The Role of Sudanese Doctors in the United Kingdom in Mitigating COVID-19 Vaccine Hesitancy Among Their Diaspora Communities

Campaign Description

The Sudanese community in the United Kingdom is considered the oldest and among the largest Sudanese diaspora groups in the Global North and includes, according to the last UK census, about 24,000 Sudanese-born residents.¹⁶ It is a diverse community encompassing professionals, academics, and nonskilled workers, as well as refugees and asylum seekers. In January 2021, the UK Branch of the Sudan Doctors Union (SDU-UK) launched a health awareness campaign targeting Sudanese communities in the United Kingdom. The campaign involved live, direct question-and-answer sessions and made use of various social media platforms (Box 1).¹⁷ It also released a series of short videos through a collaborative program between a volunteer-run, UK-based Sudanese television station and mainstream television platforms, which facilitated the distribution of educational materials to a wider audience, including viewers in Sudan (Box 1). Furthermore, a collection of illustrative posters was devised to debunk the myths surrounding COVID-19 vaccination. The posters were phrased in simple language and used the Sudanese Arabic dialect. The SDU-UK additionally combined efforts with refugee organizations to share video material on the benefits of the vaccine. Through the assistance of the Sudanese “Community Champions,” remote question-and-answer sessions were organized for local communities in the United Kingdom with high densities of refugees from Sudan and East Africa (Box 1). These sessions were particularly relevant in light of data showing that refugees in the United Kingdom have become an increasingly difficult-to-reach population for the vaccination program.¹⁸

Involvement of Sudanese Diaspora Doctors

The content of the awareness campaign was produced by expert UK-based Sudanese doctors specialized in infectious diseases, virology, and public health. Involving health care professionals from the same cultural background enables the implementation of educational programs that can conceivably diminish feelings of cultural conspiracy among vulnerable diaspora communities. In scenarios such as global vaccination campaign rollouts, trust involves 2 components: (1) the relationship between individuals and (2) the relationship between individuals and a system. The latter is linked to a long history of structural racism and medical abuses against Black populations,¹⁹ which is often compounded by negative personal experiences with health care systems and providers.^9,19 Hence, among ethnic minority groups with an engendered feeling of mistrust in the authenticity of the vaccine development process, diaspora health care professionals addressing those fears with their respective ethnic communities could readily assist in enhancing vaccine uptake rates.

Approaches Used to Foster Vaccine Acceptance

To promote engagement with the targeted audience, the campaign occasionally adopted an approach of embedding positive vaccination messages within a broad health awareness session, beginning with the provision of general health and well-being advice before moving on to the subject of COVID-19 (Box 2). This approach avoids eliciting anxiety and resistance among listeners and captures their attention. Live-streamed interactive sessions helped break down the perceived complexity of the topic while tackling conspiracy theories surrounding COVID-19 vaccination. Conspiracy theories tend to emerge in the context of social crises, such as pandemics, when uncertainty and collective fear prevail with attempts to psychologically fill in the knowledge gap with a coherent and predictable narrative.^9,10 Therefore, diversification of the speakers, methods, and educational platforms was vital in enabling our campaign to overcome these hurdles. Furthermore, we used constant reinforcement of positive messages to harness motivation among those disinclined to engage in the vaccination campaigns. Our program also included focused discussions on specific demographics, such as vaccinations in children and pregnant women.

Challenges

One of the most challenging aspects of the vaccination awareness campaign was the dynamic evolution of misinterpretations and constant emergence of data regarding the safety and efficacy of vaccines. Such developments demanded close monitoring and a swift response to address false material being promulgated in the media, as well as a high degree of adaptability and fluidity within our awareness campaign for the Sudanese community. We made an additional, peculiar observation—the intercommunication and interactions of diaspora communities with people in their native countries through readily accessible social media platforms meant that any anxieties or misinformation about the vaccines would propagate momentously and spill over from 1 group to the other, despite geographical distances. The similarity in risk perception of COVID-19 among the African diaspora in high-income countries and those living in Africa was documented in earlier studies, raising the possibility that this may also apply to COVID-19 hesitancy.²⁰ Diaspora communities may retain their vaccine-related misbeliefs and concerns from before they immigrated to the host country or continue to be influenced by anti-vaccine campaigns in their native country, particularly those coming from societies engulfed with superstition and anti-science bigotry. Hence, campaign implementers should be aware of the continuous influence on the diaspora by health-related developments in their native country and vice-versa. A similar case was observed among Polish parents in the United Kingdom who appeared to have been swayed towards the rejection of the childhood influenza vaccine by a strong anti-vaccine movement in Poland.²¹ The report on COVID-19 vaccine uptake by South Sudanese diaspora in Canada also broached the notion of their engagement through online networks with families at home spreading misinformation.¹⁴ There is also the potential of cross-exchange of negative anti-vaccine messages between members of diaspora groups with the same background but who live in different host countries. Moreover, misinformation and rumors on social media tend to have a considerable effect on the decision to get vaccinated compared to factual information.²² To this end, our campaigners had to be persistent and maintain integrity in their efforts to combat negative social media influences and promote vaccine uptake.

Our doctors’ union was notably involved in supporting the COVID-19 vaccination campaign in Sudan in its initial phase and providing guidance to local health authorities since the arrival of the first batch of COVID-19 vaccines in the country.²³ Direct collaboration with Sudan’s Ministry of Health and the World Health Organization’s Sudan Office put our health educators in an ideal situation to address the dominant misconceptions for both the Sudanese people in the United Kingdom and in Sudan. In doing so, they had to navigate through 2 social cohorts that were distinct geographically yet overlapping in terms of ethnocultural and epistemic backgrounds.