Dr Christian Mayala and Dr Rodin Nzembuni Nduku sit together on a bench outside the Covid ward at Kinshasa’s Mama Yemo hospital.
They are discussing the health of their father, Noel Kalouda, who contracted coronavirus weeks before, and is now lying in a hospital bed, breathing through an oxygen mask.
Despite the brothers’ medical knowledge, and vaccines being available to them in the capital of the Democratic Republic of the Congo (DRC), all three men had chosen not to get vaccinated because of fears over potential side-effects of the only jab available, the AstraZeneca vaccine.
“On social media, there was a story about a guy who died 20 hours after getting vaccinated. Things like this make me scared to get the vaccine,” said Nduku.
Already facing shortages and huge logistical challenges in getting vaccines out to people in far-flung areas, experts worry that distrust of pharmaceutical products will further undermine the global fight against Covid.
While anger grows over the failures of rich countries to supply enough vaccines to poorer ones, vaccine hesitancy of citizens has been overlooked, epidemiologists warn.
Prof Pascal Lutumba, of the University of Kinshasa’s department of infectious diseases, said: “If people in Congo remain unvaccinated, the South African variant could meet with the Delta variant and the virus could mutate into a variant that is resistant to some vaccines.
“If a Congo variant arrives in a country like the UK, which has high vaccination rates, it could put them back into the same position they were at the beginning of the pandemic. They’d have to get vaccinated again with a new vaccine,” Lutumba said.
“We would be back to square one,” said Dr William Schaffner, a professor at Vanderbilt University medical centre in Nashville, US.
The Delta variant represents up to 79% of infections sequenced in DRC, according to figures released by the World Health Organization last month.
The country had officially recorded 50,529 cases and 1,045 Covid-related deaths by 4 August, according to the Johns Hopkins University tracker, but the virus has torn through the DRC’s elite. In May the vice-president of the Congolese national assembly said the pandemic had killed as many as 32 MPs – about 5% of the total.
Setting the tone for vaccine scepticism, the DRC’s president, Félix Tshisekedi, admitted last month he had not yet had the vaccine.
“We were ready to launch the vaccination campaign. The day before, I saw this [misleading] information on television first and then in social networks,” Tshisekedi told journalists.
The DRC has only received AstraZeneca vaccines so far, but according to Dr Jean-Jacques Muyembe-Tamfum, the country’s head of Covid response, new vaccines are expected to arrive this month, which should include different brands – which both Muyembe-Tamfum and the president have said they will take.
Nduku said: “The president said that he doesn’t trust AstraZeneca, so that makes me doubt it … I would die of anxiety if I took this vaccine, because of how the president described it. I would be worried that I was going to die.”
On 2 March DRC received 1.7m doses from Covax, the global vaccine-sharing scheme, but delayed the rollout until April after several European countries suspended use of the AstraZeneca vaccine in response to reports of side-effects involving rare blood clots. About 75% of the shots were relocated to other African countries to be used before they expired. Since then the rollout has been sluggish.
Delivering vaccines across a vast, forested country divided by large rivers and with poor infrastructure is a challenge in itself. The DRC is almost the size of western Europe yet has under 2,000 miles (3,000km) of paved roads, less than 1% of the total in the UK.
Willingness to have a Covid vaccine in the DRC was reported to be the lowest in 15 countries surveyed by the African Union between August and December last year, with 38% of people surveyed in the DRC unwilling to be vaccinated compared with just 4% in Ethiopia.
More than 70% of healthcare workers in the country said they would not take the vaccine, according to a study published by Vaccines journal in February.
The failure over healthcare messaging historically has had catastrophic consequences here. An Ebola outbreak in the eastern DRC in 2018 killed more than 2,200 people as international aid agencies and health authorities failed to communicate effectively with people and communities, to properly train health workers and to explain consent in local languages, according to the World Bank.
Healthcare workers who spoke to the Guardian in Kinshasa said these mistakes had been repeated with Covid as the government has failed to adequately explain the severity of the virus, allowing disinformation to spread.
“People were getting all sorts of messages from the churches – for example, that Covid was created to finish off Africans. The small churches were spreading many messages that Covid was not real,” said Dr Cris Kacita Osako, an epidemiologist who worked on the government’s Covid response last year.
Meanwhile, as they hope for their father’s recovery, Nduku and his brother are torn. “People didn’t believe it,” said a doctor at the hospital, Jean-Paul Nsimba. “They resisted, they doubted its existence. They thought it was a disease that killed white people.”