JOHANNESBURG (BLOOMBERG) - As if the struggle to secure its meagre supplies of Covid-19 vaccines was not bad enough, Africa is now having a hard time getting people to take them.
Only 5.22 million people in Sub-Saharan Africa - a region with a population of about one billion - have been vaccinated.
From suspicions about China-made vaccines in Zimbabwe and conspiracy theories in Ivory Coast about Covid-19 being "a planned event by foreign actors" to Somalia, where the Islamist militant Al-Shabaab group is warning people they are "guinea pigs" for AstraZeneca, large sections of Africans are steering clear of vaccines.
Only about 17.5 per cent of the doses available in Ivory Coast and 19 per cent in Zimbabwe have found their way into arms.
Already lagging behind the rest of the world in its inoculations, the wave of vaccine scepticism - made worse by a lack of trust in local governments and misinformation on social media - threatens to put the continent even further behind.
"There's a lot of fear and suspicion surrounding the vaccines," said Mr Salomon Sadia Koui, a 32-year-old nurse who waited for people to turn up at a white vaccination tent at the Parc des Sports de Treichville in Abidjan, Ivory Coast. "Women ask if the shot will make them sterile. They believe it's a way to control the population because Africans have too many children."
Vaccine hesitancy is standing in the way of efforts by African governments to head off successive waves of the virus.
A prolonged pandemic will delay the continent's recovery, already forecast by the International Monetary Fund to be the slowest region to revive. It will also provide a fertile breeding ground for virus variants that are reducing the efficacy of some of the vaccines used in the rest of the world.
The reluctance to be inoculated comes as the relentless pace of deaths from the pandemic continues unabated. Having claimed more than three million lives across the globe since it emerged in 2019, the virus' burden is increasingly being borne by some of the poorest places on the planet.
Africa is relying primarily on the AstraZeneca shots supplied by Covax - the initiative backed by the World Health Organisation, the vaccine alliance Gavi and the Coalition for Epidemic Preparedness Innovations to offer doses cheaply to developing countries.
The programme has delivered about 11.5 million doses to Sub-Saharan Africa. In addition, Zimbabwe, Cameroon, Senegal and other countries have received doses donated by China, Russia and India.
Even as vaccines start to trickle in, a deep distrust of government is becoming one of the biggest obstacles medical authorities face.
"A majority of Nigerians do not believe the disease is as serious as the federal government is trying to portray," said Dr Ifeoluwa Asekun-Olarinmoye, a public health lecturer and epidemiologist at Babcock University in Nigeria.
In Ivory Coast, a survey by the Africa Centres for Disease Control and Prevention (CDC) showed that two out of three Ivorians feel the threat from Covid-19 is exaggerated. More than two-fifths believe the disease was planned by "foreign actors", Africa CDC said in February.
One of the world's first countries to receive shots from the Covax initiative, Ivory Coast is barely using the doses, having inoculated only about 94,800 people, or 0.4 per cent of its population. Elsewhere, the disease is seen as a scheme by the elites to profit.
"When international organisations and donor countries started announcing their intention to pump in financial assistance, Cameroon announced its first case," said Mr Fidelis Mbawah, a postgraduate student in Yaounde, the country's capital. "This is a ploy to make money."
It does not help that the official numbers for Africa are relatively small, registering just 4.43 million cases and 117,890 deaths, a fifth of the number of people who have died in the United States alone.
Anecdotally, however, poorly equipped hospitals across the continent have buckled under the strain of people infected with the coronavirus. Testing is sparse and accurate record keeping is rare.
In South Africa, the continent's most developed nation, the number of excess deaths is triple the official tally of almost 54,000, and scientists say they are almost all due to Covid-19.
That has not helped the case for vaccination. In Zimbabwe, a country plagued by poor governance and economic collapse for two decades, the barrier that hesitancy presents is particularly stark. A March survey of 561 people by the Zimbabwe Christian Alliance showed 75 per cent were unwilling to be vaccinated.
The source of its supplies, China, inhibits many from taking the shots. The ruling party, in power for all 41 years since independence, has had a close relationship with Beijing since a liberation war in the 1970s. Anti-China sentiment has risen in tandem with antipathy towards the government.
Teachers are "concerned and suspicious, more so since the vaccine came from China", said Mr Takavafira Zhou, president of the 200,000-strong Progressive Teachers Union of Zimbabwe, whose members are eligible for the shots in the first inoculation phase. "Very few are willing to be vaccinated."
Of the 1.635 million doses that have arrived in the country, just over 311,900 have been administered, with the daily number inoculated falling to as low as 140 on March 10.
The low numbers are in spite of government efforts across Africa to encourage citizens to get vaccinated.
Politicians in South Africa, Zimbabwe and Nigeria have been among the first to receive shots and both Christian and Muslim leaders in Nigeria, Africa's most populous country, have publicly taken vaccines.
In Ivory Coast, the government mounted social media campaigns such as Facebook Live events, and in Zimbabwe, the Health Ministry has used animated videos on Twitter to urge citizens to visit inoculation sites.
The continent's health leaders say they are confident the roll-out will eventually succeed.
"There's an element of fear, which leads to misinformation and can make the population reluctant to accept a vaccine," Dr John Nkengasong, director of the Africa CDC, said at a March briefing. "As people receive their vaccines this will shift. When they see people they know receive the vaccines this will hopefully lead to an increase of people who are willing to get vaccinated."
Many front-line health workers are less sanguine.
"We fear that people won't accept the vaccine when it arrives here," said Ms Jean-Marie Kongoue, a nurse in the northern Ivory Coast town of Odienne. "Some people can't read and don't follow the news. They listen more to friends and family who tell them not to get the vaccine. Others don't believe the virus exists."