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.

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.

briefly pause delivery of the Johnson & Johnson vaccine, leading South Africa to delay its rollout to health care workers. Both countries decided to resume the shots after concluding that they were safe.

The South African government held regular briefings, but these were on television and in English, when radio remains the most powerful medium and most South Africans do not speak English as their mother tongue.

a recent study found. That is in part because of mistrust of the Black-led government, but also because American Covid conspiracists have found wide reach among white South Africans on social media, according to Mr. Vick of Covid Comms.

Covid pill from Merck for high-risk adults, the first in a new class of antiviral drugs that could work against a wide range of variants, including Omicron. The pill could be authorized within days, and available by year’s end.

The first modern, worldwide campaign, begun in 1959 against smallpox, provoked deep skepticism in parts of Africa and Asia, where it was seen as a continuation of colonial-era medical abuses. Some W.H.O. officials used physical force to vaccinate people, deepening distrust. The campaign took 28 years.

The effort to eradicate polio, which finally ramped up in poor countries in the 1980s and is still ongoing, has run into similar resistance. A study in the science journal Nature found that vaccine avoidance was highest among poor or marginalized groups, who believed that the health authorities, and especially Western governments, would never voluntarily help them.

In Nigeria in the early 2000s, amid a spike in religious tensions, unfounded rumors circulated that foreign health workers were using polio vaccines as cover to sterilize the country’s Muslim population. Boycotts and local bans led to a polio resurgence, with cases spreading to 15 other countries, as far as Southeast Asia.

survey by the Africa Center for Disease Control found that 43 percent of those polled believe Africans are used as guinea pigs in vaccine trials — a legacy of Western drug companies’ doing exactly this in the 1990s.

Even within their own borders, Western governments are struggling to overcome vaccine resistance. So it is hard to imagine them doing better in faraway societies where they lack local understanding.

Any appearance of Western powers forcing unwanted vaccines into African or Asian arms risks deepening the backlash.

“If the objective is to keep the U.S. and the rest of the world safe, it should be pretty obvious that the success of the domestic program depends on what happens internationally,” Dr. Omer said.

Declan Walsh contributed reporting from Nairobi.

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