Representative image: A vial is displayed containing the AstraZeneca COVID-19 vaccine at a mass vaccination centre in Madrid, April 9, 2021. Photo: Reuters/Sergio Perez
Mohammad Rahmani is not a COVID-19 denier. He wears a mask and practices social distancing. But the 24-year-old software engineer from Kabul, Afghanistan is deeply sceptical of COVID-19 vaccines. Online videos – created in Afghanistan and neighboring countries, then uploaded on social media – have convinced him that SARS-CoV-2 and the vaccine that protects against it are part of a large conspiracy to reduce the global population.
This kind of scepticism is common within Afghanistan, where very few residents even follow basic public health guidelines. Local physicians lament that many people mistakenly believe the COVID-19 threat is already over or that it has been greatly exaggerated. “They fall for rumors like the virus will not affect Muslims,” said Mohammad Sarwar Firozi, a physician and administrator within the Afghan Ministry of Public Health. “There is very little awareness, and people don’t realise that this virus can kill you and is killing Afghans.”
In fact, COVID-19 sceptics could point to the government’s statistics, which suggest just over 2,800 coronavirus deaths have occurred in the country of 38 million people. But the government has likely undercounted; a survey backed by the World Health Organisation found that roughly 10 million people – nearly one third of the country’s population – had been infected with the virus as of last summer. According to Firozi, 40% to 50% of SARS-CoV-2 tests in Kandahar province are coming back positive. The percentage is particularly high for individuals returning from neighboring Pakistan, which is experiencing a new wave of infections.
In February, India donated half a million doses of the AstraZeneca Covishield vaccine to Afghanistan as part of a diplomacy effort. Tragically, not long after making the donation, India suffered one of the world’s worst coronavirus outbreaks, and it is now experiencing vaccine shortages despite being home to the world’s largest producer of vaccines. (“The way to hell is often paved with good intentions,” wrote one former diplomat in The Times of India.) A second, slightly smaller batch of vaccines arrived in Kabul in March through COVAX, the World Health Organisation-backed program designed to distribute vaccine doses to poorer countries.
But a mixture of scepticism and misinformation perpetuated on social media has slowed an already under-resourced vaccination campaign. As a result, doctors and officials contacted by Undark say vaccines that are desperately needed in India may soon expire in Afghanistan. The Afghan government denies this charge. Ghulam Dastagir Nazary, director of the Afghan Ministry of Public Health’s immunisation campaign, confirmed that the country received 500,000 vaccine doses from the Indian government that were due to expire on June 4. “But,” he said, “they have already been utilised.”
“Of the first doses we received, we have so far administered over 80%,” acknowledged a senior health official working on the country’s immunisation campaign. However, he shared an internal tally of available vaccine in one government department alone that showed more than 5,000 doses set to expire on June 4. In addition, the vaccines donated through COVAX will expire on July 15. The health official spoke with Undark on the condition of anonymity out of fear of government reprisal. “We won’t be surprised if they are wasted simply because people are not convinced,” the official said, showing stocks of unused vaccine vials to Undark’s reporter in the Afghan capital.
Afghanistan’s vaccine rollout started out well, said Nazary. The Ministry of Public Health prioritised health care workers, security forces, journalists, and teachers – and demand was huge. But then interest tapered off after reports that the vaccine had been paused in some European countries due to a rare but potentially associated side effect: blood clotting. (The European Medicines Agency has since determined that the benefits of the AstraZeneca vaccine outweigh the risks.)
These legitimate reports of possible side effects soon gave way to misinformation and false rumors, said Nazary, and the country’s vaccination rate “was reduced to almost zero for some weeks.” In response, the government is undertaking a “crisis communication management plan,” he said. The Ministry of Public Health is asking other ministries, as well as the media, for help promoting the vaccine. Immunisation has also been opened to all adults, not just essential workers.
In Afghanistan, vaccination is voluntary, and Afghans must proactively seek vaccination from medical centers. Currently, with vaccine doses from India and the WHO, the country has enough to cover 3% of its total population, said Nazary, but health officials are struggling to administer even this amount to the public. Yet Nazary denied that there is any expected wastage: “We only have 75,000 doses remaining across the country,” he said, and they expire in mid-July.
When Undark showed Nazary photographs of vaccine vials with a June 4 expiration date, he insisted that no such vials exist inside the country. He did, however, say that some wastage is inevitable as part of any COVID-19 vaccine rollout.
The anonymous official who showed Undark the soon-to-expire vaccine doses agreed that some amount of wastage is to be expected because each vaccine vial contains eight to 10 doses and “an opened vial is good only for a very short period of time.” If a physician opens a vial but only sees, say, six patients that day, some of the vaccine will go to waste. But this type of wastage is different from what he’s witnessing in the capital: vaccines at risk of exceeding their shelf life, even before they’ve been opened.
In contrast to the many vaccine deniers in the country, some employees at the various government departments administering vaccines are putting together leftover shots to make whole doses and taking them to their families, the health official shared. “Each vial usually has a little left over even after the 10 doses are administered,” he said. Government employees are combining the leftover drops to create a full dose, then taking it to their families. “They are treating these vaccines as precious lifesavers,” he said. “And that is how it must be, because wasting these precious lifesaving drugs that were gifted to us by India – even though they needed it more – is criminal.”
Firozi agreed: “It would be a grave injustice if these vaccines get wasted, especially when people in the donor country are suffering.” People should be motivated to take these vaccines, and make India’s sacrifice worthwhile, he added. “Not taking the vaccine when you have the opportunity to is an oppression to yourself and the society.”
Many Afghans remain unconvinced. “If the vaccine really works, then why is India giving it away to us for free when thousands of them are dying on daily basis?” asked Ghulam Farooq, a 29-year-old civil servant from Kabul who has also refused to take the vaccine. He reasons that if the vaccine really worked, then India – its largest producer – would not be in the position it is in today.
Farooq’s decision to abstain from the vaccine also arrived from claims of alleged side effects, including infertility and impact on sexual performance. “I am still young and I got married only four years ago. I have two kids and I am planning to have at least a couple of more kids. I can’t risk that,” he explained. “Anyway, this whole corona thing is propaganda by the West.”
These types of conspiracy theories are rife in much of Afghan society, and range from the vaccines being a CIA project to track and target Afghans to a widespread but mistaken belief that the vaccine was made with ingredients that violate Islamic law, a serious issue in the Muslim-majority country. The claims of CIA interference and its resulting impact on immunisation campaigns have a precedent in parts of Afghanistan and Pakistan, where the United States government did, in fact, use a hepatitis B vaccination drive to track Osama Bin Laden.
In an attempt to reach a wider and largely devout Muslim population, the public health ministry has enlisted the help of prominent religious leaders to dispel some of the rumors swirling around the vaccine. “After years of living in conflict, Afghans are susceptible to fake information because we tend to believe the worst,” explained Mauvali Ehsanul Haq Hanafi, a religious leader who had joined the Afghan government’s campaign to spread awareness of the vaccines. “I have come across people with no medical or religious knowledge who are spreading wrong information that the vaccine is haram,” or un-Islamic, he said, adding that their information was based on rumors. (Spreading rumors is considered sinful in Islam.)
Firozi went one step further and blamed rumor-spreaders for the COVID-19 deaths in Afghanistan. “People who are spreading misinformation and influencing others to not get the vaccine are responsible for the lives we lose on a daily basis,” he said. “They will be answerable to God.”
On the first day of Ramadan last month, the Ministry of Public Health enlisted the leadership of the country’s Ministry of Hajj and Religious Affairs to take the vaccines in front of the media to dispel the myth that the vaccine could impact the practice of fasting during the most holy month for Muslims.
As a deeply religious and conservative society, it isn’t uncommon for Afghans to devoutly follow the words of religious leaders and community elders. Hanafi attempts to use his influence to convince the people to take the vaccine by delivering sermons, talking to other religious leaders, and using social media to encourage Afghans to get the shots. He says he is often challenged to respond to misinformation, particularly related to claims questioning the religious soundness of the vaccine. “I once heard from a person saying that the vaccine consists of pork ingredients,” which are forbidden in Islam, he said. “I know there is no evidence to this rumor. Another person believed that because the vaccine is produced by a non-Muslim, it can have a negative impact on a believer’s faith.”
In response, he explains that “the virus does not see if one is a Muslim or a non-Muslim. There is only one thing it targets and that is the human body.” Hanafi says he urges all Afghans, including religious leaders, to stop the spread of misinformation.
The anonymous official blamed the government for creating an environment of mistrust that allows such conspiracies to thrive. “The leadership of the government, specifically his excellency, the president and his deputies, should have taken the vaccine in front of the media in order to convince the people of its effectiveness,” the official said. “Other world leaders did so; that is how you earn your people’s trust.”
Hanafi agreed, adding that the government could have done more early in the vaccine rollout. “They could have used the voice of those who people listen the most to, who will be most effective in convincing people; instead they ran the campaign with artists and singers,” he said referring to the choice of campaign ambassadors endorsing the vaccine. Hanafi believes that employing community elders, security officials, and more religious leaders to address concerns of the community would have been more effective. “It would be grave negligence if these vaccines are wasted,” he added. “Islam is against wasting.”
However, his appeals fail to resonate with those like Farooq, who believes that his faith will protect him better than the vaccine. “I believe that if I survived so many wars, it is unlikely that this corona will kill me,” he said. “I have faith in God, and I know God will protect me.”