With fewer than 1% of its 90 million citizens vaccinated against COVID-19, the Democratic Republic of Congo (DRC) has resorted to training teams of “rumour-busters” to tackle misinformation about the virus in order to encourage more people to get the vaccine.

David Olela, communications lead for the DRC health ministry’s vaccination programme,  admits that his government had been “stuck”, with “no idea how to combat both the pandemic and the disinformation at the same time” until it got help from “infodemic experts”.

Health workers, religious and community leaders and journalists spread across the DRC’s vast landmass of around 2.3 million square kilometres have been trained to help combat misinformation.

“Having a local team trained in rumour management has helped us turn an anti-vaccine narrative into a pro-vaccine one,” says Olela, whose ministry is being supported by partners including the World Health Organization (WHO) and UNICEF. 

Rumours about pork in vaccines

Imam Famba Ali Huseini, leader of the Usoke Central Mosque in Kinshasa, is one of 30 imams who has been trained in the capital city.

“At the start of the pandemic, we were inundated with rumours and disinformation on COVID-19 and vaccines,” says Huseini. “In Kinshasa’s Muslim community, people feared the vaccine. Some thought Africans were being used as guinea pigs, and that the vaccines were made with pork gelatine.”

Part of their training involved a doctor explaining how the vaccine was made to show that no pig gelatine was involved. But more impressive for Huseini was learning that people in Muslim countries such as Saudi Arabia and Indonesia had accepted the vaccine. Around 10% of DRC citizens are Muslim.

More than 600 health workers have been trained in identifying and refuting myths surrounding the COVID-19 vaccine. Question-and-answer sessions on rumour refutation have also been organized in the national parliament, before 300 national and provincial representatives.

In addition, 144 media professionals have been trained in fact-checking and source reliability. This includes Congo Check, an online fact-checking agency, which has been exposing fake news about the pandemic and vaccines.

Hesitation to call out vaccine ‘hesitancy’

While none of the international agencies working in the DRC is willing to ascribe the low vaccination rate to “vaccine hesitancy”, it is evident that the country is facing a huge struggle to win people over to vaccines.

A survey conducted in November involving 74,388 people found that respondents were split equally between those that supported vaccinations and those who didn’t (see above).

For those who are not yet vaccinated, the main reason (28%) was that they “don’t believe in them”. The second most popular reason was that the person felt healthy (18%), followed by fear about vaccine side effects (13%).

But even the survey itself was met with apathy. It had tried to solicit the views of almost two million people and only got a 4% response.

In late 2020, an online survey of 4131 people conducted by researchers from the University of Kinshasa found that a quarter of respondents doubted the existence of COVID-19. 

However, 55,9% were prepared to be vaccinated. Among the 1821 participants not willing to receive a COVID-19 vaccine, the majority (60.6%) indicated they did not trust the vaccine. Some also believed it had been made to kill Africans (14,4%) or to sterilise people(5.9%).

SMS campaign to promote vaccines

Overall, immunisation in the DRC is low even for well-established diseases, according to WHO and UNICEF. In 2019, 57% of people were vaccinated against Hepatitis B, 73% had the BCG vaccine against tuberculosis and only 59% had been vaccinated against polio.

UNICEF ascribes the low vaccine uptake to “chronic poverty, limited essential service infrastructure, disease outbreaks, recurrent armed conflict, massive displacement and the lack of a steady supply of vaccine doses”.

To address this, UNICEF and partners – including the mobile network operators Orange, Vodacom and Africell – launched an SMS campaign in late 2021 to support the COVID-19 vaccination campaign.

To start with, 16 million people in 15 priority provinces were sent messages encouraging them to get vaccinated by registering online by SMSing a toll-free number where they would get instructions in five main local languages. 

After four weeks, 54,000 people had registered and the government was able to prioritise delivery to areas where there is strong interest in getting vaccinated.

Bad history with COVID vaccine supply

But the DRC’s history with COVID-19 vaccines has been fraught from the start, and the supply chain problems affecting COVAX, the global vaccine access platform, did not help.

Within a month of getting 1.7 million Astra Zeneca vaccines from COVAX in March last year, the DRC stopped its vaccine rollout over concerns about blood clots. Three-quarters of these vaccines were then redeployed to other African countries to prevent them from expiring. 

But once concerns about blood clots had been addressed (found to be a rare risk outweighed by benefits), COVAX’s supply chain had dried up as India had halted the export of AstraZeneca vaccines manufactured by the Serum Institute of India, COVAX’s main supplier. 

The lack of a reliable supply of vaccines made it hard for the DRC to plan a rollout or prepare people for their arrival.

Now that a reliable stream of vaccines is available through COVAX, the DRC government is trying to speed up its vaccination programme but it has a lot of lost ground to catch up.

“Our objective is to enable 50 million Congolese to receive the vaccine by the end of 2022 and thus be better protected against the disease,” says Elisabeth Mukamba, director ot the Expanded Program on Immunization. “This innovative SMS pre-registration initiative is welcome and allows us to communicate more quickly and effectively, even in the most remote communities.”

Image Credits: Christian Mokili/ UNICEF, Gavi/2021/STARRY.