A covid-19 vaccine might be tough to distribute in countries at war

My research suggests countries experiencing civil war will find it particularly difficult to distribute the vaccine. Here are the three big challenges.

Armed groups control millions of people worldwide

The research suggests humanitarian groups may gain this type of cooperation by leveraging armed groups’ interest in legitimacy. Armed groups are likely to see cooperation as a way to boost their popularity among the population they control — as well as their credibility in the eyes of the international community. Humanitarian organizations have found that recognizing armed groups’ concerns and appealing to their interests have proved effective in negotiating humanitarian access in conflict areas.

Many armed groups believe they are entitled to regulate and control humanitarian activities — and may be more willing to cooperate if they have some oversight in the vaccination process. Indeed, many of these groups have offices that coordinate, facilitate and monitor humanitarian action. In Afghanistan, for example, the Taliban has inserted itself directly into hiring and monitoring health workers, vetting and approving individuals based on their association with the government or international security forces as well as their medical qualifications.

Governments may not support equal access to the vaccine

In countries at war, governments may have incentives to reserve the vaccine for their supporters — and neglect groups they view as hostile to the regime. In the past, Myanmar, Sudan, Ethiopia and other countries have blocked humanitarian aid groups from reaching communities the government perceived as enemies. International sovereignty laws protect the right of countries to be the ultimate authority over all people and things within their territory, which suggests government decisions on how to distribute the vaccine will be one of the most difficult challenges to overcome. In the past, some humanitarian groups have resorted to cross-border operations, bypassing government barriers and delivering aid by entering rebel-controlled areas through neighboring countries.

Misinformation may boost distrust of government vaccine programs

Misconceptions and mistrust in health care, and in science more broadly, pose a further challenge. In 2019, before the coronavirus outbreak, the World Health Organization identified vaccine hesitancy as one of the top 10 global health threats. While misinformation exists everywhere, it may become more acute in times of conflict — it’s possible some populations may refuse to be vaccinated, and some may even launch forms of violent resistance.

Suspicions and violence against health workers are nothing new — misinformed people across Europe murdered surgeons, physicians, pharmacists and nurses in response to cholera outbreaks in the 19th and 20th centuries, for instance. When Ebola broke out in 2014 in Guinea, Sierra Leone and Liberia, protesters could be seen carrying signs declaring “Ebola is a lie!” Some people engaged in violent attacks on clinics, health workers and burial teams, resulting in numerous deaths of humanitarian workers.

There’s evidence that public awareness campaigns in the form of radio advertisements, signs and door-to-door canvassing resulted in greater compliance with measures that prevent the spread of Ebola. With violence against health workers often driven by fear or anger, humanitarian organizations have adopted strategies like recruiting trusted community members and training them to deliver accurate public health information as a way to broaden support for their work.

In the Ebola example, people tended to associate security forces accompanying vaccination teams with distrust and fear of forced vaccination — while vaccination teams without military escorts typically encountered far more willing communities. The international medical assistance group Doctors Without Borders, for instance, generally refuses military support, believing this approach generates less suspicion from armed groups.

In this year’s increasingly polarized political environment, misinformation and skepticism pose a truly global challenge to efforts to combat the coronavirus. In a September survey, nearly two-thirds of Americans worried that pressure from the Trump administration would prompt the Food and Drug Administration to rush the approval of a covid-19 vaccine, and potentially ignore safety concerns. Other surveys suggest Republicans in particular have grown distrustful of scientists including Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases — a Trump adviser on the pandemic whose covid-19 advice has often been at odds with the president’s views.

These findings suggest that from Washington to more remote areas in conflict-affected countries, building up trust in government messaging will be an important part of the global covid-19 response. In order for vaccination campaigns to work, public health officials note it is essential that governments present a clear and consistent message to build public confidence in vaccine programs. Higher levels of trust in government are linked to individuals being more likely to accept vaccines.

Jori Breslawski is a postdoctoral research associate at the Watson Institute for International and Public Affairs at Brown University. Follow Jori on Twitter: @BreslawskiJori.