Vaccination roll-out has been a slow development in Sub-Saharan Africa. Factors like the “vaccine apartheid” — whereby rich countries are hoarding doses of the vaccines and transnational companies through patents — are monopolising the production of vaccines and causing inequalities in vaccine distribution. The World Health Organisation’s (WHO) director general even criticised high-income countries for rolling out booster COVID-19 shots while poorer countries faced shortages.

Pfizer-BioNTech has recently announced their intent on building vaccine manufacturing plants in Senegal and Rwanda, and the COVAX mechanism has facilitated more equitable access to vaccines. However, in The Gambia, only 9.1 per cent of the population had been fully vaccinated by the end of October. Guinea-Bissau’s proportion of fully vaccinated persons as of early November was 15.5 percent. 

While health authorities and advocates in sub-Saharan Africa and from multilateral organisations continue to work towards increasing vaccine access on the continent, another challenge that must be confronted is the issue of hesitancy among the population. Of particular concern is the gender gap in vaccine acceptance. Women in Guinea-Bissau and The Gambia, particularly women who work in the informal sector, are hesitant to be vaccinated.

Vaccines as threats to women’s livelihoods

Hesitancy is being attributed to the spread of misinformation and disinformation about the side effects of the COVID-19 vaccines. The main sources of information in The Gambia are from traditional news outlets (radio, newspaper, and TV). But phones, texts and calls represent up to 20 per cent of COVID-19 information sources. Among hesitant groups of people, Africa CDC found that social media tended to be the most trusted source of information. In Guinea-Bissau, radio represents the most important source of information in the country, but many have relied on social media, in particular Facebook, for communications on the pandemic.

A news report from the Associated Press looked into the reasons for the gender gap in The Gambia. Those who were unwilling to get vaccinated were often heads of household and women of childbearing age who participated in the informal sector. The groups of women who are most hesitant in Guinea-Bissau are similar. Their fears are that side-effects of the vaccine would make them unable to work or that they would cause infertility. Sometimes their access to vaccines even depends on receiving permission from their husbands. 

A similar phenomenon took place in the 1990s in Cameroon and in the early 2000s in Nigeria, where it was rumoured that polio vaccines were being administered to sterilise women with the polio vaccination campaign, where the vaccine was rumoured to cause infertility among women. A study on COVID-19 vaccine perceptions in Africa found from social media monitoring that rumours spread that the vaccine would cause infertility and was a weapon for population control in poor countries.

Gendered disadvantages have perpetuated cycles of poverty and dependence on relationships with men in both nations. Low female literacy rates prevent women from accessing positions in the formal market where income is less precarious. Women make up approximately 51.6 per cent of the informal market workforce in Guinea-Bissau, including market trading and agriculture. Of the women who are heads of households, 62.2 per cent are engaged in the informal market. Bissau-Guinean women also have limited rights to land tenure and property ownership. Poverty is also gendered in The Gambia, so women constitute the majority of the poor and the extreme poor and have limited access to land too. 

Women’s limited access to resources and precarious income opportunities means that the side-effects of COVID-19 are perceived as threats to themselves and their household’s livelihoods. Marriageability is key because of the high dependence on men for access to resources. A compromised ability to conceive children threatens their opportunities for marriage and thus cuts off the social protection that marriage provides. 

According to the CDC, “Currently no evidence shows that any vaccines, including COVID-19 vaccines, cause fertility problems (problems trying to get pregnant) in women or men.” They also recommend that pregnant people and people trying to become pregnant should take the vaccine. But while sanitary authorities work hard to combat the spread of false information, in Guinea-Bissau, for example, the High Commission for COVID-19 launched a campaign to increase vaccine confidence and acceptance among women through radio programmes and community awareness campaigns in November. A study on how information spreads on Twitter found that fake news spreads faster and more widely than true news. Indeed, a video of a woman seemingly “magnetised” after receiving the COVID-19 jab has become viral in Gambia despite the CDC’s findings and myth-busting by other sanitary authorities.

When it comes to other side-effects of the vaccine like fatigue and fever, women in the informal market worry that it would compromise their income. Lucy Jarju from The Gambia, whose husband has passed away, said to AP, “If my arm gets heavy and I can’t go to the water, who will feed my children?”

The pandemic has already compromised household incomes around the world, and in Africa where the informal market is the largest employer, lockdown measures are ill-adapted to the socio-economic realities on the ground. Agriculture and tourism, important sectors for the economies of Guinea-Bissau and The Gambia respectively, were hard hit by the pandemic, and gender inequalities have meant that women were disproportionately affected. Anything that might potentially increase poverty and food insecurity for themselves and their families is too high a cost. The suspension of AstraZeneca in many countries because of their links to blood clotting only reinforced the belief that vaccines would have adverse health effects.

In the long run, sanitary authorities fear that this reluctance will stand in the way of post-pandemic recovery because the virus will continue to circulate and mutate. Gambian and Bissau-Guinean women, and women in other nations, where a gender gap exists in vaccine acceptance, remain vulnerable to the virus.

The slow supply to Africa is said to have allowed enough time for fear about the vaccines to fester, weakening their demand. To combat hesitancy adequately among women, it is not enough to fight false information and manage fears through community interventions. It is also necessary to implement safety networks for women so that should side-effects manifest after receiving the jab, or any vaccine that might be developed, their livelihoods will not factor in their risk analyses.