The detection of the Omicron variant in Africa signals the next stage of the battle against Covid-19, which is getting many more people inoculated in poorer nations in order to deter new mutations from developing.
The experience of South Africa, at least, hints at a far more complex set of challenges, which is why world leaders sometimes talk about this as if it were a matter of delivering doses overseas.
South Africa was made to wait months for vaccines as wealthier countries dominated them. Many countries don't have enough to inoculate their populations.
As shots began arriving in greater numbers, the problems did not end.
Storage and staffing problems are common in rural areas, where neglected and underfunded public health infrastructure has slowed their delivery.
There are growing signs in parts of Africa, as well as South Asia, that skepticism or outright hostility toward the Covid vaccines may run deeper than expected, even as the new and possibly more dangerous Omicron variant is spreading. Omicron cases have been reported in three countries in Africa.
distrust of governments and medical authorities may be stalling out vaccination drives The legacy of exploitation and medical abuses during and after colonization is weighing heavily.
Some of the misinformation on social media is from the United States and Europe, where vaccine refusal has been an issue.
The Africa director of the World Health Organization said that vaccine hesitancy is a factor in the roll out of vaccines. She said that news or rumors of potential side effects get picked out and talked about, and some people become afraid.
South Africa turned away shipments of doses from Pfizer-BioNTech and Johnson & Johnson because they were worried that their 16 million shots would be in short supply.
The deaths of Muslims in South Africa during the Pandemic were noted.
According to government statistics, only 36 percent of South African adults are fully vaccine free.
It is not limited to South Africa.
According to several health officials involved in the effort to distribute vaccines to developing nations, vaccine manufacturers and donors have been asked to hold off on sending more shots because they can't use the supplies they have.
Public distrust and vaccine distribution can increase vaccine hesitancy. The issues have been more prevalent in poorer countries during the Pandemic.
Public messaging campaigns and carefully orchestrated vaccine deliveries are in short supply.
Almost no investment in vaccine education or promotion has gone into low-income countries. People will come running to the airport to get the vaccine if we just drop it at the airport.
According to the World Health Organization, only one in four health workers in Africa are protected from vaccine-related diseases. Less than half of people in several countries plan to get vaccine.
It's not a problem only for Africa.
In India, health workers have faced resistance. The vaccine hesitancy rate is 50 percent among those who have not finished high school. More than a third of the doses in some parts of the country are ruined.
Many people are eager to be vaccine free. In South Africa, a third of the country's adults got inoculated when the first doses were widely available.
The New York Times has a story about a covid vaccine.
The young woman said that Covid is not real. They are playing with everyone.
Many people fear side effects.
South Africa delayed the roll out of the Johnson & Johnson vaccine after the United States temporarily paused delivery due to reports of rare blood clot. Both countries decided to resume the shots after they were safe.
Most South Africans don't speak English as their mother tongue, so the government in South Africa used to hold regular briefings in English on television and on radio.
People in South Africa are receiving Covid-19 tests.
There are millions of people who do not have regular access to the internet.
The president's spokeswoman was forced to step down due to corruption scandals. The health minister resigned after his office was found to have cheated.
The racial divide is a factor.
A recent study found that white South Africans are more likely to be skeptical of vaccines. The distrust of the Black-led government is part of the reason for the wide reach of American Covid racists on social media.
There was a vaccine protest in Cape Town.
Black South Africans are less likely to bevaccinated at lower rates due to difficulty getting to vaccination sites. Some people are hesitant about getting a second shot.
Card 1 of 5.
There are a lot of regulations. The scattershot approach to coronaviruses containment was exemplified by the two flights from South Africa. At least 14 people had Omicron when they tested positive for the virus.
There is a new type of treatment. An expert panel voted to recommend that the F.D.A. authorize a Covid pill from Merck for high-risk adults, the first in a new class of antiviral drugs that could work against a wide range of variant, including Omicron. The pill could be available by the end of the year.
There is vaccine hesitancy in Africa. The next stage of the battle against Covid-19 is getting more people inoculated in poorer nations, after the detection of the Omicron variant in Africa. The new hurdle is overcoming local skepticism or hostility.
Health experts say that vaccine hesitancy indicates that some of the drivers predate the Pandemic.
Health resources are often hard to come by in rural areas. Doctors from the capital or abroad are often involved in vaccinations. Communities are distrustful of outsiders due to histories of neglect and exploitation.
In parts of Africa and Asia, the first modern, worldwide campaign against smallpox provoked deep skepticism because it was seen as a continuation of colonial-era medical abuses. Some W.H.O. officials used force to get people to take the vaccine. The campaign took a long time.
The effort to eradicate the disease, which was finally achieved in poor countries in the 1980s, has run into resistance. The study found that vaccine avoidance was highest among poor or marginalized groups, who believed that the health authorities would never help them.
In Nigeria in the early 2000s, there were rumors that foreign health workers were using the vaccine to wipe out the Muslim population. Cases of the disease spread to 15 other countries as a result of boycotts and local bans.
A nationwide push to inoculate every child under the age of 5 in Nigeria took place in 2005.
The rumors of a rise in the number of cases of the disease among India's Muslim minority were similar.
The health authorities may be paying the price for exploitation before and after colonization that made them distrust Western medical authorities. A survey by the Africa Center for Disease Control found that 43 percent of those surveyed believe that Africans are used in vaccine trials, a legacy of the 1990s.
Western governments are struggling to overcome vaccine resistance. It's hard to imagine them doing better in societies where they don't have local understanding.
Any appearance of Western powers forcing unwanted vaccines into African or Asian arms will cause a backlash.
If the goal is to keep the U.S. safe, then the success of the domestic program depends on what happens internationally.
Health care workers are waiting to receive a vaccine.
Walsh was reporting from Nairobi.
