, children, and communities from vaccine-preventable diseases, allowing them to live happier, healthier lives.
Many experts consider vaccines to be among the most cost-effective health intervention. They have helped eliminate and prevent many deadly diseases, including smallpox—which was eradicated globally in 1980—diphtheria, poliomyelitis (polio), measles, rotavirus, and malaria. The recent global COVID-19 vaccine rollout was estimated to have saved over 20 million lives as of the end of 2021.
The Downside of History
But the history of medical colonialism should not be forgotten in the scientific discourse. The success of vaccines has not been without its challenges—especially when it comes to vaccine hesitancy, which remains a major threat to global health. Vaccine resistance during the COVID-19 pandemic, even by health workers, is one point in the history of a larger sociocultural resistance dating back to vaccines’ development.
Hesitancy surrounding the COVID-19 vaccine was in part attributed to the unclear scientific communication at the beginning of the pandemic. The pandemic exposed an issue with science communication—the process of educating the public and promoting issues relating to science. This was particularly illustrated by the way vaccine effectiveness, vaccine risks, and disease transmission were conveyed without empathy, with limited community involvement, and with a sense of superiority among certain individuals involved in science communication.
Some scientists and organizations did not take accountability for this but rather considered vaccine hesitancy reprehensible considering that the vaccines were highly effective and made available in part through support and donations. This manifested as an attitude of intellectual elitism—an assumption that the general public lacks the ability to understand complex scientific concepts. Such an attitude led to disregard of public concerns about the efficacy of vaccines and the context in which these concerns arose: history.
Even though vaccines improve health and wellbeing, public health interventions have a mixed history, especially on the African continent, so deep-seated skepticism throughout the continent should come as no surprise. Certain American and European medical interventions in Africa can help explain some of the historical and political contexts for why COVID-19 vaccines from corporations and Western countries were met with suspicion in Tanzania, Madagascar, and Northern Nigeria.
The misuse of vaccine research and medical colonialism has eroded public confidence in developing countries in the safety of vaccines. Medical colonialism is not new, and its consequences are evident in people's reluctance to use contemporary vaccines. Medical colonialism occurs when industrialized nations impose their medical practices, research, and healthcare systems on developing nations or marginalized groups without considering their cultural, social, and economic settings. Examples include the Guatemalan syphilis experiments, the Tuskegee Syphilis Study, the medical campaigns in Central Africa, and numerous unethical trials conducted all over the world. Medical campaigns in Central Africa to treat sleeping sickness were characterized by forcefully administering medicines with unconfirmed efficacy and severe side effects, which was unethical. A Pfizer drug trial from 1996 killed 11 children in Northern Nigeria.
Taken together, these cases of malpractice, along with others from the past, contributed to the distrust in the government and vaccines perceived to be “foreign.” This led to the polio vaccine boycott in Northern Nigeria that lasted for about 16 months, the emergence of a new polio outbreak at the time, and a 30% increase in polio prevalence in Northern Nigeria.
To this, one could even argue that “anti-vaccination” sentiments around the world, especially the position of President John Magufuli of Tanzania, was not a position against COVID-19 vaccinations per se, but rather a position against surveillance, stigmatization, and differentiation of developing countries. History influences behavior. The dark past of medical colonialism in Africa and beyond can help us understand the current context in which individuals, communities and governments make health decisions.
A Respectful Strategy That Works
It is imperative for the scientific community and global policymakers to remember history. Compelling individuals and countries to adopt vaccines and medicines will not work. Recognizing that individuals and communities have concerns with vaccines, attempting to comprehend their concerns and then communicating with empathy will help reduce reluctance towards vaccination. The science of vaccines should be communicated in clear, precise, culturally appropriate ways, respecting countries' contexts and priorities.
To achieve this, scientists and officials can adopt social and behavior change communication (SBCC). SBCC follows a systematic process to analyze problems in order to define barriers and motivators to change and ultimately design a comprehensive set of tailored interventions that promote desired behaviors. It involves the strategic use of communication techniques, theories, and frameworks to influence knowledge, attitudes, beliefs, and behaviors of individuals and communities. The process involves understanding the target audience, then mobilizing and involving communities in solving health problems.
Following the polio vaccine boycott in Northern Nigeria, the massive engagement of communities, religious and traditional leaders in health interventions and risk communication fostered acceptance and uptake of the vaccines. This engagement involved working with communities to identify problems and develop solutions. These efforts enabled the eradication of wild poliomyelitis in the African region and globally. Leveraging this existing structure during the COVID-19 pandemic helped reduce reluctance towards vaccination and promoted the uptake of vaccines among the population. Community engagement is sacrosanct for addressing vaccine hesitancy.
Future pandemics are inevitable due to the increased risk of climate change and a changing ecosystem, epidemiological transition, increasing risk of bioterrorism, and antimicrobial resistance. Considering this, there is a need to better communicate the science behind vaccines while acknowledging the role of history in influencing individuals’ health-seeking behaviors. To do this, adopting SBCC in science communication will help encourage the uptake of life-saving vaccines, promote health, and ultimately prolong and improve the lives of individuals and communities.
a global affairs media network
Overcoming the Dark History of Medical Colonialism
September 5, 2023
A long history of medical colonialism in the Global South helps explain vaccine hesitancy that, as during the COVID-19 pandemic, can cost lives. To be ready for the next medical crisis, we need a new, more respectful approach to communicating medical interventions, writes YPFP's Nsikakabasi George.
T
he development of vaccines is considered one of the most significant advancements in modern medicine. Since the 18th century, vaccines have saved millions of lives, significantly improved quality of life, and promoted overall wellbeing of populations. The ultimate goal of vaccines is to protect individuals, children, and communities from vaccine-preventable diseases, allowing them to live happier, healthier lives.
Many experts consider vaccines to be among the most cost-effective health intervention. They have helped eliminate and prevent many deadly diseases, including smallpox—which was eradicated globally in 1980—diphtheria, poliomyelitis (polio), measles, rotavirus, and malaria. The recent global COVID-19 vaccine rollout was estimated to have saved over 20 million lives as of the end of 2021.
The Downside of History
But the history of medical colonialism should not be forgotten in the scientific discourse. The success of vaccines has not been without its challenges—especially when it comes to vaccine hesitancy, which remains a major threat to global health. Vaccine resistance during the COVID-19 pandemic, even by health workers, is one point in the history of a larger sociocultural resistance dating back to vaccines’ development.
Hesitancy surrounding the COVID-19 vaccine was in part attributed to the unclear scientific communication at the beginning of the pandemic. The pandemic exposed an issue with science communication—the process of educating the public and promoting issues relating to science. This was particularly illustrated by the way vaccine effectiveness, vaccine risks, and disease transmission were conveyed without empathy, with limited community involvement, and with a sense of superiority among certain individuals involved in science communication.
Some scientists and organizations did not take accountability for this but rather considered vaccine hesitancy reprehensible considering that the vaccines were highly effective and made available in part through support and donations. This manifested as an attitude of intellectual elitism—an assumption that the general public lacks the ability to understand complex scientific concepts. Such an attitude led to disregard of public concerns about the efficacy of vaccines and the context in which these concerns arose: history.
Even though vaccines improve health and wellbeing, public health interventions have a mixed history, especially on the African continent, so deep-seated skepticism throughout the continent should come as no surprise. Certain American and European medical interventions in Africa can help explain some of the historical and political contexts for why COVID-19 vaccines from corporations and Western countries were met with suspicion in Tanzania, Madagascar, and Northern Nigeria.
The misuse of vaccine research and medical colonialism has eroded public confidence in developing countries in the safety of vaccines. Medical colonialism is not new, and its consequences are evident in people's reluctance to use contemporary vaccines. Medical colonialism occurs when industrialized nations impose their medical practices, research, and healthcare systems on developing nations or marginalized groups without considering their cultural, social, and economic settings. Examples include the Guatemalan syphilis experiments, the Tuskegee Syphilis Study, the medical campaigns in Central Africa, and numerous unethical trials conducted all over the world. Medical campaigns in Central Africa to treat sleeping sickness were characterized by forcefully administering medicines with unconfirmed efficacy and severe side effects, which was unethical. A Pfizer drug trial from 1996 killed 11 children in Northern Nigeria.
Taken together, these cases of malpractice, along with others from the past, contributed to the distrust in the government and vaccines perceived to be “foreign.” This led to the polio vaccine boycott in Northern Nigeria that lasted for about 16 months, the emergence of a new polio outbreak at the time, and a 30% increase in polio prevalence in Northern Nigeria.
To this, one could even argue that “anti-vaccination” sentiments around the world, especially the position of President John Magufuli of Tanzania, was not a position against COVID-19 vaccinations per se, but rather a position against surveillance, stigmatization, and differentiation of developing countries. History influences behavior. The dark past of medical colonialism in Africa and beyond can help us understand the current context in which individuals, communities and governments make health decisions.
A Respectful Strategy That Works
It is imperative for the scientific community and global policymakers to remember history. Compelling individuals and countries to adopt vaccines and medicines will not work. Recognizing that individuals and communities have concerns with vaccines, attempting to comprehend their concerns and then communicating with empathy will help reduce reluctance towards vaccination. The science of vaccines should be communicated in clear, precise, culturally appropriate ways, respecting countries' contexts and priorities.
To achieve this, scientists and officials can adopt social and behavior change communication (SBCC). SBCC follows a systematic process to analyze problems in order to define barriers and motivators to change and ultimately design a comprehensive set of tailored interventions that promote desired behaviors. It involves the strategic use of communication techniques, theories, and frameworks to influence knowledge, attitudes, beliefs, and behaviors of individuals and communities. The process involves understanding the target audience, then mobilizing and involving communities in solving health problems.
Following the polio vaccine boycott in Northern Nigeria, the massive engagement of communities, religious and traditional leaders in health interventions and risk communication fostered acceptance and uptake of the vaccines. This engagement involved working with communities to identify problems and develop solutions. These efforts enabled the eradication of wild poliomyelitis in the African region and globally. Leveraging this existing structure during the COVID-19 pandemic helped reduce reluctance towards vaccination and promoted the uptake of vaccines among the population. Community engagement is sacrosanct for addressing vaccine hesitancy.
Future pandemics are inevitable due to the increased risk of climate change and a changing ecosystem, epidemiological transition, increasing risk of bioterrorism, and antimicrobial resistance. Considering this, there is a need to better communicate the science behind vaccines while acknowledging the role of history in influencing individuals’ health-seeking behaviors. To do this, adopting SBCC in science communication will help encourage the uptake of life-saving vaccines, promote health, and ultimately prolong and improve the lives of individuals and communities.
