**2. Vaccine Resistance in the Developed World versus Vaccine Resistance in Africa and the Legacy of Colonialism**

When the first wave of COVID-19 hit Britain in early 2020, clerical responses were generally measured. The leaders of the Muslim community, the Church of England, the Hindu faith, and the Jewish diaspora all advised their adherents to follow the government's public health guidelines according to which government did not mandate the closing of places of worship, but left the decision on how to proceed to national organizations and local clergy. Government policy supported *prima facie* the practice of worshiping privately at home, reducing the risk of exposing oneself or others to infection, but allowing communities to make judgment calls about worship and attendance policy. (The Guardian 2021). By contrast, the leader of the Roman Catholic Church in Britain, Cardinal Vincent Nichols, despite broad support for mitigation efforts on the part of Roman Catholic leadership, opposed any limits on attending services. Cardinal Nichols claimed that there was no evidence that such a measure would control or restrict the spread of infection. As the progress of the pandemic advanced and vaccine development and deployment took center stage, many Catholics objected to those vaccines that may have used fetal stem cells in their development, despite a later statement from the Pope that objections on this ground were unfounded and that the Curia fully embraced vaccines (Ellis 2022).

India's government responded with alacrity to the pandemic's onslaught, progressively embracing border controls, social distancing and ultimately lockdown. The eventual vaccination rollout was severely hindered by high VR in many parts of the country, spurred mainly by beliefs in the power of local deities and the convictions that "folk remedies"

were superior to vaccines. In many Hindu districts there remains a strong belief that the products of the cow (particularly its urine and feces) are sufficient, when consumed or used as an emollient, to ward off all infections (Daria and Islam 2021). In one remote area, villagers refused the vaccine because the local deity had expressed, via the mouthpiece of a "possessed" woman, disapproval of the vaccine. In another area VR was manifest in the widely held belief that anyone who worked outside in the sun was immune (Jaswal 2021). Attempts to enforce lockdown also resulted in raised communal tensions between Hindus and Muslims (Naqvi and Upmanyu 2022).

The United States provides an interesting case study in the complexities, confusion, and inconsistencies surrounding vaccine policy and ambivalence of vaccine acceptance. On the one hand, the leaders of virtually all major religions in the United States endorse COVID-19 vaccination, including Catholics, Protestants, Mormons, Buddhists, Jews, and Muslims. According to Pope Francis, receiving the vaccine was 'the moral choice because it is about your life (and) the lives of others' (Ellis op.cit.). The only American religious denominations known to officially oppose COVID-19 vaccination are the Dutch Reformed Church and Christian Scientists, whose members object on the ground that it interferes with divine providence (Wingfield 2021). In spite of a fairly unified voice and ethos in support of vaccination, the United States, for its part, has led the world in chaotic responses to the pandemic. This noted, the US federal government "offered surprisingly little effective response to the pandemic", something exacerbated by the failure of the Trump administration to take the advice of infectious disease experts. When the Biden administration came to power "infections and deaths [had heavily impacted the entire country]. A vaccination program had been started, but was poorly coordinated, resulting in far fewer vaccinations delivered . . . than the initial goal" (Elflein 2022). Add to this the high resistance among evangelical republican Christians to taking any protective measures against infection, including when gathered together in congregation under anti-mask and -vaccine preachers—'*You will not wear masks in this church. I'm telling you right now, do not get vaccinated*' (Pastor 2021)—and you have one explanation for the United States having among the world's highest COVID-19 fatality numbers (Locke 2021; Mansfield 2017; Smith 2016; Hall et al. 2010).

Bolsonaro's Brazil, led by a demagogue in many ways similar to Trump in his disregard for scientific evidence, has suffered from a similar, almost mirror-like trajectory of arrogance and negation of duty in its leader, making Brazil second only to the USA in the global deathtoll (the third highest is India) (Kibuuka and Gordon 2020). To be sure, certainly in the early going phases of the pandemic, and arguably still, the countries with the least excuse to shun science have had the most spurious results, and their leaders are in no position to preach. If four of the world's greatest, most economically advanced, functioning democracies have a fractured response to such a situation, how can we expect other countries to fare any better? In some ways, democracy can be its own worst enemy in the battle to gain vaccine acceptance. Religious freedom and the devolvement of power, especially in federated and parliamentary countries such as the United States, Great Britain and India, has given the proponents of VR a free hand to do their worst. Likewise, countries such as Russia, China and Japan—highly conformist societies with rigid power structures and social hierarchies have also had to deal with a history of vaccine refusal, and they have not yet managed, for all their power, to suppress dissent (Galpin 2021; Cooper 2022; Yoda and Katsuyama 2021). It seems that VR is an ever-present factor in all types of society.

In this light, it is useful to set up a contrast between two contexts of VR, one where power and advantage counterintuitively work against nations with resources, and another where a relative absence of power and influence, perhaps less counterintuitively, provide a kind of narrative, if not justification, for refusing the vestiges of paternalism and colonialism, even those parts of colonialism which contain good. Sadly, many African countries contribute to a reality that Africa almost exclusively dominates the club of the world's least-vaccinated polities (Chakamba 2021). Two important studies, for example, show that confidence in vaccines was lowest in the world in the Democratic Republic

of Congo (DRC) (Ditekemena et al. 2021; Kabamba et al. 2020). At the same time, it is somewhat specious to make direct comparisons between Africa and the developed world, as nowhere in the developed world have governments refused on principle to implement a vaccination program for COVID-19 (whether by incorporating vaccine mandates or merely by committing sufficient resources to making vaccines accessible.) By contrast, four African countries, Tanzania, Eritrea, Burundi and Madagascar, have done both of these things (though all but Eritrea had, by 9 December 2021, decided to accept COVID-19 vaccines after all) (Chakamba op.cit.).

Tanzania refused them because, in the opinion of the Tanzanian Ministry of Health, the efficacy of the vaccines on offer had not been fully verified (Makoni 2021), doubling down to assert that the developed world's drug companies would likely use Tanzanians as "guinea pigs" (Chakamba, op.cit.). Eritrea rejected vaccines on the grounds that it did not want to become a "dumping ground" for vaccines unwanted in the West (Zere 2020). Burundi claimed that its hygiene measures were sufficient to control the outbreak (Ayandele et al. 2021). Madagascar rejected vaccine programs on the grounds that vaccine efficacy had not been proven, and that the many side-effects vitiated vaccine effectiveness (Oduor 2020). Among African countries, it is routinely believed that Western, developed, "white" countries—not only the old colonial powers (Britain, France, Portugal, Belgium, Germany and Italy), but also post- or neo-colonial powers (particularly the United States)—have used Africa as a laboratory for new drugs, and Africans as guinea-pigs (Hotez 2018). For these historically relevant reasons, centered around a shared memory of colonialism, Africa was already a hotspot of resistance even before the vaccination campaigns got underway.

Whether one interprets such resistance as "ignorant", or more as an understandable reflection of being turned off by outside, top-down (even if "benevolent") paternalism, there is, either way, a problem in need of solving, but one that cannot be solved without a fresh and dialogical approach. In the same way that African-American communities were resistant to admonitions on the part of clinicians and public health officials to vaccinate when Pfizer and Moderna first announced their "miracle remedies", living in the wake of such human-subject atrocities as Tuskegee, African nations, particular those whose independence was more recent, were not so eager to take orders again from those who had betrayed them in the past. It will be helpful to separate and examine some of the components of a paternalism, perhaps well intended, which contribute to VR in the African context.
