The Colonial Effect: Language, Trust and Attitudes to Science as Predictors of Vaccine Hesitancy across Africa

"These findings improve our understanding of the drivers of vaccine hesitancy in Africa and provide valuable input for future vaccine policy and health-awareness campaigns."

Perceptions of vaccine safety, importance, and effectiveness are at the core of vaccine hesitancy around the world, and Africa has had its own share of vaccine resistance movements. For instance, state governors in northern Nigeria banned the use of the oral polio vaccine in 2003 during a nationwide vaccination exercise; the vials were rumoured to have been contaminated with substances capable of sterilising women. More recently, anti-vaccination campaigns, spread by social media, have been associated with declining vaccine coverage and have contributed to vaccine hesitancy in Kenya. This study explores the roles of language, trust, knowledge, and attitudes to science in vaccine hesitancy on the African continent. It explores the roles of trust in science, scientists, and social actors, as well as knowledge of science and health and the performance of activities that show engagement with science.

Unique to this study is the use of colonial language as a predictor variable. Colonial languages are still used as lingua francas in many African countries, splitting the continent into French and English speakers, alongside less common languages such as Portuguese and Spanish. African countries, since independence, have continued to have cultural, linguistic, and economic ties with the former colonising countries, and this study examines the effect that those ties may have on vaccine hesitancy.

In providing background, the paper reviews some of the literature on vaccines and public health, trust in science and vaccines, anti-vaccination movements, and African people's perceptions of the importance, safety, and effectiveness of vaccines, focusing on the roles of language, trust and other psychosocial and economic predictors.

This study uses the 2018 Wellcome Global Monitor on public perceptions of vaccines in 40 African countries (22 francophone; 18 English speaking) to examine the predictors of vaccine hesitancy. The methodology involves examining levels of hesitancy from a language perspective, comparing French speakers with others, mostly English speakers.

Results show that French speakers were significantly more hesitant about vaccine importance and safety, while English speakers and others were more hesitant about effectiveness. The hesitancy about vaccine safety average for the 22 francophone countries was more than double the average for the 18 anglophone countries. Hesitancy about vaccine importance for francophone countries was also almost double that for English speakers.

The researcher explains: "These differences mirror that observed between the United Kingdom and France, splitting Africa along colonial lines, and are thus strong indicators of the colonial or francophone effect. This division on vaccine hesitancy plausibly reflects the strong role of a continued sharing of language, education and cultural ties with former colonies. Shared communication is also more readily accessible through social media with expanding internet access, its popularity and reach. Language restricts African people to news and public debates from French- or English-speaking media, and this has become even more important as health news is increasingly sought from online groups, blogs and social-media apps rather than from official vaccine information sites."

Other patterns in the data:
 

• With scientific actors, higher levels of trust in scientific research led to more hesitancy about the importance and safety but not the effectiveness of vaccines. Trust in scientists was significant only for hesitancy about importance.
• Respondents with high levels of trust in social actors (such as national government, journalists, people in the neighbourhood, doctors and nurses) were also more hesitant about the safety and effectiveness of vaccines, indicating the importance of non-scientists in influencing vaccine hesitancy.
• Those with high levels of education were more likely to be hesitant about vaccines in general, indicating that having more education may have an opposite effect.
• Africans in the sample population who saw science as progress and as benefiting the public and improving lives were less likely to be hesitant about the importance, safety, and effectiveness of vaccines.
• People in urban areas, who are more likely to have internet access, were more hesitant about vaccine importance and effectiveness than those in rural areas, who, in Africa, are largely farmers and less likely to have internet access.
• At the country level, there was no overarching predictor, indicating the strong role of local social and cultural factors. 
   

In conclusion: "This research has shown the role of continent-wide and country-level predictors for all three types of vaccine hesitancy and will be valuable for informing future public-health policies and communication campaigns, even beyond vaccines. Health policies and campaigns need to recognize continent-wide similarities, the potential impact of language differences and country-level cultural differences for successful implementation and outcomes. It is also important to keep a longitudinal data stream as part of a monitoring and evaluation process to guide the content of communication campaigns and the direction of further policy. More research is needed on the relationship between language and vaccine hesitancy, in particular the role of the media in public perceptions."