By Gunjan Veda
On December 9, we polled a virtual room full of civil society representatives if they felt prepared to engage with the World Health Organization and the African Centers for Disease Control and Prevention (Africa CDC) on COVID-19 vaccine acceptability and rollout. The answer was a resounding no.
This gathering of community-led development (CLD) organizations has happened monthly since April, bringing together practitioners to discuss how to adapt programming to the COVID-19 pandemic. Organized by the Movement for Community-led Development (MCLD), a consortium of 70+ international non-governmental organizations (INGOs) and hundreds of local civil society organizations (CSOs), these calls have been a space for partners to share challenges, workshop solutions, and help prepare their organizations and the communities they work with. Representing both large global NGOs and small community based organizations, the sample size on that December call was comparatively small (too small to generalize), but the poll results reinforced what had been echoed in calls and conversations throughout the pandemic.
Lack of access to reliable information and insufficient engagement with guiding bodies from government and international institutional structures have been recurring themes. Communities and their partners have been largely on their own, mobilizing for answers and solutions themselves with limited and inconsistent support. This has also been true during the vaccine development process and preparation for its rollout. As the likelihood of a viable Covid-19 vaccine became more real, concerns were repeatedly raised in our calls and conversations about both access to vaccines and their safety and acceptability.
To help us understand the vaccine, the planning for distribution and how we as CLD organizations could support its safe, equitable rollout, MCLD focused its November and December calls on these issues. We brought in the People’s Vaccine Movement, a coalition supporting Community Health Workers, and community partners. A delegation from the World Health Organization came to explain the structure of vaccine decision-making and the mechanisms that had been put in place for civil society engagement. They were keen to speak to the grassroots organizations that are closest to communities and able to influence local vaccine uptake. We heard from INGOs who are part of these initiatives, and shared information on engagement opportunities with the African CDC and their efforts around vaccine acceptability. Yet, even after hearing this, the call participants still expressed a reluctance to engage with institutional platforms. In the poll, they identified two reasons for their hesitancy: they needed more information and they were unsure that their voices would be heard and valued by the institutions.
The Global Action Plan for achieving the Sustainable Development Goal 3 (Healthy Lives and Well-being for All) cites community and civil society engagement as a key accelerator. Governments and international institutions recognize that they need community engagement and leadership to tackle this pandemic. This has resulted in a slew of mechanisms to engage civil society members who are seen as a bridge to communities. But, as one speaker noted, this engagement comes a bit late. Moreover, there is little clarity on who constitutes civil society. Oftentimes, the seat at the table for non-governmental actors has been occupied by large INGOs, partly because of their influence, partly because their reach is greater, and partly because they are familiar faces and more easily accessible. As a result, community-based organizations (CBOs) and local civil society organizations (CSOs) have been left out and are largely unaware of these mechanisms. It also means that, like the communities with whom they have been on the frontlines, they feel marginalized, un-supported and under-appreciated. A lack of resources compounds the problem. In a common example shared by a CBO from the Democratic Republic of Congo, when the government needed to spread the word on COVID-19 prevention, they gave organizations pamphlets for distribution in French. Yet, in the villages where they operate, people only speak Swahili. The CSOs were expected to assist, but where were the resources to translate and print the guidance in the local languages? Errors and oversights like this are compounding frustration and mistrust. So now when approached by powerful institutions to assist in the vaccine rollout, civil society organizations are eager to do their part but can be skeptical. This is not a surprise in a world where the space for civil society has been rapidly shrinking.
Access to policymakers and institutional structures is important for communities and civil society organizations. But it is not sufficient. It needs to be accompanied by trust. However, building trust takes time and requires more than periodic briefings. It calls for information sharing, active listening and responding to people’s needs.
One example of this is in support to community health workers (CHWs). The vaccine distribution policy in almost every country states that frontline workers will be the first to be inoculated. Does this include the thousands of CHWs who have been essential frontline workers in remote, rural communities to stop the spread of the virus? The Community Health Impact Coalition notes that many CHWs are not counted as part of the formal health force in a country and have long been under-recognized and under-resourced, including in the COVID-19 response. If they are not engaged and protected as part of the vaccine distribution strategy, the effort will falter. But there has been insufficient information sharing, listening and response to their needs. This extends to the vaccine itself. Even if they have access to it, will they be willing to take it?
In our calls and conversations, many civil society representatives admit that they are themselves uncomfortable about the idea of taking the vaccine. They trust the science behind the vaccine, but need more information. They have questions around who was included in the vaccine trials and the potential side effects for different population groups. They are concerned about the lack of infrastructure for storing and administering the vaccines, which could affect its efficacy. CHWs, often in rural areas, with limited access to top-down information, may also have these same reservations. With these questions in mind, how could they effectively convince community leaders or members to take the vaccine?
CSOs, including those that work with CHWs want to ensure that community leaders and community members have all the necessary information around the vaccine to make informed choices. This is vital to halt the pandemic. Public Health officials estimate that the vaccine uptake rate needs to be 60-70% to break the transmission of the virus. For this to happen, CSOs, community leaders and CHWs are the key. Therefore, spending time to ensure that they feel informed and equipped to relay the information to communities is not just a courtesy but a necessity.
Gunjan Veda is Senior Advisor, Advocacy and Global Collaborative Research with the Movement for Community-led Development.
Featured image: Africa CDC.