**1. Introduction**

Across the world, the COVID-19 pandemic has elicited responses from all formal religions. From the point of view of public health officials and politicians trying to mobilize an effective counter to the pandemic, these responses have at times been anomalous. Secular authorities trying to deal with the pandemic have often found religious responses to be a mixed blessing. In general, the ruling bodies of all the major religions have fallen in with the policies advocated by their own governments, only to find that, sometimes, as in Britain, India, Brazil and the United States, parishioners go their own way to defy the official and public pronouncements of their church leaders and the state. While many people have duly followed government guidelines as recommended by their religious leaders, those same people are often urged by co-religionists to ignore governmental attempts to impose upon them controlling and perceived arbitrary policies, such as the prohibition or truncating of community gatherings, restrictions on the methods of administering the sacrament, communal singing, or even total lockdowns. This tension has resulted in and contributed to inadequate or failed attempts to contain the pandemic in those regions of the world facing the most pressing public health crises. In this article, we explore the assertion that better communication–including a more diligent attempt to make global ambitions cohere with local norms–represents the most viable chance of reaching those most resistant to mitigation efforts, particularly efforts to implement successful vaccine campaigns.

There are numerous reasons why people refuse vaccines. Refusal often starts with vaccine hesitancy (VH), which has been defined as "a delay in acceptance ... of vaccines despite availability of vaccine services", a state which has been identified by the World Health Organization (WHO) as being one of the ten top obstacles to the success of health initiatives globally (World Health Organization 2019). VH manifests itself irrespective of political boundaries, race, ethnicity and gender, social organization, and level of national development. If left unaddressed, it can progress to vaccine refusal (VR) (Mangal et al.

**Citation:** Davies, Tim, Kenneth Matengu, and Judith E. Hall. 2023. COVID-19 and the View from Africa. *Religions* 14: 589. https://doi.org/ 10.3390/rel14050589

Academic Editors: Andrew Flescher and Joel Zimbelman

Received: 17 October 2022 Revised: 21 March 2023 Accepted: 21 March 2023 Published: 29 April 2023

**Copyright:** © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

2014; Dubé et al. 2014; Byström et al. 2020). In the countries of the developed world, there is a long history of scandals involving drug companies. These incidents have generated significant skepticism among the citizens not only of drug companies, but also of the medical establishment engaged in clinical trials, vaccination campaigns and related activities. Government suspicion is also pervasive, and political institutions and their agents are often seen to be in collusion with the quintessentially capitalistic and Western pharmaceutical industry (Rao and Andrade 2011; Luthy et al. 2012; McIntosh et al. 2016; Jack 2008; Basham and Luik 2012; Jefferson 1998).

In the developing world there is also resistance to such medical interventions. In some settings the negative sentiments and suspicions are shared with citizens of developed nations, but often these attitudes are motivated as well by additional stimuli. These include the beliefs by many people that ancient folk remedies are superior to imported drugs; that drugs imported from the developed world are designed to harm or even kill people; that a certain amount of illness in childhood is good for strengthening the constitution (a view shared by some in the developed world); and that there are good reasons to distrust local medical facilities and personnel. Africa has among the world's highest levels of VH and VR, much of it precipitated by religious leaders who often reject the authority of Western science, medicine, and those who advocate for them. The tragedy of this attitude plays out in some grim statistics: Africa has the highest vaccine-treatable mortality rates for children under the age of 5 suffering from infectious diseases in the world, a figure that accounts for an alarming 40% of the total mortality rate for that age-group, thus making the matter one of great urgency (Bangura et al. 2020).

In this paper, we examine the reasons for the high incidence of VH and VR in the developing world with a focus on sub-Saharan Africa, consider the role that religion plays in this hesitation and refusal, and advance some concrete policy suggestions to improve the situation. We seek to demonstrate that although VR has many underlying causes, and while the conditions giving rise to a need for vaccination programs correspondingly vary greatly from one country to another, common factors can be identified in the reasons that top-down vaccination program planning does not work as effectively as strategies which go out of their way to reflexively look at the culture and context in which such strategies are meant to be implemented.
