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Background

To end the COVID-19 pandemic, billions of doses of vaccines will need to be distributed around the world.
However, the challenges associated with the global vaccine rollout go far beyond the widely discussed needs for cold chain storage, air freight distribution, and a massive supply of needles and vials. One of the biggest hurdles in reaching the world’s most vulnerable people will be pervasive mistrust in the government agencies that will play a central role in implementing vaccination campaigns. Vaccine hesitancy that is driven by mistrust in public authorities is particularly acute in fragile and conflict-affected settings, in which long-standing corruption and abuse of power are the root causes of widespread political grievances and legitimacy gaps.

The process of rolling out a COVID-19 vaccine will be protracted, particularly in the world’s poorest countries. While there are concerted global efforts that are working to accelerate equitable access to vaccines globally, continued public health measures will be needed in the world’s most fragile contexts over the next several years to prevent recurring waves of disease spread and the emergence of new vaccine resistant strains. Even where public health measures are successful at curbing COVID-19 infections and deaths, a prolonged pandemic will further lengthen and intensify secondary impacts on conflict, food insecurity, inequality. At the same time, “pandemic fatigue” will continue to grow, particularly among communities for whom COVID-19 is a distant and abstract threat relative to myriad challenges that they face on a daily basis related to health, security, hunger, and livelihoods.

In communities that have had few positive experiences with government service delivery, this gap between prioritization of COVID-19 prevention measures by governments and grassroots-level lived realities will further intensify community mistrust in authorities. When community members hold pre-existing beliefs that the government is ineffective or actively malicious, it may be easier to believe disinformation COVID-19 and the vaccine than it is to accept that government and international actors are working to address a real problem. 4 By the time that vaccine campaigns reach communities in fragile and conflict-affected contexts, there is a very real risk that compliance with public health guidelines will be low and vaccine refusal will be high, further prolonging the spread of the virus and fueling protracted waves of conflict and economic disruption.

In order to break this vicious cycle, it is necessary to overcome the trust deficit between communities and the actors who will be leading vaccine rollout. Building public trust will require an enormous, united effort from governments, public health experts, humanitarian groups, civil society organizations, the private sector, and local community leaders. This will require deep and inclusive community engagement to build trust in the actors that will be distributing the COVID-19 vaccine. It will also entail improving the trustworthiness of government agencies by directly addressing the gaps in accountability, inclusion, and effectiveness of service delivery that fostered mistrust in the first place. When linked to ongoing governance and peacebuilding programs focused on strengthening state-society relationships, these types of investments in trust-building for the COVID-19 vaccine rollout have the potential to lay the groundwork for broader transformation of fractured state-society relationships that are an important root cause of recurring cycles of violent conflict in fragile contexts.

This report collects evidence from past vaccine rollouts and examples from programs implemented by Mercy Corps during the COVID-19 pandemic and other public health crises to highlight drivers of mistrust in efforts to distribute vaccines in fragile and conflict affected settings. The core takeaway from this review of evidence is that donors must invest in inclusive community engagement alongside the global vaccine rollout, to ensure a swift end to the pandemic and its associated impacts on conflict, food insecurity, and inequality. Existing evidence indicates that this can be achieved through interventions that: (1) facilitate inclusive planning by communities, (2) train government agencies on the skills and values needed for vaccine rollout, and (3) build equal partnerships with local civil society organizations and community health workers.