Immunization is one of the most cost-effective public health measures, saving millions of lives annually and enhancing community health through herd immunity. However, there is both cause for celebration and concern. During the COVID-19 pandemic, disruptions in routine immunization led to increased outbreaks of diseases like diphtheria, measles, polio, and yellow fever in over 100 countries. This was due to challenges in vaccine supply, reduced healthcare worker availability due to confinement policies, illness, and diversion to COVID-19, alongside declining confidence in vaccines. Vaccine hesitancy, the reluctance or refusal to vaccinate, poses a significant barrier to immunization and threatens global health. Some argue that demand for vaccines can be encouraged through communication campaigns. While evidence exists on what and how to communicate, there is less understanding of who should communicate. Recent U.S. studies indicate that public vaccination by high-profile politicians may boost vaccine confidence, but systematic information is lacking, and applicability in different contexts is unclear.
A recent study aimed to address these gaps by examining the Democratic Republic of Congo, where vaccine confidence dropped significantly during the pandemic. This is alarming as Africa is already behind in achieving universal vaccination. The study focused on whether public presidential vaccination would increase vaccine uptake. Findings showed it could, but only if the president is trustworthy and the vaccination is widely communicated, especially in areas with limited media access. In cases where these conditions aren’t met, public vaccination of village leaders or respected community elders might be more effective. Globally, 168 out of 173 leaders supported the COVID-19 vaccination campaign; 139 leaders publicized their vaccinations, and 108 shared images or videos of the process. President Felix Tshisekedi of the DRC received his vaccine live on Congolese television on September 13, 2021. By March 2022, only 5.7% of the population had received at least one dose, with just 1.03% fully vaccinated.
Several factors contributed to these low vaccination rates: low confidence in COVID-19 vaccines, limited healthcare services, poor transportation infrastructure, concerns about the AstraZeneca vaccine’s safety, and governance issues like corruption and political instability. Ranked low on the Human Development Index, DR Congo faces significant health, education, and income challenges. The research took place in the east, a region affected by ongoing violence and an Ebola outbreak when COVID-19 struck. Researchers analyzed whether President Tshisekedi could serve as a vaccine ambassador to boost uptake. In September 2021, a survey of 600 people was conducted in six villages in Lubero territory, North Kivu province—a remote area with poor infrastructure and limited media access. COVID-19 vaccines were unavailable at the time. The survey asked, “If a coronavirus vaccine were available, would you take it?” Although 98% had vaccinated their children against other diseases, only 22% were willing to accept a COVID-19 vaccine, mainly due to distrust and fear of side-effects. Trust in institutions was also low, with only 17% endorsing the president as representing Congolese interests. Respondents had low access to media, with 91% not watching television and 57% not listening to the radio.
A third of survey participants received a prompt: “Assume President Félix Tshisekedi took the vaccine live on television.” The impact was measured by comparing vaccine acceptance against a control group, finding that trust influenced the results. Among those trusting the president, the prompt boosted acceptance by 25 percentage points, while for those distrustful, acceptance fell by 6 points. During the survey, Tshisekedi’s live vaccination occurred, but only 18% post-broadcast were aware of it due to limited media access. Comparing respondents with similar backgrounds and trust levels, awareness of the president’s vaccination increased acceptance by 20 percentage points. The study concludes that an effective vaccination model involves a trusted leader and extensive communication.