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Tanzania's Dilemma: It's Not So Easy To Go From Vaccine Denier To Vaccine Embracer

On Wednesday, Tanzania's president, Samia Suluhu Hassan, is scheduled to get her COVID-19 vaccine, marking the official launch of the country's vaccination campaign.It's a stark contrast to the country's COVID stance earlier this year. On February 2, health minister Dr. Dorothy Gwajima stood before press cameras with her deputies. They all drank concoctions containing ginger, garlic and lemons to assure the public that the best way to beat the coronavirus was through natural remedies."The government has no plans to receive COVID-19 vaccines that are being distributed in other countries,'' Gwajima told the press conference.It was part of President John Magufuli's position that no vaccines were necessary."You should stand firm. Vaccinations are dangerous. If the white man was able to come up with vaccines, he should have found a vaccine for AIDS by now," the president said live on national television at a gathering at his home village, Chato, on January 28. Tanzania was one of the four African countries that was not interested in vaccinating its citizens (along with Burundi, Eritrea and Madagascar). This anti-vaccine stand was a marked contrast to Tanzania's previous record on vaccines. With a 99% coverage of child immunization, Tanzania was ranked among top ten countries in Africa in 2014 for high vaccination rates. It was hard to make sense of this vaccine turnaround. The medical journal The Lancet offered this explanation: Tanzania's reasons for refusing COVID-19 vaccines are baffling. "I think the government was compelled to take that decision because they had already declared Tanzania a COVID-19-free country," Zitto Kabwe, party leader of the Alliance for Change and Transparency (the third largest political party in Tanzania and main opposition in Zanzibar), told The Lancet. "I feel very sad for my country men and women," says Kabwe. "The government has abdicated its duty to protect the lives of the people and it must be held to account. I can't comprehend the government approach at all. I simply see it as mumbling and dangerous."Six months later, the president himself is dead. Heart disease is the official cause given for his demise on March 17 at age 61, although rumors spread (and were denied) that he himself had contracted COVID-19. And the new leadership has reversed the anti-vaccine stance. On June 12, Tanzania submitted a request to the global COVAX program, which is distributing vaccines to low-resource countries. Prime Minister Kassim Majaliwa announced on July 21 that the East African nation has started receiving the vaccines. The first batch — a shipment of 1 million doses of Johnson & Johnson vaccines — was donated by the U.S. government. "People should get ready for vaccination,'' he said in a government statement. The country goal is to vaccinate 60% of its country's population of 58 million, prioritizing health workers, according to a Ministry of Health statement on July 22. There is no explanation of why that percentage was set or what the timeline is for achieving this goal. Skepticism vs. sciencePublic health officials worry the months of denial and misinformation will have consequences – that many Tanzanians will not step up to receive their jab."Things changed so suddenly. I know many people who are still trying to reconcile themselves to the government's new COVID approach," says Herrieth Makwetta, a health reporter for a Swahili daily newspaper, Mwananchi, based in Dar es Salaam. "There was a time it felt like a taboo to write the word COVID-19 anywhere on internet,'' says Makwetta, referring to online regulations passed in July 2020, prohibiting the sharing of information on outbreaks without government approval — and leaving room for disinformation to spread."I met so many people who believed that COVID-19 didn't exist, and that it was mere propaganda from Western countries. Proving them wrong publicly was a bit tricky. How do you prove it when the authorities say it doesn't exist in the country? "says Dr. Deus Kitapondya, an emergency medicine specialist based in Dar es Salaam. "The obvious truth is that the general public is still deeply divided about vaccines, even among some pro-government scientists. For a long time, people were officially made to believe that vaccines are not safe,'' says a medical doctor who works at a hospital in Dar es Salaam, the commercial capital. He asked for anonymity for fear that speaking out could bring government reprisals that would cost him his job. Even with this new government attitude, the online regulations prohibiting discussion of COVID-19 remain intact."As doctors, we didn't have the platform and the freedom to publicly fact-check what the government was telling the public," says the medic. "Misinformation [about COVID-19 vaccines] is widespread, and unfortunately it came from official sources," he says.Dr. Shindo Kilawa, a general physician at Muhimbili National Hospital, says the government faces a tough task ahead in promoting the vaccines. "To break away from the past, psychologically, I see the need for a massive awareness campaign, mainly targeting the general public. [Otherwise] we could end up with many unused stocks of vaccines," suggests Kilawa.The former president's stanceJohn Magufuli, who had a Ph.D. in chemistry, ruled Tanzania for five years. He said he believed there were "ulterior motives" behind COVID-19 vaccines. He questioned their safety without evidence – just as former U.S President Donald Trump once did regarding the measles vaccine (although he did support the development of vaccines for COVID and was himself vaccinated).Tanzania is now struggling to reset the public messaging about the science of COVID-19.When the country recorded its first case on March 25, 2020, the government formed a COVID-19 task-force in response to the pandemic, which enforced physical distancing and other preventive measures. Schools and stadiums were closed. Then, three months into the pandemic, on June 8, 2020, President Magufuli called for three days of national prayer and encouraged Tanzanians to rely on herbal remedies and steam inhalation to treat COVID-19 symptoms.He declared the country "coronavirus free" that same day, claiming God had eliminated the virus.Following the president's declaration, all COVID-19 response programs, including the government task force, ceased operation. At that time, the country had officially recorded 509 cases and 21 deaths. From then until Magufuli's passing on March 17 of this year, no further data on COVID-19 was released. In his last days of life, Magufuli began changing his tone about the pandemic. "The virus exists, we must take all precautions," he said during a church service he attended in Dar es Salaam on February 21. At that time, rumors had spread (and were refuted by the government) that many government officials were ill due to COVID-19.For weeks after that church service, Magufuli did not appear in public. His death was announced on March 17.A seemingly new attitudeThe attitude toward COVID is completely different these days. On April 17, the new president, Samia Suluhu Hassan, an economist educated at Manchester University in the United Kingdom, formed a scientific advisory committee whose recommendations led the government to request vaccine doses from COVAX. Health Minister Dr. Gwajima, who was a staunch supporter of Magufuli's policies, is now implementing the committee's recommendations. While she previously did not mask up in her public appearances, she now wears a face mask in public and has started advocating preventive measures like physical distancing and hand-washing. And she is asking the public to accept COVID-19 vaccines.She has faced backlash on social media over her sudden change. "My position on COVID-19 hasn't changed," she responded on a live broadcast on local TV channel Wasafi on July 13. She noted that she still advocates use of herbal remedies but stressed that she has to go along with current scientific recommendations.NPR asked Gwajima to clarify her COVID-19 approach and her decision not to wear a face mask amid a public health crisis in the past administration; she did not respond to text messages or phone calls.The authority of the minister and her deputies in advocating vaccination doesn't guarantee a new national attitude, says Aikande Kwayu, honorary research fellow specializing in political governance at the University of Wisconsin-Madison, who is based in Tanzania. "Their actions and statements during the last administration influenced a lot of conspiracies, lies and also denial about the pandemic,'' says Kwayu.President Hassan, meanwhile, has warned that COVID-19 cases have been surging since June. "We are in the third phase of the pandemic. We should take all precautions," she said at a meeting with media editors in the statehouse in Dar es Salaam, the commercial capital.On June 28, Tanzania made COVID-19 data public for the first time in over a year. The president reported 100 cases, with 70 patients on oxygen therapy and no deaths. No time frame was given for those numbers. Since then, the minister of health has released various case numbers, adding up to 858 cases and 29 deaths as of July 22. Data is not updated regularly.Progress ... or not?There are signs of change in the rest of the country. Hamisi Kigwangala, a medical doctor and a member of parliament from Nzega, a constituency in central Tanzania, publicly spoke against COVID-19 vaccines on February 6.But on July 24, he made a U-turn and urged all Tanzanians to turn up for vaccination. On camera, he was filmed at a private vaccination center taking a shot of the Russian-made Sputnik Light. "[The vaccine] is the only sure way we have for now to remain safe, so if one gets a chance, they should take it without wasting time,'' he told NPR. He has started a social media awareness campaign to educate Tanzanians on COVID-19 vaccines.But deep-rooted skepticism remains, says Egidius Kamanyi, a lecturer at the Department of Sociology and Anthropology of the University of Dar es Salaam. "For a long time, many people in rural and urban areas have not been part of a health system that encourages a biological approach to the treatment of diseases," says Kamanyi."There is a large section of this society still believing in the use of traditional medicine to cure off their illnesses. It's not surprising if people may not turn up for vaccines partly because of that," he says. Patty Magubira, a resident of Arusha in northeastern Tanzania, says he is still undecided about being vaccinated because he isn't sure what to believe. "Of course, I trusted president Magufuli. He had the same questions about vaccines like I did. He was a very patriotic president,'' says Magubira. "I can only accept vaccination if it's compulsory, otherwise I won't take the vaccines,'' he says. And the politicization of vaccines continues. Josephat Gwajima, a member of Parliament and a preacher, has consistently told his followers not to take the jabs. A diehard Magufuli supporter, he started an anti-vaccine campaign on July 25. "Being vaccinated is voluntary, use that opportunity to refuse vaccines,'' reads his social mediapost. The government hasn't commented on this campaign. With inoculation of the general public expected to start this week, the looming question is: How many people will show up?Syriacus Buguzi is a Tanzanian science journalist and a medical doctor. Find him on Twitter at https://twitter.com/buguzi Copyright 2021 NPR. To see more, visit https://www.npr.org.