Vaccine Hesitancy: Why 'anti-vaxxers' refuse to get vaccinated against Covid-19

Vaccine hesitancy has always been an issue for millions around the world but the topic has emerged to the forefront of world discussions since the pandemic erupted last year.

In 2019, the WHO named vaccine hesitancy as one of the world’s top global health threats. Vaccine hesitancy is the reluctance or refusal to vaccinate despite the availability and granted access of vaccines.

Vaccines have long been considered as one of the most successful public health advances of all time, yet hesitancy remains a big issue that can undermine and interfere with the control of infections.

It is due to vaccine hesitancy that diseases such as the measles – a highly contagious illness that was considered eradicated in the US in the year 2000 – started resurfacing and spreading to the point that we now witness some of the worst outbreaks seen in recent years.

There are a few reasons why people refuse vaccinations, either for themselves or for their children. These reasons often vary between families but can generally be summarised and divided into four main categories: religious reasons, safety concerns, personal beliefs, and desire for more information.

Hesitancy amid Covid-19

Today, as we witness the global roll out of the Covid-19 vaccine, it is crucial to spread the word about the safety and importance of vaccination in order to avoid setbacks. Studies from around the world that explore the attitudes towards the Covid-19 vaccines have been launched, and early results show high levels of hesitancy, with statistics ranging from 20% to 40% of the surveyed populations.

In Qatar, attitudes towards vaccinations and concerns surrounding the Covid-19 vaccine are likely to differ from other countries, seeing as the majority of the population (approximately 90%), are working immigrants or expats who do not live with or around extended family members, and do not have elderly relatives within close proximity.

This unique population characteristic was one of the factors that motivated the launch of a cross-sectional, online survey in Qatar, between October 15 and November 15, 2020, that explores the attitudes of adults toward the Covid-19 vaccines.

Over 7,800 adults took part in the survey and as many as 20% expressed hesitancy toward taking the vaccine, with another 20% being undecided on whether they would take it or not.*

This study, led by researchers from Hamad Medical Corporation, revealed that 53.8% of the survey participants expressed concerns around the safety of the vaccine, seeing as Covid-19 is a relatively new disease and 47.9% expressed concerns around long-term safety. In addition, 92.1% of survey respondents expressed that they believed that natural exposure to the disease provided the safest protection against it.

The link between religion and vaccine refusal

Other factors that could drive vaccine hesitancy are based on personal or religious beliefs. In order to help address some of the perceived religious concerns that drive hesitancy to the Covid-19 vaccine, several senior religious figures and scholars have taken on the responsibility of exploring and highlighting issues in the moral discourse around Covid-19 vaccines.

The International Islamic Fiqh Academy (IIFA), a global Jeddah-based Islamic institution for the advanced study of Islamic jurisprudence and law, recently issued a fatwa on Covid-19 vaccines saying that it permits, indiscriminately, all vaccines authorised for use. Scholars even said shots can be purchased using some, not all, of the obligatory Zakat money.

The fatwa also re-emphasised the role of governmental authorities in making vaccination mandatory and referred to scholars who disagree as “trouble-makers”.

Notably, participants who took part in the deliberations that resulted in the outcome of this fatwa are representative of various Islamic sects, including scholars from Sunni, Shia and Ibadi backgrounds.

In Egypt, the highest Sunni authority Al Azhar Fatwa Centre confirmed in a statement that the country’s inoculation campaign would continue during the holy month of Ramadan. Taking the vaccine would not break the fast of those partaking in Ramadan, the fatwa said.

Earlier this month, Saudi Arabia’s health ministry confirmed the vaccine would be obligatory for those willing and planning to attend the annual Hajj pilgrimage this year. Weeks earlier, the Iraq-based Ali Al-Sistani – the highest Shia authority – ruled Muslims must “take all of the necessary preventive precautions and treatment based on what is determined by the medical experts while staying away from unscientific methods.”

The discussion was expanded further in Qatar, Dr. Mohammed Ghaly, Professor of Islam and Biomedical Ethics at Hamad Bin Khalifa University, who explored the interplay of science and religion in the age of the novel coronavirus – Covid-19 vaccines in particular – in his article titled “Islamic Ethical Perspectives on Vaccination: the interplay of Science and Religion in the Age of Covid-19”.

Ghaly mentions in his article that almost all religious concerns around vaccines that have been shared on social media and circulated in the press are closely related to the perceived scientific knowledge that people access or believe to be true.

He provides the example of the recent fatwa issued by the Fatwa Council of the UAE on the Covid-19 vaccines, that emphasised that it is within the expertise of the scientists alone to determine the safety, efficacy and overall beneficence of the newly developed vaccines.

Another concern that Ghaly addresses in his article is that some Muslims fear that they may contain “religiously prohibited” substances such as pork. In response to this fear, the fatwa stated that all the information that was provided by Pfizer and Moderna indicates that no such materials were used.

The fatwa even went on to explain that even if a religiously prohibited substance was indeed used to manufacture the vaccine, it would still be considered permissible to use, based on the notion that the original material would have undergone substantial chemical transformation during the manufacturing process, and so as a result, would not retain its original nature.

Vaccination: a moral duty

Dr. Ghaly echoed the sentiments of the WHO Director General who recently warned that “the world is on the brink of a catastrophic moral failure”.

He explains that cardinal values such as justice and compassion are often neglected or forgotten, during the quest of dispelling and refuting claims about the vaccinations not being compatible with religious norms. He stresses the importance of ensuring equitable and fair access to vaccines, and that Muslim-majority countries have a moral obligation to help poor individuals and countries who cannot afford to acquire the Covid-19 vaccines.

From a Christian, Catholic standpoint, earlier this year, Pope Francis, during a TV interview, suggested that people are morally obligated to get vaccinated against Covid-19, stressing that it is a choice that doesn’t just affect one’s life personally, but also the lives of others. These remarks aimed at the world’s 1.3 billion Catholics, confirmed his personal support, and the support of the Vatican, for the global vaccination roll out.

Experts estimate that between 70% and 90% of the global population needs to be vaccinated in order for us to reach herd immunity and return to some kind of normalcy. While vaccination for Covid-19 is unlikely to become mandatory in the concrete sense of the word, the vaccines are absolutely crucial to bring about the end of the pandemic.

Therefore, it is imperative that we as a global community continue to take the vaccine as it becomes available to us and play our part as policy makers and change leaders to help the vaccine reach remote areas and populations, in order to ensure that those less fortunate do not get left behind.

“No one will ever be truly safe until everyone is safe” – Amina Mohammed, Deputy Secretary- General, United Nations.

*It is important to note that these figures have potentially changed as the study was conducted before the vaccination drive was launched. It is expected that the more people get vaccinated, the less hesitant others become to follow suit.

Maha El Akoum, MPH, is a public health professional currently working as Head of Content at World Innovation Summit for Health [WISH].

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