At a crowded market in Sadr City, a working-class neighborhood of Baghdad, Iraq, 42-year-old vendor Jasim Khudhaier stands behind a pile of shoes, sneakers and sandals.
Like most of the vendors, he's not wearing a mask – but shares that he has been deeply affected by COVID. He lost two sisters to the disease in the first wave of the pandemic. He was sick with it himself for a month early in 2021.
Yet Khudhaier refuses to get vaccinated.
"I don't trust this vaccine because some people say it can cause bad side effects," Khudhaier says. "I know many people who have taken the vaccine. But I don't have faith in it."
Only about 17% of Iraqis are fully vaccinated against COVID even though the country has enough vaccine doses for anyone who wants them. The vaccination rate is far below the global average of 54% and a far cry from the World Health Organization's goal of getting at least 70% of residents of every country fully vaccinated by the end of June. Iraqi government health workers are now trying to build confidence around the vaccine and get more people vaccinated.
A lack of trust
Khudhaier, a father of four, says his biggest fear about the vaccine is that it makes you infertile. "It can cause damage," he says, waving his hand over his groin. "I'm talking with you seriously."
In all the scientific studies of the approved COVID vaccines, some rare side effects have been found — but infertility is not one of them. Yet the false notion is widespread in Iraq, hampering efforts by public health officials and doctors.
Dr. Haider Salman, a physician who works for the Iraqi Ministry of Health in the southern city of Basra, says part of the problem in rolling out a new vaccine is that Iraqis are reflexively skeptical of any program from the government.
"We don't have any trust even in our leading persons or in our system or in our governing rule," he says.
Iraq has three brands of COVID vaccine available: AstraZeneca, Sinopharm and Pfizer-BioNTech.
Some Iraqis, Salman says, don't trust the Pfizer shot because it's from the U.S. Others refuse to take Sinopharm because it's from China. Others don't want any of them simply because it's the Iraqi government urging them to get immunized.
Making vaccinations convenient
Despite launching its COVID vaccination campaign nearly a year ago, Iraq ranks 183rd in the world, according to the WHO, in the percentage of its people who are fully immunized. Less than 1 in 5 Iraqis have gotten two injections, while in neighboring Iran, 65% of the population is fully vaccinated.
In October, Iraq launched an expanded effort to get more people protected by offering vaccines outside of health clinics, including at schools, mosques and other busy places.
At the gleaming Zayoona shopping mall in Baghdad, a team of four government health workers have set up a mobile COVID vaccination clinic. They work from a folding table in the marbled lobby in front of a clothing boutique called "Shopping Shop." The actual injections are administered behind a blue curtain next to an ATM machine.
Nurse Munira Muzher's job is to talk with people, answer questions and try to convince them to get vaccinated. She says she and her colleagues started working in the mall in October of last year.
"Some people find it difficult to come to health clinics during the day," she says — because they are working or because of the terrible traffic in Baghdad. "So we opened these vaccination centers in malls and other places to get more people vaccinated." They offer vaccines until 8 p.m. in an effort to reach people after they've gotten off work.
One nurse's 5-year-old daughter sits upright behind the table next to her mom as if she's part of the health team, waiting for people to stop by. An older woman in a long black abaya signs up for a vaccine, followed by a college student in tight black jeans. The student says he got his first dose months ago at his school but then lost his vaccination card and is now finally getting his second shot.
This vaccination team is administering doses of Pfizer. And while the jabs are supposed to be spaced three weeks apart, Muzher says she's not too worried if people show up late. The most important thing is to get them immunized.
Power of persuasion
It isn't always easy. Muzher says she regularly has to debunk the rumors about the vaccine affecting your reproductive organs.
"Our role is to educate," she says with a shrug. "We tell [people] that the World Health Organization provided the vaccine not to cause harm but to protect people and stop the spread of pandemics and diseases."
Some Iraqis refuse to get the second dose because they got flu-like symptoms after the first one. Many who live off daily wages can't afford to miss even one day of work. Muzher tries to assure them that any side effects from the vaccine aren't nearly as bad as the disease itself.
In a country burdened by corruption and a lack of basic services, Muzher says some people tell her "the government can't even provide me with electricity, how do I know that they're providing me with a safe vaccine?"
Each day her team gives shots to roughly 50 people, sometimes more on holidays when the mall is particularly busy. Muzher has handouts from the World Health Organization that people can take with them. She points out that millions and millions of people around the world have been inoculated. Slowly, she says, more and more Iraqis are coming around.
And she has faith the power of persuasion will prevail.