3.1. National Epidemiological Results on COVID-19 Cases and Death
From the start of the epidemic in March 2020 until October 2021, 79,861 confirmed cases of COVID-19 were recorded in the national database. The median age was 35 years, with an interquartile range of 23 to 40 years. They were mostly adults, with the most represented age group of 30 to 49 years comprising 38.3% followed by that of 50 years and over.
In a total of 76,434 confirmed cases in which the sex was known, it appears that the men were more affected than the women, with 54.6 % and 45.4 %, respectively, yielding a sex ratio of 1.2. Among affected women with COVID-19, 0.4% were pregnant.
Out of 50,580 cases whose evolution was recorded, 1232 deaths were reported, with a case fatality rate of 2.4%. The risk of death was slightly higher in women than in men, with an OR of 1.135 (CI: 1.012–1.274). Regarding age, 71.4% of deaths occurred in people aged 50 and over. The probability of death was 4.6 times higher in the elderly, and this difference was statistically significant (p = 0.001). Case confirmation could be made in 482 people who died at the time of notification, accounting for 0.8%.
3.9. Qualitative Analysis Result
Some informants identified themselves as being anti-COVID-19-vaccine and explained several reasons, including doubts about the quality or safety of the vaccines: “You must first know if the content of the vial is really a vaccine against COVID-19”; the fact that COVID-19 remains a disease of the “white”; “That they should not force Africans to get vaccinated when the disease kills white people much more”; and the fact that the vaccine is perceived or presented as being an obligation: “I am against an imposed vaccine”.
Another reason was the fact that there is a multitude of vaccines on the market: “The COVID-19 pandemic is real but the real problem arises with the variety of vaccines”; and “The efficacy difference in percentage of vaccines and different names generally creates doubt in people, especially women”. According to them, women are more insightful than men: “We women have much more wisdom in decision-making. One problem already has several vaccine proposals in such a short time, why? Let the people in charge of those vaccines first agree on one, do some testing and release the results over time, and then we’ll see”. Other informants finally suggested that there are alternatives to the vaccine: “It would be better to use naturopathy, to overcome this pandemic:” “Do not take any vaccine, take Ekouk and Mfol, it is effective”.
A few participants had no suggestions to share, either because they had no idea about it or because they felt it was a personal decision: “I have no advice for them. Everyone is free to engage in it or not”. Others, because they themselves are against the vaccine, stated: “For common vaccines, I can agree. But for COVID-19 I cannot encourage people even less women because, they are responsible for lives and their security”.
The people who were pro-COVID-19-vaccine thought that the vaccination of women should be obvious because: “For me, women are more vulnerable because of their fragility”; “She must protect herself and those around her since women remain at the center of many activities”. One respondent, however, underlined the incongruity of the question because according to him: “There is no difference for me, the same actions must be carried out in both sexes”.
Some respondents have suggested that we could improve the vaccination acceptance and uptake by ensuring their reliability through the implication of African companies in the manufacture of the COVID-19 vaccine, or by manufacturing vaccines for young people and pregnant women. They stated that we could also: “Distribute the same vaccine throughout the country’’ and ‘’ Introduce COVID-19 vaccine as routine vaccine”. This means “We can take advantage of pregnancy to let them be vaccinated”. It must not be forgotten to “Bring the vaccine closer to the population, in other words create more vaccination centers even in the neighborhoods”. Because: “The vaccination team does not cover a tenth of health areas”.
They stated a need to support vaccination; that is, “Provide financial motivation for vaccination. “They also stated a need to think about ways to:” Make compensation commitments in case the side effects exist”.
To improve women’s adherence to COVID-19 vaccination, some informants believed that it was necessary to: “First gain men’s confidence in the admissibility of globally credible and acceptable vaccines”. As an appropriate solution to implement, the majority identified “sensitization.’’ They also identified “Communication”. For upstream solutions, participants stated that: “We must first identify the reasons for their refusal and after that it will be easier to carry out campaigns to raise their awareness”. In order for women to be more receptive, it would be necessary to: “Engage female leaders at all social levels”. Therefore, “We need to develop better communication on COVID-19”. This can be presented in several ways: “Proximity sensitization”; “Targeted sensitization”; “Door to door sensitization”; “Community sensitization”; “Educational meeting”; and “Put the posters everywhere”.
More specifically, it is: “The need to make them understand that the vaccine is for both sexes and has no negative effects on women”; “Famous women who received the vaccine should communicate strongly about it” and “They need role models”; “Make videos with more actresses that show the benefits of the vaccine and develop messages that contradict the fake news about vaccination”; “Raise awareness, testify, remind people of the benefits of vaccination, give the right information on the risks on fertility, procreation, breastfeeding, etc.”; “I have published my photos of the vaccine action in associations and meeting, I do with my neighborhood comrades. I made them aware of vaccination benefits”; “Get closer to women’s associations, community meetings for women, put women at the front of the business”; “Good communication and essential messages with community leaders, religious, influencers and extend to all women layers”; “Focused sensitization and health education. Encouragement and no attempt at all at coercion or obligation. Government has to increase opportunities for sensitization of women and general public. But also, we have to be honest and produce very credible and convincing reports on how we have used COVID-19 funds, because this issue of mismanagement of COVID-19 funds has come to embolden earlier suspicion that there is no COVID-19 and that government is using it to get money from Europe and America and from monetary organizations”; “Raise awareness of the importance of the vaccine and reduce beliefs that the vaccine is harmful or lethal”; “Organize sensitization sessions in health facilities, in places of gathering (places of worship, markets, etc.), explain to men the need to have their girlfriends, wives, sisters, mothers, etc. vaccinated”; “deny fake news from the social media”; and “Strengthen pre and post vaccination counselling”.
“We recognize the good tree by the sweetness of its fruits, if we realize that the vaccine really protects with contamination drop in vaccinated countries like Israel, sensitization will be easy and convincing.” Statistics from good model countries such as Israel might just as well be convincing. However, the most drastic measure is to: “Make vaccination compulsory”.
In response to the second question of how to use social media to improve vaccine confidence and vaccine uptake, a few informants had no knowledge to share. Other respondents shared their doubts about the feasibility of this project: “Very difficult because we find too many rumors in social media”.
Some people thought that social networks are not suitable for impacting the population: “The media and Radio Stations are great sources of manipulation. The population has already understood it, that is why you will always see thousands of likes but few acts. “But according to some people, Social networks should rather help to sensitize people on the respect of barrier measures.” To improve confidence in vaccines and vaccine uptake, it is important that people: “Do not avoid the mistakes of scientists. One dose, two doses, three doses. Vaccinated people who still get contaminated by the disease etc.”.
Social networks are important channels of communication and networking between communities, and to use social networks in improving confidence in vaccines and vaccine uptake, informants stated: “Communicate regularly on: the role of vaccines, the advantages of prevention over treatment, the quality of the vaccine, the possible side effects and their management in Cameroon, indicate the vaccination points, schedules etc.”; “Post the comparative reports of a country affected by COVID-19 before and after taking the vaccine”; “By posting videos of people who have received the vaccines, videos that explain the types of vaccine”; “Aggressively invest social networks with messages, videos and images on the benefits of vaccination”; “Encourage more social groups to create their accounts in social media and let the leaders of such groups share their pics on how they already took the jab”; “Make videos from theatres to illustrate the benefits of COVID-19 vaccination and the harms of not doing so”; “By live sessions during the vaccination sessions in the sites and share them”; “Invite vaccinated and infected people to speak at a round table or a health program”; “By using our status to share positive images”; “Take pictures showing people who get vaccinated and who give good testimonials”; “By sending messages to our contacts informing them about the importance of the vaccine, by advertising through leaflets on the benefits of the vaccine”; and “The government itself should have their own specific social media platform, whose duty will be to scan social media for all the COVID-19 vaccine negative propaganda, and elaborate simple, clear, objective and convincing messages, reports, short videos or audios, brief social media slots to disperse the propaganda. To make info available to everybody. Social media is the most followed media today and we must be serious to get on with it”.
It emerges from the respondents’ answers that all communication through social media should be carried out transparently and by professionals, people who have been vaccinated, opinion leaders, or influencers trained for this purpose.
The respondents wished to point out that while social networks are important for information dissemination, professionals should take a closer look at the information circulating: “A lot of rumors and fake-news are disseminated through social networks”. They offered several solutions to this, including: “Set up at all levels, monitoring/listening committees for social networks”; “Strengthen the information system and rumor management”; “To counter information, that is to say deny what has been said with the help of experts in the field”; “prevent doctors and other health personnel who are against the vaccine to give their opinions on TV channels to discourage others”; “The state needs to control all the sterile information that can create social psychosis, if possible, completely suppress social media”; and “why not even punish those who spread fake news of the vaccines”.