From rejection to advocacy: How religious clerics helped drive high COVID-19 vaccination in Kano

THE nationally-promoted COVID-19 vaccination campaign in Kano had initially suffered a setback due to an ugly experience with a failed Pfizer vaccine trial in the state and a deluge of misinformation. Today, data shows that Kano has vaccinated 100 per cent of its targeted residents.

In this report, Nurudeen Akewushola examines how religious clerics who were once against the coronavirus vaccine helped to drive high vaccination in the state.


Musa Muhammad, a 25-year-old resident of Kano state, vowed in 2021 to avoid the COVID-19 vaccine after hearing a rumour that someone passed away a week after taking a jab. However, following the sermon of a cleric in the community of  Dawakin Kudu, where he lives, Muhammad changed his mind.  The cleric, Ismaila Haruna took the vaccine during a community vaccination exercise in May 2022, and in his sermons, he began encouraging worshippers also to take their jabs to fortify themselves against the coronavirus.

“I took the vaccine because my cleric was a testimony that it wasn’t harmful,” Muhammad said. “Our cleric, Ismail Haruna, talks about the vaccine in the mosque. He told us how important the vaccine is and how it will protect us against contracting the virus. He also received his vaccine without anything happening to him. I have received two doses of the vaccine.

Musa Muhammad.

“I heard that anybody who received the vaccination would die. But the people I knew who took the vaccine did not die. So, I don’t believe the rumour anymore. I have taken the vaccine, and I’m healthy,” he said.

At the onset of a nationally-promoted  COVID-19 vaccination campaign in Kano, a predominantly conservative Muslim state, there was a notable rejection by the residents of the state. Some religious leaders even propagated misinformation and conspiracy theories, further fueling the mistrust.

Today, though, Kano has witnessed a dramatic transformation. Muslim clerics who previously opposed the vaccine campaign are playing a pivotal role in driving a relatively high vaccination rate in the state.

The influential clerics changed their stance on COVID-19 vaccines after realising the gravity of the pandemic and receiving engagement and sensitisation from community health workers and mobilisers in the state.

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The clerics’ efforts have helped to counter misinformation and achieve increased public trust, leading Kano to become one of the best-performing states in Nigeria in terms of COVID-19 vaccination.

Involving religious clerics

Public appeals were an important step in this process. On May 21, 2021, Kano State Governor, Abdullahi Ganduje, received the second dose of the AstraZeneca vaccine in public, at Government House in Kano. The governor urged the medical personnel, community leaders and religious clerics to make the immunisation campaign a success.

Abdullahi Ganduje, the Governor of Kano State receiving the second jab of COVID-19 vaccine. SOURCE: Kano State Ministry of Health.
Abdullahi Ganduje, the Governor of Kano State receiving the second jab of COVID-19 vaccine. SOURCE: Kano State Ministry of Health.

He pleaded with community and religious leaders to be steadfast in the fight against COVID-19, adding that vaccination was very important and that they needed to work together against the pandemic.

“Your continued intervention in creating awareness among your people will go a long way in making the exercise a success. So also our scholars and other community leaders. You have an important role to play in this exercise and beyond,” he informed them.

The governor’s remarks were rooted in a vaccine controversy that erupted in Kano in 2003. That’s when rumours about the Polio vaccine causing infertility and HIV led to residents boycotting the vaccine. To counter the boycott, a coalition of traditional and religious leaders joined hands with government officials to initiate how to gain public trust and best implement government health policies. The platform serves as an avenue where government health policies are discussed.

Harnessing that 20-year-old coalition structure, the National Primary Health Care Development Agency, which is responsible for developing basic health care programmes and policies in Nigeria, solicited the support of traditional rulers and religious leaders to mobilize people at the community level.

Several symposiums and sensitisation programmes were organised for Muslim clerics and influential Imams of Juma’at mosques to help clear the misconceptions attributed to the vaccine and gain public trust.

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The Imams were enjoined to engage their followers and constantly encourage them after daily prayers, Juma’at sermons and at public gatherings such as naming and wedding ceremonies.

In 2021, a crucial gathering organised by the Islamic Forum of Nigeria brought together hundreds of Imams from mosques for a one-day symposium on the COVID-19 vaccine. The chief Imam of Al-Furqan Juma’at Mosque in Kano, Bashir Aliyu Umar, addressed the large gathering of clerics and told them that Islam urges people to take preventive steps, including vaccines, to stop the spread of disease.

He cited prophetic traditions recommending taking seven pieces of Ajwa dates daily as a shield against diseases.

The campaign also enjoyed the backing of the first-class Emir in the state, Aminu Ado Bayero, a Muslim spiritual leader in Nigeria who also wields a strong influence on the Muslim community in the state. He also issued a special call to mobilise the people to support the vaccination campaign, as the emir urged the residents to avail themselves of vaccination against the coronavirus.

Emir of Kano receiving COVID-19 vaccine. Source: Kano state ministry of Health.

In his speech, which was broadcast across social media platforms and radio stations, Emir Bayero reiterated that the vaccine is real, informing the residents that he has been vaccinated. He publicly displayed his vaccination card to clear people’s doubts.

By late 2021, the Imams of Juma’at mosques started emphasizing the significance of the vaccination in their Friday sermons, everyday conversations, and on radio stations. Consequently, the vaccination rate began to increase. As of March 2022, Kano climbed to the fifth position among the top-performing states in Nigeria, with 1.6 million individuals fully vaccinated and 1.8 million residents partially vaccinated.

Some residents of Kano State, who spoke with The ICIR, explained how their decision to take the vaccine was influenced by their religious leaders during religious gatherings.

Saratu Abdulmalik.

Saratu Abdulmalik, 46, a resident of Gaida Cikin Gari, heard when the vaccine first became available that it could cause infertility. However, after community health mobilisers visited her adult Islamic school, Madarasatul Ulumul Dunniya, Abdulmalik said she shed her fears and felt comfortable enough to get vaccinated.

“I took one dose of the vaccine in November but I haven’t been able to receive the second dose because I was ill. But  I’m looking forward to taking the second dose this month,” Saratu said. “I heard a lot of rumours about people getting various forms of ailments when they took the vaccine, but since when I received the vaccine I have been healthy, so I don’t actually believe the rumours again. All my children are also vaccinated.”

Jafar Aliyu, 68, the Chief Imam of Masjid Ansarul Mikdad Albasu, Kano Municipal, took two doses of the AstraZeneca vaccine together with his family to serve as an example for his followers. Aliyu leads hundreds of community members for daily prayer.

“My lectures have influenced my followers to accept the vaccine,” Aliyu said. “I even brought health workers to vaccinate those who accepted it during the mass vaccination. Though there were rumours regarding the vaccine, people who took the vaccination are living fine without any health complications. Many of them have thanked me for the impact I have made.”

Islamic Cleric, Jafar Aliyu.

Sani Salihu, 30, from Gaida Tsakuwa, Kumbotso LGA of Kano, said his Imam, Mallam Aminu Ibrahim, also influenced him to get vaccinated.

“He told us that we need to take the vaccine to reduce the spread of the virus,” he shared.

“There  were so many rumours that I heard initially. I heard that the vaccine can cause diarrhea, stroke, blindness or disability. But after the talks from my Imam, I was convinced to disregard them.”

Salihu also said that his desire to comply with Islamic tradition also played a role.

“I received two doses of the vaccine around March last year,” he said.  “I wanted to perform Hajj last year and it was part of the requirements.”

Sani Salihu.

COVID-19 misinformation in Kano

Still, once they accepted the vaccine as safe, Muslim clerics faced a challenge because some of them and others had already spread so many false claims at the peak of the COVID-19 pandemic.

Inaccurate information about the virus’s origins, transmission, and potential treatments, promoted by influential politicians, local music celebrities and social media influencers, had significantly influenced people’s perceptions about coronavirus. Besides religious clerics, these actors were also responsible for spreading false information about the pandemic.

In Kano, over 90 per cent of residents are Muslims, and Muslim clerics are highly respected and revered. Their  words are held in high esteem in the state. They strongly influence public opinions and, in many cases, government policies.

The hindrance of community acceptance towards vaccines in Nigeria was not limited to Kano and Muslim clerics alone. Nigerian Christian leaders also shared misinformation during religious gatherings.

Some Muslim clerics in Kano who spoke to The ICIR confessed that they had opposed the vaccines because they had heard false information that Westerners developed the vaccine to induce infertility in women and, consequently, reduce Africa’s population.

Abubakar Abdulsalam, a Juma’at Imam in the Kano metropolis and a top member of the Jama’atil Izalatil Bid’a wa Ikamatu Sunnah (JIBWIS or IZALA), the largest Sunni group in Northern Nigeria, admitted that he and other IZALA clerics changed their views when they realised the truth about the virus’ origins and vaccines’ effectiveness.

“Our stance about the COVID-19 vaccine was not consistent,” Abdulsalam said.

“Initially, when it first started, there were wild opinions and analyses suggesting that COVID-19 is more of a biological war among powerful countries in the world, especially between the Eastern part of the world and certain Western countries. We heard that some powerful countries created the virus in order to reduce our population.”

Islamic Cleric, Abubakar Abdulsalam.

He said it took some clerics suffering through the virus themselves or losing relatives to COVID-19 to persuade them to think differently.

Abdulsalam’s view is that  Islam encourages prevention against viruses and diseases.

According to him,  the religious clerics were excited when they learned about the arrival of the vaccine. But that excitement was dampened by unsettling conspiracy theories that soon followed and were spread on social media clerics read.

“There are allegations that some powerful countries in the western part of the world are trying to use the vaccine to inject some scientific instruments into us so as to collect some essential data that would enable them to control us. That inspired some fears in our minds,” Abdulsalam explained.

He said his views started to shift after government health workers launched their campaigns promoting the vaccination.

Abdulrahman Ishaq, an Imam in Gaidan Cikin Gari in Kano, revealed that he also initially heard that the vaccine could cause death and severe diseases. However, the 65-year-old  clergy decided more quickly to trust in what medical workers were urging people to do.

“I have been fully vaccinated, alongside my children,” he said. “ I took the vaccination with my family so we can protect ourselves against the virus.”

Abdulrahman said as a result of his words of encouragement during Friday sermons, most of his followers have taken the vaccine. “I even invited health workers to administer vaccines for most of them,” he said.

The Genesis of vaccine hesitancy in Kano

Part of the history of vaccine hesitancy in Kano can be traced back to 1996 when the state experienced one of Africa’s worst Meningitis outbreaks ever. On April 3, 1996, a six-member research team from one of the world’s biggest research-based pharmaceutical companies in the United States, Pfizer, arrived in Nigeria. They pledged to tackle the outbreak by testing the efficacy of its new antibiotic, ‘Trovan.’ The drug was tested on 200 young meningitis patients in Kano State.

Among these patients, 99 were treated with Trovafloxacin/Alatrofloxacin, while 101 received Ceftriaxone, the standard treatment for meningitis.

Barely a month later, five of the children given Trovafloxacin died, along with six others who were given Ceftriaxone. Others and many suffered brain damage, were partly paralysed, became deaf or suffered slurred speech.

Even though Pfizer claimed the children’s death was not a result of the drugs, investigations found the company guilty of conducting human trials without informed consent. Questions were also raised over the documentation of the trial.

The devastating result led to a long legal tussle involving Pfizer, the Kano State Government and the parents of the deceased. In 2009, the case was settled out of court. $75 million was paid to the state government and $175,000 each to the families of four of the children.

Today, 26 years after, the incident still haunts some Kano residents and continues to threaten genuine measures towards addressing public health in the state. The incident has made many residents of the state remain sceptical about any form of vaccination – including the polio vaccination in 2003 and in recent times, the COVID-19 vaccine.

As COVID-19 spread globally and vaccine development began,  health experts in Kano state knew they would have to contend with more than patients. Because of a legacy of vaccine hesitancy, residents were inclined to be sceptical of COVID-19 vaccines – one of which was produced by Pfizer.

Ibrahim Musa, a Kano-based public health expert who specialises in epidemiology, believes that memory of  the Pfizer vaccine trial in 1996 was one of the main reasons that Kano residents hesitated to trust the COVID-19 vaccine.

“I believe the whole issue of COVID-19 was misconstrued and misunderstood basically because it’s a new disease,” Musa said.

“Even the world had not have much information about the disease when it came out. Nobody knew the clinical cause of the disease. Nobody knew exactly how the disease evolved and that’s why many people think it’s just a creation in the laboratory. And that’s the major misconception about the disease.”

Musa, who is also a medical doctor at the Aminu Kano Teaching Hospital in Kano, explained that conspiracy theories were also fueled by a few expected side effects that can follow vaccinations.

But he said that health workers have had success in explaining that side effects are normal. He also said that having senior government officials get vaccinated publicly has helped gain trust. “That’s a way of reinforcing the public’s confidence that the vaccine is safe,” he said. “They were able to show that if there’s anything that’s wrong with the vaccine, they wouldn’t have taken it.”

He added that  Muslim clerics’ decision to urge people to get vaccinated has also been crucial.  “Since the time when polio vaccination was resisted, there’s been a mechanism,” he said. “There are forums where community and religious leaders and government officials come together, where issues of vaccinations are properly addressed so that people can benefit from the vaccination. I think that strategy has been working.”

Increase in vaccine uptake 

Data show that Musa’s hunch about Kano’s strategy working is right. The state, which is the most populous state in Northern Nigeria, is now ranked among Nigeria’s best-performing states when it comes to COVID-19 vaccination rates. It has vaccinated 100 per cent of its targeted residents, according to recent data by the NPHCDA.

According to the agency, about 7.9 million people in the state have been fully vaccinated against the virus, with over 3 million partially vaccinated. Experts say that Kano’s vaccination campaigns demonstrably surged after Saudi Arabia required that anyone entering the Hajj, must have a proof that they have been vaccinated.

A community mobiliser and vaccinator at Gwagwarwa Primary Health Care Centre in Kano Municipal, Abdullahi Bakin Ruwa Gawuna, said, “During our house-to-house vaccination campaign, we vaccinated the leaders and Imams of the communities first to assure the residents that the vaccine is safe.”

The Director of Disease Control and Epidemiology, Kano State Primary Health Care Management Board, Idris Wada, disclosed the state’s COVID-19 Vaccination Operation Team reeled in community and religious leaders across the 44 Local Government Areas in the state to gain public trust.

“We mapped and engaged all community and religious leaders,” Wada said. “We worked with religious leaders to clear misconceptions during Jumaat sermons to increase uptake of the vaccine.”

“We also paid advocacy visits to five Emirate councils in Kano. We engaged social media influencers on COVID-19 vaccination and we developed short video clips to sensitise people on COVID-19 vaccination.”

Infographic showing number of vaccinated residents per targeted population. Source: NPHCDA
Infographic showing number of vaccinated residents per targeted population. Source: NPHCDA
Infographic showing number of vaccinated residents per targeted population. Source: NPHCDA

Wada confirmed that the team vaccinated thousands of residents during a special vaccination to serve intending pilgrims to Mecca. The team also organized announcements about vaccines on media platforms, including radio and TV stations.




     

     

    He also explained that beyond vaccination at health centres, the team also took the opportunity to get jabs directly to people involved in daily life. Health workers took the vaccine to strategic places such as schools, markets, malls,  churches and mosques.

    As they played a role in the spread of misinformation about the vaccine, religious clerics have been very key to the success of the nationally-promoted COVID-19 vaccine campaign in Kano. This has helped the state to vaccinate 100 per cent of its targeted residents and achieve herd immunity.

    * This report was supported by the Pulitzer Center.

    Nurudeen Akewushola is an investigative reporter and fact-checker with The ICIR. He believes courageous in-depth investigative reporting is the key to social justice, accountability and good governance in society. You can reach him via [email protected] and @NurudeenAkewus1 on Twitter.

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