Dr Christian Mayala and Dr Rodin Nzembuni Nduku sit together on a bench outside the Covid ward at Kinshasa’s Mama Yemo hospital.
They are discussing the health of their father, Noel Kalouda, who contracted coronavirus weeks before, and is now lying in a hospital bed, breathing through an oxygen mask.
Despite the brothers’ medical knowledge, and vaccines being available to them in the capital of the Democratic Republic of the Congo (DRC), all three men had chosen not to get vaccinated because of fears over potential side-effects of the only jab available, the AstraZeneca vaccine.
“On social media, there was a story about a guy who died 20 hours after getting vaccinated. Things like this make me scared to get the vaccine,” said Nduku.
Already facing shortages and huge logistical challenges in getting vaccines out to people in far-flung areas, experts worry that distrust of pharmaceutical products will further undermine the global fight against Covid.
While anger grows over the failures of rich countries to supply enough vaccines to poorer ones, vaccine hesitancy of citizens has been overlooked, epidemiologists warn.
Prof Pascal Lutumba, of the University of Kinshasa’s department of infectious diseases, said: “If people in Congo remain unvaccinated, the South African variant could meet with the Delta variant and the virus could mutate into a variant that is resistant to some vaccines.
“If a Congo variant arrives in a country like the UK, which has high vaccination rates, it could put them back into the same position they were at the beginning of the pandemic. They’d have to get vaccinated again with a new vaccine,” Lutumba said.
“We would be back to square one,” said Dr William Schaffner, a professor at Vanderbilt University medical centre in Nashville, US.
The Delta variant represents up to 79% of infections sequenced in DRC, according to figures released by the World Health Organization last month.
The country had officially recorded 50,529 cases and 1,045 Covid-related deaths by 4 August, according to the Johns Hopkins University tracker, but the virus has torn through the DRC’s elite. In May the vice-president of the Congolese national assembly said the pandemic had killed as many as 32 MPs – about 5% of the total.
Setting the tone for vaccine scepticism, the DRC’s president, Félix Tshisekedi, admitted last month he had not yet had the vaccine.
“We were ready to launch the vaccination campaign. The day before, I saw this [misleading] information on television first and then in social networks,” Tshisekedi told journalists.
The DRC has only received AstraZeneca vaccines so far, but according to Dr Jean-Jacques Muyembe-Tamfum, the country’s head of Covid response, new vaccines are expected to arrive this month, which should include different brands – which both Muyembe-Tamfum and the president have said they will take.
Nduku said: “The president said that he doesn’t trust AstraZeneca, so that makes me doubt it … I would die of anxiety if I took this vaccine, because of how the president described it. I would be worried that I was going to die.”
On 2 March DRC received 1.7m doses from Covax, the global vaccine-sharing scheme, but delayed the rollout until April after several European countries suspended use of the AstraZeneca vaccine in response to reports of side-effects involving rare blood clots. About 75% of the shots were relocated to other African countries to be used before they expired. Since then the rollout has been sluggish.
Delivering vaccines across a vast, forested country divided by large rivers and with poor infrastructure is a challenge in itself. The DRC is almost the size of western Europe yet has under 2,000 miles (3,000km) of paved roads, less than 1% of the total in the UK.
Willingness to have a Covid vaccine in the DRC was reported to be the lowest in 15 countries surveyed by the African Union between August and December last year, with 38% of people surveyed in the DRC unwilling to be vaccinated compared with just 4% in Ethiopia.
More than 70% of healthcare workers in the country said they would not take the vaccine, according to a study published by Vaccines journal in February.
The failure over healthcare messaging historically has had catastrophic consequences here. An Ebola outbreak in the eastern DRC in 2018 killed more than 2,200 people as international aid agencies and health authorities failed to communicate effectively with people and communities, to properly train health workers and to explain consent in local languages, according to the World Bank.
Healthcare workers who spoke to the Guardian in Kinshasa said these mistakes had been repeated with Covid as the government has failed to adequately explain the severity of the virus, allowing disinformation to spread.
“People were getting all sorts of messages from the churches – for example, that Covid was created to finish off Africans. The small churches were spreading many messages that Covid was not real,” said Dr Cris Kacita Osako, an epidemiologist who worked on the government’s Covid response last year.
Meanwhile, as they hope for their father’s recovery, Nduku and his brother are torn. “People didn’t believe it,” said a doctor at the hospital, Jean-Paul Nsimba. “They resisted, they doubted its existence. They thought it was a disease that killed white people.”
Belgium might close schools and cultural activities
Today, Friday, Belgian governments are meeting again in order to decide on new Covid measures in order to stop the spreading of the virus as numbers are spiking. This time the concertation committee is gathering on the request of the Flemish minister-president Jan Jambon who suggested to close down all indoor events, including all concerts and theatre productions. The closing of schools is also on the agenda.
El Salvador ‘responsible for death of woman jailed after miscarriage’ | Global development
The Inter-American court of human rights has ruled that El Salvador was responsible for the death of Manuela, a woman who was jailed in 2008 for killing her baby when she suffered a miscarriage.
The court has ordered the Central American country to reform its draconian policies on reproductive health.
The decision on Tuesday marked the first time an international court has ruled on El Salvador’s extreme abortion laws and was celebrated by women’s rights activists, who believe it could open doors for change across the region.
Since 1998, abortion in El Salvador has been banned without exception, even in cases of rape and incest. Over the past two decades, more than 180 women have been jailed for murder for having an abortion after suffering obstetric emergencies, according to rights groups.
The case of Manuela v El Salvador was brought after the 33-year-old mother of two from the countryside died from cancer after receiving inadequate medical diagnosis and treatment, leaving her two children orphaned. She had been serving a 30-year prison sentence for aggravated homicide after a miscarriage.
When Manuela – whose full name has never been made public in El Salvador – went to the hospital after miscarrying, staff failed to provide her with timely treatment and instead subjected her to verbal abuse and accused her of having an abortion, according to the Center for Reproductive Rights. Manuela was handcuffed to her bed and denied access to a lawyer while police interrogated her.
“There is no doubt that Manuela suffered an obstetric emergency,” the landmark court ruling stated. “Such situations, as they are medical conditions, cannot lead to a criminal sanction.”
The court also ruled that the state must pay reparations to Manuela’s family, and should develop comprehensive sexual education policies and guarantee doctor-patient confidentiality.
“The Inter-American court has done justice by recognising Manuela was another victim of an unjust legal context that originates in the absolute prohibition of abortion,” said Morena Herrera, at the Feminist Collective for Local Development, one of the parties in the case supporting Manuela’s family.
“Manuela’s story is a sad one, but it represents a change and becomes a path of justice and hope for all women in Latin America and the Caribbean who are criminalised for obstetric events.”
Most countries in the region respect the Inter-American court’s jurisdiction, opening the door for sweeping change, activists said.
“This is a huge advance for reproductive rights, not only in El Salvador but across Latin America,” said Catalina Martínez Coral, regional director for Latin America and the Caribbean at the Center for Reproductive Rights, another party in the case. “This is a standard we can apply to the constitutions and states across the region.”
Martínez Coral added that while the ruling was to be celebrated, the issue of poverty affecting access to reproductive rights remained a challenge.
“There are over 180 cases of women in jail, or that have been jailed, over these issues,” said Martínez Coral, who also worked as a litigator on the case against the Salvadorean state.
“What that means is we’re dealing with a state that criminalises women and, above all, criminalises poor women in the most rural and impoverished areas,” she said.
EU commission unveils proposal to digitalise justice systems
The European Commission unveiled on Wednesday a proposal to digitalise EU cross-border justice systems, aiming at making them more accessible and effective. Under the new draft law, the EU executive wants to tackle inefficiencies affecting cross-border judicial cooperation and barriers to access to justice in cross-border cases. Shifting paper-based communications to electronic formats would save up to €25m per year across the EU in postage and paper costs.
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