Challenges to COVID-19 vaccine introduction in the Democratic Republic of the Congo – a commentary

Abstract

COVID-19 vaccination in the Democratic Republic of the Congo (DRC) began in April 2021. A month later, most COVID-19 vaccine doses were reallocated to other African countries, due to low vaccine uptake and the realization that the doses would expire before use. Based on data available on 13 August 2022, 2.76% of the DRC population had been fully vaccinated with last dose of primary series of COVID-19 vaccine, placing the country second to last in Africa and in the last five in global COVID-19 vaccination coverage. The DRC’s reliance on vaccine donations requires continuous adaptation of the vaccine deployment plan to match incoming COVID-19 vaccines shipments. Challenges in planning vaccine deployments, vaccinating priority populations, coordinating, and implementing the communications plan, disbursing funds, and conducting supervision of vaccination activities have contributed to low COVID-19 vaccine coverage. In addition, the spread of rumors through social media and by various community and religious leaders resulted in high levels of vaccine hesitancy. A strong risk communication and community engagement plan, coupled with innovative efforts to target the highest-risk populations are critical to increase vaccine uptake during the next phase of COVID-19 vaccine introduction.

COVID-19 Vaccine Perceptions among Ebola-Affected Communities in North Kivu, Democratic Republic of the Congo, 2021

“…It is important to note that this survey was implemented between March 5 and 16, 2021, overlapping with the arrival of the DRC’s first shipment of 1.8 million vaccine doses from the COVAX facility [ 38 , 39 , 40 ]. However, on March 15, the vaccine campaign was paused due to widely publicized concerns about the rare but serious thrombotic side effects of the Oxford–AstraZeneca vaccine [ 7 , 40 ]. Due to low acceptance and the realization that most doses would expire, the DRC returned over 1.3 million vaccine doses to COVAX.…”

“…Vaccination subsequently began in Kinshasa on 19 April, and then in North Kivu in early May. Owing to slow acceptance, fewer than 6000 doses were administered in North Kivu by June 2021 [ 7 , 41 ]. Unfortunately, vaccine acceptance has remained extremely low, with an actual vaccine acceptance level of <5% in North Kivu as of the end of 2022—even lower than the rates of intention to vaccinate found in this survey [ 28 ].…”

“…The Democratic Republic of the Congo (DRC) has one of the lowest COVID-19 vaccination rates in the world, having fully vaccinated 12% of its 100 million estimated population as of April 2023 [ 6 ]. Vaccinations in the DRC began with the rollout of the ChAdOx1-S (recombinant) (AstraZeneca ® /Covishield) vaccine in April 2021 and subsequently in September 2021 with the Moderna mRNA-1273 and Pfizer-BioNTech (BNT162b2) COVID-19 vaccines, through the COVID-19 Vaccines Global Access (COVAX) facility, and the Sinovac vaccine through a bilateral agreement between the DRC and China [ 6 , 7 , 8 , 9 ]. Specific challenges to COVID-19 vaccine uptake in the DRC include healthcare worker (HCW) shortages and strikes, concurrent outbreaks of other vaccine-preventable diseases (VPDs), including Ebola Virus Disease (EVD), and high rates of vaccine hesitancy due to misinformation [ 7 , 10 ].…”

“…Vaccinations in the DRC began with the rollout of the ChAdOx1-S (recombinant) (AstraZeneca ® /Covishield) vaccine in April 2021 and subsequently in September 2021 with the Moderna mRNA-1273 and Pfizer-BioNTech (BNT162b2) COVID-19 vaccines, through the COVID-19 Vaccines Global Access (COVAX) facility, and the Sinovac vaccine through a bilateral agreement between the DRC and China [ 6 , 7 , 8 , 9 ]. Specific challenges to COVID-19 vaccine uptake in the DRC include healthcare worker (HCW) shortages and strikes, concurrent outbreaks of other vaccine-preventable diseases (VPDs), including Ebola Virus Disease (EVD), and high rates of vaccine hesitancy due to misinformation [ 7 , 10 ]. A 2020 survey conducted by the Africa Centers for Disease Control and Prevention (Africa CDC) found that DRC respondents had the lowest willingness to receive a vaccine among the 15 African countries included in that survey (59% DRC vs. >90% in Ethiopia, Nigeria, and Tunisia) [ 11 ].…”

The Struggle to Vaccinate: Unveiling the Reality of the first year of Covid-19 Vaccination in the Democratic Republic of Congo

“…Research conducted where either limited in scope like addressing one province [19,20] or one component of the vaccination for instance, the communication, the demand generation [21][22][23][24]. The only study that gave an overview of implementation was a commentary but was limited as it only focused on ChAdOx1 [25]. While commentaries can provide valuable insights and perspectives, they are generally considered inferior to a full research article because they lack the same level of rigor and systematic methodology as empirical research [26].…”