Situating COVID-19 Vaccine Hesitancy in Tanzania

This article is part of the following series:

In early February 2021, Tanzanian Health Minister Dorothy Gwajima announced that the Tanzanian government would not partake in COVID-19 vaccination campaigns—“we are not yet satisfied that those vaccines have been clinically proven safe.” Instead, Gwajima shared that the Government Chemist was testing and approving natural local remedies, where “these traditional remedies have been in use for ages in our societies and [where] many have been helped by them, including myself and my family.”

In many ways, Gwajima’s announcement, which included a demonstration where she and health officials drank a mix of traditional and household herbs and medicines, was emblematic of the Tanzanian government’s response to predominantly Western-funded, Western-engineered biomedical preventions and treatments for COVID-19. The pervading skepticism, however, should not be disregarded as “cultural,” nor should reports of “denialism” by various news media sources and international institutions[1] be simply understood as such.

Turning to histories of American and European medical interventions in Africa more broadly can provide some of the historical and political context as to why aid and biomedical science offered by multilateral institutions, corporations, and Western countries, especially in the form of a vaccine, are being strongly contested in Tanzania.

Western researchers and organizations have committed grievous acts of racist human experimentation and medical coercion on the African continent, much of which was, and is, unrecorded, burned, or missing. Of what we do know, French colonial governments in present-day Cameroon, Chad, Republic of Congo, Central African Republic, and Gabon organized extensive medical campaigns to prevent sleeping sickness where people were “forcibly examined and injected with medications with severe, sometimes fatal, side effects” to prevent the spread of “tropical diseases” from 1921 to 1956. Accompanied by Belgium, Germany, and Britain, France was not alone in undertaking forced, violent colonial medical campaigns on the African continent.

Yet, such violence is not only bound to the past nor to direct colonial rule. In 1996, during a severe meningitis outbreak in the state of Kano in Nigeria, Pfizer administered 100 doses of its experimental drug, Trovan, in a clinical trial without proper documentation and informed consent from patients’ families. Although the gold standard treatment of ceftriaxone was available and was provided to one hundred other children as part of the experiment, Pfizer continued their clinical trial. Eleven children died. Pfizer argued that the children died of meningitis but eventually paid a settlement to the parents of four of the children who died only after the families provided DNA evidence that the children were their biological offspring. In the 1990s, HIV-prevention projects funded by the United States’ Centers for Disease Control (CDC) and National Institutes of Health (NIH) to test the antiretroviral azidothymidine (AZT) were conducted on African women living with HIV without their proper informed consent, without adequate warning of possible side effects, and without their full understanding of the role of a placebo in clinical trials. In many of these trials, a significant portion of women received placebos, rather than AZT, although AZT had already been proven to reduce the risk of transmission of HIV from mother to child.

In the 21st century, similar unethical research continued. During the West Africa Ebola outbreak from 2014 to 2016, US, French, and British laboratories took close to 270,000 blood samples from Ebola patients without their informed consent before the samples were shipped across the continent and the world. Researchers from South Africa, France, the United Kingdom, and the United States, countries in which patients’ blood are used to develop Ebola treatments, vaccines, and defense against biological agents refuse to share how many samples remain. An anonymous Liberian technician interviewed by the Telegraph said, “after the samples were collected, we were left out of the picture…The research that you’re going to do with these samples [abroad], should be done here so that the citizens of this country benefit from that research.” The United States has filed patents using West African samples and in 2019, the Ebola virus isolated from 0.5 milliliters of a Guinean woman’s blood, anonymized as C15, was being sold at 170 times the price of gold. Ebola survivors who were also interviewed by The Telegraph shared that they did not know their blood was being used for research.

In the last year, French scientists have come under fire for suggesting that a potential vaccine for COVID-19 be tested in Africa first and researchers have been “puzzled” as to why there have been low COVID-19 case numbers and fatality rates on the continent. The medical landscape remains largely uneven today, similarly following colonial dynamics of medical access and quality care. Worsening vaccine apartheid, private companies such as Moderna, Pfizer, AstraZeneca, and Johnson and Johnson refuse to share their vaccine recipes; countries hoarding unused vaccines are reluctant to share their stockpiles; and the World Trade Organization has repeatedly rejected proposals for waiving intellectual property rights to COVID-19 vaccines.

The late Tanzanian president John Pombe Magufuli warned against the Western-developed COVID-19 vaccines in relation to such inconsistencies and concerns of exploitation and experimentation:

“You should stand firm. Vaccinations are dangerous. If the white man was able to come up with vaccinations, he should have found a vaccination for [AIDS] by now; he would have found a vaccination for tuberculosis by now; he would have found a vaccination for malaria by now; he would have found a vaccination for cancer by now…Tanzanians must be mindful so that we are not used for trials of some doubtful vaccinations which can have serious repercussions on our health.”

Magufuli asked Tanzanians to be vigilant, further noting that “they will experiment on us and that will breed detrimental effects,” and that “not every vaccine is relevant or beneficial to our country.” He made a parallel request of the Ministry of Health to not rush into accepting vaccines without their testing and total satisfaction with the safety and efficacy of said vaccines.

Magufuli’s comments and both the official and unofficial deaths from COVID-19 in Tanzania are not to be excused or trivialized. His anti-colonial stance can be understood in the context of medical colonialism and the damaging effects of structural adjustment programs on the healthcare systems of many African countries, including Tanzania. Relatedly, Magufuli has disrupted the strong grip Western-owned and operated corporations have had on the industries of big agriculture and mineral mining in Tanzania, bringing attention to how Western agencies continue to extract capital from Tanzania on unequal terms. Notably, there are overlaps between the Western institutions and interests Magufuli has rejected during his presidency in the spheres of foreign-owned monopolies, research, and COVID-19 prevention, with the Bill and Melinda Gates Foundation being a key connector. The majority of vaccination campaigns in Tanzania since the 1970s have been, and continue to be, heavily funded and supported by Western interests where Global South nations hold little to no sway, such as in bilateral and multilateral agencies like the United States Agency of International Development (USAID), Global Alliance for Vaccines and Immunizations (GAVI), World Bank, and World Health Organization (WHO) among many others.

Such imbalances in the recommendations and funding of health interventions are also represented in what is considered an epidemic—”within the country, among the people”—and a pandemic—“of all the people,” and of the world. The question of what is considered an epidemic instead of a pandemic is a political one, and it is one that implies a hierarchy of lives.

During the H1N1 pandemic, the WHO answered the question “what is a pandemic?” in a single sentence: “a pandemic is a worldwide spread of a new disease.” Arguably, the classification of HIV/AIDS, TB, and malaria as epidemics should be those of pandemics. By the end of 2019, 690,000 people died of HIV/AIDS; 1.4 million people died of TB; and 409,000 people died of malaria. In making such distinctions about scale, spread, and temporality, decisions too are made about whose borders count and whose lives are considered to be affected anew. The reaches of HIV/AIDS, TB, and malaria are international, and these diseases are new with every patient’s first diagnosis.

Taking this all into account, what is perceived to be culturally-influenced or ignorant decisions to not pursue COVID-19 vaccinations as an individual or as a nation not only has historical and political precedents, but also contemporary and political presents. This is not to argue for weak health system responses. Instead, it is to better understand the context in which such decisions are made. “Anti-vaccine” sentiments in Tanzania are not positions against getting vaccinated from COVID-19, but are rather positions of ensuring that COVID-19 does not become another weapon for surveillance, stigmatization, and the differentiation of developing countries from developed ones along (neo)colonial fault lines.

The etymological root of the word “truth,” the suffix deru, means to be “firm, solid, and steadfast.” “Contested,” from the Latin contestari, is “to call to witness, bring action,” with “com” being “with, together.” Meditating on this series’ title, “Contested Truths,” we ask: who is being called to witness, to stand firm, and to action during the COVID-19 pandemic? Who is being called upon to suffer, and who has the burden of proof?

Tom Nyalile is a Tanzanian citizen pursuing a PhD in Biomedical Sciences at the University of Massachusetts Medical School where he studies the molecular virology of HIV-1 and SARS-COV-2 viruses. His primary research focuses on understanding and re-engineering host restriction factors of HIV-1. Secondarily, he studies SARS-COV-2 spike variants and deciphers what drives their infectivity from a biochemical and structural perspective. @tom_nyalile

Leanne Loo (she/her) studies Anthropology and Women’s, Gender, and Sexuality Studies at Tufts University. Her research and organizing are centered in abolition, decolonial feminisms, and transnational solidarity. She is broadly interested in how power operates and how narratives are produced, reproduced, and silenced, with specific attention to imperializing narratives of disease and contagion. @leanne_loo


[1] Including, but not limited to, the Council on Foreign Relations, the World Peace Foundation, Bloomberg, Kaiser Health News, Deutsche Welle, Devex, Africanews, World Politics Review, and Africa is a Country.