JOHANNESBURG — The detection of the Omicron variant in southern Africa signals the next stage of the battle against Covid-19: getting many more people inoculated in poorer nations where vaccines have been scarcest in order to deter new mutations from developing.
But while world leaders sometimes talk about this as if it were largely a matter of delivering doses overseas, the experience of South Africa, at least, hints at a far more complex set of challenges.
Like many poor countries, South Africa was made to wait months for vaccines as wealthier countries monopolized them. Many countries still do not have anywhere near enough vaccines to inoculate their populations.
The problems have not ended as shots began arriving in greater numbers.
Neglected and underfunded public health infrastructure has slowed their delivery, especially to rural areas, where storage and staffing problems are common.
And now, there are growing signs in parts of Africa, as well as South Asia, that skepticism or outright hostility toward the Covid vaccines may run deeper than expected.
Deep distrust of governments and medical authorities, especially among rural and marginalized communities, may already be stalling out vaccination drives. The legacy of Western exploitation and medical abuses during and after colonialism is weighing heavily, too.
Misinformation circulating on social media often fills the vacuum, some of it floating in from the United States and Europe, where vaccine refusal has also been an issue.
“There’s no doubt that vaccine hesitancy is a factor in the rollout of vaccines,” said Dr. Matshidiso Moeti, the Africa director of the World Health Organization. News or rumors of potential side effects, she said, “gets picked out and talked about, and some people become afraid.”
Just days before the Omicron variant was first detected, health officials in South Africa turned away shipments of doses from Pfizer-BioNTech and Johnson & Johnson, worried that their stockpile of 16 million shots might spoil amid insufficient demand.
Though only 36 percent of South African adults are fully vaccinated, daily vaccinations have already been flatlining, according to government statistics.
It is not just South Africa.
Namibia, Zimbabwe, Mozambique and Malawi have also asked vaccine manufacturers and donors to hold off on sending more shots because they can’t use the supplies they have, according to several health officials involved in the effort to distribute vaccines to developing nations.
Research has consistently found that factors like public distrust and uneven vaccine distribution can increase vaccine hesitancy in any country. But these issues have often been more prevalent in poorer countries during the pandemic, said Dr. Saad Omer, a Yale University epidemiologist, and they have had a deeper effect.
Public messaging campaigns and carefully orchestrated vaccine deliveries can counteract the distrust — but they are in short supply.
“Almost no investment in vaccine education or promotion has gone into low-income countries,” Dr. Omer said. “Why do we expect that all we will have to do is drop vaccines at an airport, do the photo op, and people will come running to the airport and grab the vaccine?”
Only one in four health workers in Africa are vaccinated, World Health Organization officials have said. In several countries, fewer than half say they intend to get vaccinated.
It is not a problem only for Africa.
In India, health workers have met sometimes-violent resistance in rural communities. Vaccine hesitancy rates there approach 50 percent among those who have not completed high school. In some parts of the country, more than a third of doses spoil amid the low demand.
Still, many are eager to be vaccinated. When doses first became widely available in South Africa earlier this year, a third of the country’s adults swiftly got inoculated, a pattern that is repeating elsewhere.
Experts stress that even partial uptake will slow the spread of new or existing variants. But that may not be enough to achieve the high vaccination rates needed if the world is to put the pandemic behind it.
Distrust of government and medical authorities long predate Covid in South Africa. But a series of setbacks with the vaccine rollout, as well as widespread allegations of corruption amid last year’s lockdown, have heightened public unease.
“There’s a lack of confidence in the public health system’s ability to provide vaccines,” said Chris Vick, the founder of Covid Comms, a South African nonprofit group.
The group has been holding vaccine information sessions, but overcoming skepticism is not easy. After a session in the Pretoria township of Atteridgeville, one 20-year-old who attended said she had not been persuaded.
“I think that Covid is not real,” said the young woman, Tidibatso Rakabe. “They are playing with us, politicians and everyone.”
Many say they fear side effects.
Earlier this year,…