Why Some Countries Have Refused the COVID19 Vaccine

By Tinnie Louie & Candela Iglesias Chiesa 

While some individuals have refused vaccines, at the country level, most governments have been scrambling to get vaccines to cover their populations. And yet, a tiny group of countries has (at least initially) refused opportunities to get vaccine doses.

It has been well over a year since the pandemic caused most of the world to shut down. During that time of uncertainty, most countries implemented guidelines for social distancing and isolation to curb the spread of the virus. Businesses were closed, parks were empty, and many people could not visit loved ones. Simultaneously, scientists and researchers scrambled to develop a vaccine against SARS-CoV-2, the virus responsible for COVID19. The quick turn-around for developing, testing and manufacturing an effective and usable vaccine has been mind-blowing. 

While some countries have come a long way in vaccinating their residents to slow the progression of COVID19, the majority do not have enough doses to vaccinate everyone. COVAX, a program co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, and the World Health Organisation (WHO), aims to support low and middle income countries with attaining enough doses to vaccinate 10-50% of their population (2). The goal with this is to achieve the end of the acute phase of the pandemic. Countries that wish to join this program must submit certain documents to become eligible. However, not every country was eager to participate in COVAX. 

Why would a country refuse vaccines, or vaccine aid?

Because of COVAX, most countries have been able to vaccinate at least a small portion of their population. However, there are several countries that do not have any data on vaccine coverage on the WHO website as of the 3rd of July, 2021. These countries include Burundi, Eritrea, and Tanzania, which all reside in East Africa (3). All three countries initially rejected the vaccine (4). 

Information available from news media states that initially, the health minister of Burundi did not believe vaccines were necessary and that the long-term effects were not fully known (5). There is not much data publicly available on why Eritrea initially refused vaccines. Thankfully, Burundi and Eritrea are now in the process of completing the necessary documentation for COVAX eligibility. 

The story of Tanzania has been more closely followed by the media. Tanzania refused vaccine aid until late President Magufuli passed away and current president Samia Suluhu Hassan stepped into office. The Tanzanian government states that President Magufuli passed away from a heart attack, though other political leaders speculate he died from COVID19 complications (6). The late president of Tanzania was skeptical about the vaccine’s efficacy and instead chose to rely on prayer to eradicate the virus. In the same line, the then Health Minister of Tanzania, asked the people to utilise “natural remedies”, exercise, hygiene measures, and herbal steaming to heal from COVID19 infections. The government’s strong religious beliefs played a role in the country’s refusal to make COVID19 vaccines available. Since April of 2020, Tanzania had stopped sharing pandemic data with the rest of the world (4). This has made it difficult for other countries to understand what is truly happening in Tanzania. Fortunately, with the change in the presidency the tables turned: as of 28 June 2021, President Suluhu has expressed interest in joining COVAX, and the government will allow the use of any vaccines listed by the WHO (7), which can mean many lives saved and hospitalizations averted. 

What are the Consequences of Vaccine Refusal?

While parts of the world are slowly returning to pre-pandemic “normal” times due to increasing vaccination rates, the virus, and its variants can spread quickly within countries that have little to no protection against COVID19. The risk for viral mutations increases within an unvaccinated population, and such variants could eventually escape current vaccines (8). This can undermine global efforts in combating the pandemic as countries begin to ease border restrictions and allow residents to travel internationally. Additionally, if the virus spreads rapidly within a particular region, not only are there concerns of increased mortality but also the loss of economic productivity. 

Government officials or leaders that are hesitant about vaccines, can have a truly detrimental effect on their residents’ understanding about vaccines and increase vaccine hesitancy and mistrust. Government institutions have one of the strongest and most effective influences on instilling public confidence in the effectiveness and safety of vaccines (9). 

Additionally, lack of vaccination, especially in medical personnels, can be detrimental to the healthcare system. If too many healthcare workers die due to COVID19, there would not be enough workers to look after the general public’s health. 

It’s thus really good news that these countries which initially rejected vaccines are turning around. Hopefully they will be able to access vaccines soon and start covering their population. 

Let’s just keep in mind that while vaccine hesitancy is one contributing factor to low vaccination rates in some areas, the unfair distribution of vaccines, mainly within high-income countries (HICs) is a much bigger problem. We’ll cover that in another blog post. 


  1. World Health Organization. (2019). Ten health issues WHO will tackle this year. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
  2. Berkley, S. (2020, September 3). COVAX Explained. Gavi the Vaccine Alliance. https://www.gavi.org/vaccineswork/covax-explained
  3. World Health Organization. (2021). WHO COVID-19 dashboard. Covid19.Who.int; World Health Organization. https://covid19.who.int/
  4. Kedzierska, J. (2020). Tanzania, Burundi and Eritrea refuse to join the COVAX program. Development Aid. https://www.developmentaid.org/
  5. Sguazzin, A. (2021, May 20). Vaccine Holdouts in Africa Reject World’s Route to Recovery New Covid-19 mutations are spreading quickly in the least vaccinated continent. https://www.bloomberg.com/news/articles/2021-05-20/vaccine-holdouts-in-africa-reject-world-s-route-to-recovery
  6. Steinhauser, N. B. and G. (2021, June 17). After a Year of Denying Covid-19, Tanzania Orders Vaccines. Wall Street Journal. https://www.wsj.com/articles/after-a-year-of-denying-covid-19-tanzania-orders-vaccines-11623938431
  7. Anami, L., Karashani, B., & Ndalu, D. (2021, June 28). 100 days of Samia: Her moves usher in new era of bipartisan politics, growth. The East African. https://www.theeastafrican.co.ke/tea/news/east-africa/100-days-of-samia-3452986
  8. Moore, J. P., & Offit, P. A. (2021). SARS-CoV-2 Vaccines and the Growing Threat of Viral Variants. JAMA, 325(9), 821. https://doi.org/10.1001/jama.2021.1114
  9. Pilichowski, E., et al., (2021, May 10). Enhancing public trust in COVID-19 vaccination: The role of governments. OECD. https://www.oecd.org/coronavirus/policy-responses/enhancing-public-trust-in-covid-19-vaccination-the-role-of-governments-eae0ec5a/

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