Social development and inclusion

Vaccines, information and the ongoing crisis of affordability for the urban poor

The Focal Project via Flickr (CC BY-NC 2.0)

As news on Covid-19 vaccines spreads good cheer in the wealthier countries of the global North, thoughts turn to when we will be able to return to normal life. Meanwhile governments are anxiously assessing the complications of establishing mass vaccination programmes and whether vaccine hesitancy could reduce take up and threaten the recovery. For those living in informal settlements across the global South, the potential for the vaccine to herald recovery seems very different.

To bring to life experiences from those living in informal settlements, we’ve collated these insights from our work in Ethiopia, India, Kenya, South Africa and Zimbabwe.


The idea of a vaccine sceptical population may be misplaced. In Kenya there is a long tradition of vaccination. Kenyan children typically receive 12 different shots and boosters in their first five years. Door to door vaccination drives across the country help to ensure that all infants are reached even in the lowest-income most informal settlements. Every year, children receive further vaccine boosters. Vaccination is accepted as a good thing and there is very little questioning of its value. If a Covid-19 vaccine is available in Kenya, the challenge would be meeting the demand. The situation is similar in South Africa. People are used to receiving vaccines and vaccinating their children. Rose Molokoane, a community leader in South Africa, stressed that: “Many people want to have it. Want to prevent this sickness. Everyone is frightened and does not want to die.”

The perspective from Zimbabwe is that while there has been concern that African populations were being used as “guinea pigs” by Northern companies and governments, this position has changed. People want access to vaccines and the end of the health and economic emergency. Social media may be pushing conspiracy theories (and linking vaccination to satanism), but most are not convinced by such misinformation.

In Addis Ababa (Ethiopia) there are more concerns. Here women are questioning why there is a vaccine before there is a cure. One woman suggested government officials take the vaccine first so that they are confident that it is safe. Others argue “we want to have the vaccine because Covid-19 impacted our live badly. We are poor at the same time the pandemic make us more poorer. We can’t go and do hard works to get money. We want our life back, we want to work and feed our family.”

Issues of Access

The bigger issue within the informal settlements of Ethiopia, India and Zimbabwe is that residents do not think that they are going to get access. The primary concern is that any vaccine against Covid-19 is going to be unaffordable for low-income households. Mahila Milan leaders in India asked if “vaccines can be subsidised or given free?” Populist political parties have been making promises. In India, the ruling party included in its manifesto for the recent elections in Bihar that it would give free vaccines to all Biharis if it is voted to power. But, there is little expectation in India that the government will provide free vaccination for low-income households.

In Addis, informal settlement residents believe access will be limited because of the costs and corruption. Women explained that they cannot afford access to “modern” health care because of the high costs, and this is why they use traditional medicine. When asked to elaborate, one said,

“Let alone a cure that will save life, even hand sanitizer; the one who can afford to buy are getting it, not us. …So, if you really want our opinion, we feel after the rich and government officials get access and if we survive till then, we expect to have access to vaccine. Till then, only God will protect us.

Our frustration comes from officials are using our names (the poor, poorer of the poor, etc) and bring things and use it for themselves and their families. We are fed up with this on going cycle of officials coming and promising then do the same and instead of get punished they will be promoted to a bigger office, then another will come and do the same. We are sick and tired. We believe we will not get access because the rich and officials will have it for themselves. And if it comes under the name of poor then the local officials will use it for their family and friends. So no chance for us.”

In Zimbabwe, there have been few conversations about vaccines. People concentrate on sharing information about how to manage Covid-19 and its symptoms. However, here too informal settlement residents believe that the high cost of vaccination will prevent access. They think that global efforts will prioritise other countries with higher levels of infection.


In India, affordability concerns are exacerbated by falling Incomes caused by the lockdowns and curfews and the increased the price of medicine as pharmacies have tried to recoup monies they have lost because of these restrictions on economic activities. One Mahila Milan leader in Mumbai explained that during the Covid-19 related lockdown, people were forced to buy essential medicines from their nearest shops and had to pay inflated prices. There is a fear that when vaccines are distributed there may also be restrictions. In normal times, people compare prices and buy from the cheapest shop.

In Kenya and South Africa, people will expect to get the vaccine for free because other vaccines are provided for free or, in Kenya, at a very low cost. In South Africa, “If they have to go to the doctor to pay for the vaccine they will not go.”  In Kenya, the only expensive vaccination is for yellow fever which is only required for international travel.

In India, a further challenge is that people have avoided seeking healthcare during this pandemic because of the fear that they and their families would be pushed into isolation. This response extends beyond Covid-19. For example, India has an ambitious TB eradication programme. However, the responsible officers have shared that reporting of TB was all time low during the lockdown. Consequently, they have re-launched a door-to-door campaign to identify those with symptoms for referral and further treatment. Here there are concerns about mis-information through powerful media companies.

In Kenya, the government is stressing that, while a vaccine has been approved globally, it is unlikely to be available soon. Hence the GoK is urging people to maintain current measures such as the use of masks.

What next?

Over the coming months, the Covid Collective partnership will expand its research agenda to address emerging challenges from the health pandemic. The aim is to learn from what is happening on the ground and draw from an array of lessons and evidence to combine practices, insights and ideas together. The Collective will be sharing more experiences relating to the pandemic which will include further lessons on vaccination roll-out, a preoccupation for so many globally.

This blog has been brought together by Diana Mitlin, Professor of Global Urbanism, Global Development Institute working with SDI affiliates in India, Kenya, South African and Zimbabwe and experimentation drawing on SDI approaches in Ethiopia. Particular thanks to: SDI Indian Alliance, Feven Haddis, Jack Makau (SDI Kenya), George Masimba Nyama (Dialogue on Shelter) and Rose Molokoane (Federation of the Urban and Rural Poor)

Supported by the UK Foreign Commonwealth and Development Office (FCDO), the Covid Collective is based at the Institute of Development Studies (IDS). The Collective brings together the expertise of, UK and Southern based research partner organisations and offers a rapid social science research response to inform decision-making on some of the most pressing Covid-19 related development challenges.

This blog was originally published by the Institute of Development Studies here

Diana Mitlin
Feven Haddis
George Masimba Nyama
Jack Makau
Rose Molokoane