Acceptance of COVID-19 vaccines in sub-Saharan Africa: evidence from six national phone surveys

Risk factors related to the SARS-CoV-2 vaccine additional doses hesitancy among pregnant and non-pregnant people of reproductive age and partners: A Brazilian cross-sectional study

OBJECTIVE

The aim of this study was to assess the predictors of acceptance and hesitancy of additional doses of any SARS-CoV-2 (COVID-19) vaccine among pregnant or recently pregnant and non-pregnant people of reproductive age and partners in Brazil.

METHODS

We conducted an online cross-sectional study from June 2022 to April 2023 and invited women and partners between 18 and 49 years old to participate. We employed a snowball strategy to reach all potential eligible participants. Our primary outcome was the acceptance rate of the COVID-19 booster vaccine. We estimated the frequency and percentage for the three groups and compared categorical variables using the Chi-square test. Moreover, bivariate, backward stepwise regression, and subgroup analyses were performed to evaluate risk factors and predictors of COVID-19 vaccine booster hesitancy. We reported the effect size as OR with a 95% CI.

RESULTS

We included 1487 participants, and among them, 334 (22.5%) were pregnant or recently pregnant people, 905 (60.8%) were non-pregnant people, and 247 (16.6%) were male partners. Pregnant and recently pregnant people showed greater hesitancy for the COVID-19 vaccine booster than non-pregnant people (28% vs 15%, P < 0.001) and male partners (28% vs 16%, P < 0.001). Non-pregnant women accepted the COVID-19 vaccine more often than pregnant or recently pregnant people (OR 1.75; 95% CI: 1.13-2.70). The associated factors to the reduced COVID-19 vaccine booster acceptance were family income between US$ 566-945.00 (54%), evangelic religion (65%), concern about vaccine safety (80%) and perceived common vaccine importance (93%).

CONCLUSION

Pregnant people were more hesitant than non-pregnant people to accept the COVID-19 booster vaccine. Family income, religious beliefs, vaccine safety concerns, and perceived common vaccine importance were significant barriers to accepting COVID-19 booster vaccines. The impact of these factors was more evident among pregnant or recently pregnant people, emphasizing the harmful effect of misinformation among this vulnerable population.

Sex and COVID-19 vaccination uptake and intention in the Democratic Republic of Congo, Nigeria, Senegal, and Uganda

The introduction of vaccines marked a game changer in the fight against COVID-19. In sub-Saharan Africa, studies have documented the intention to vaccinate and the uptake of COVID-19 vaccines. However, little is documented about how sex differences could have impacted COVID-19 vaccination. We conducted a multi-country cross-sectional study to assess the sex differences in COVID-19 vaccine uptake and intention to vaccinate in the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda. This study involved analysis of data from mobile surveys conducted between March and June 2022 among nationally constituted samples of adults in each country. Bivariate and multivariable logistic regression models were run. The self-reported uptake of COVID-19 vaccines was not significantly different between males and females (p = 0.47), while the intention to vaccinate was significantly higher among males (p = 0.008). Among males, obtaining COVID-19 information from health workers, testing for COVID-19, and having high trust in the Ministry of Health were associated with higher vaccination uptake. Among females, having high trust in the government was associated with higher vaccination uptake. For intention to vaccinate, males who resided in semi-urban areas and females who resided in rural areas had significantly higher vaccination intention compared to their counterparts in urban areas. Other factors positively associated with vaccination intention among males were trust in the World Health Organization and perceived truthfulness of institutions, while males from households with a higher socio-economic index and those who had declined a vaccine before had a lower vaccine intention. Overall, the factors differentiating vaccine uptake and intention to vaccinate among males and females were mostly related to trust in government institutions, perceived truthfulness of institutions, and respondent's residence. These factors are key in guiding the tailoring of interventions to increase COVID-19 vaccine uptake in sub-Saharan Africa and similar contexts.

How to increase acceptance of the COVID-19 vaccine among poor people in Africa?

This study aims to analyze whether good government management of the COVID-19 pandemic can increase the likelihood of vaccine uptake among poor people in Africa. The analysis is based on a sample of 18,010 people living in 34 African countries, drawn from data collected by Afrobarometer (Merged Round 8 data (34 countries), database, 2022). The econometric results, obtained using a bivariate probit regression, show that poverty significantly reduces the odds of accepting the said COVID-19 vaccine. However, acceptance of the vaccine increases among poor individuals when there is (i) trust in the government's published statistics on COVID-19, (ii) control of corruption by the government in managing the pandemic, (iii) individual confidence in the government's ability to ensure the safety of the COVID-19 vaccine, and (iv) belief that the Covid 19 vaccine will be more effective than religious prayer in the fight against this pandemic.

Vaccine hesitancy and trust in sub-Saharan Africa

Lack of trust is a primary reason behind the global rise in vaccine hesitancy. Existing research on the trust-vaccine hesitancy nexus has almost exclusively focused on COVID-19 with the vast majority of studies examining industrialized countries. In this study, we investigated the influence of trust in different policy-relevant actors (government, science, media, pharmaceutical companies, society) on vaccine hesitancy for recently available vaccines related to polio and HPV which we benchmark against a COVID-19 vaccine. Leveraging unique primary data on 5203 individuals from six countries (Ghana, Kenya, Nigeria, South Africa, Tanzania, and Uganda), we showed that individuals' trust in the government and society are key predictors of vaccine hesitancy. Furthermore, we demonstrated that these relationships are remarkably stable across vaccine, disease, and country contexts.

Enablers and barriers to vaccine uptake and handwashing practices to prevent and control COVID-19 in Kenya, Uganda, and Tanzania: a systematic review

The global emergence of coronavirus disease 2019 (COVID-19) posed unprecedented challenges, jeopardizing decades of progress in healthcare systems, education, and poverty eradication. While proven interventions such as handwashing and mass vaccination offer effective means of curbing COVID-19 spread, their uptake remains low, potentially undermining future pandemic control efforts. This systematic review synthesized available evidence of the factors influencing vaccine uptake and handwashing practices in Kenya, Uganda, and Tanzania in the context of COVID-19 prevention and control. We conducted an extensive literature search across PubMed, Science Direct, and Google Scholar databases following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Out of 391 reviewed articles, 18 were eligible for inclusion. Some of the common barriers to handwashing in Kenya, Uganda, and Tanzania included lack of trust in the government's recommendations or messaging on the benefits of hand hygiene and lack of access to water, while some of the barriers to vaccine uptake included vaccine safety and efficacy concerns and inadequate awareness of vaccination sites and vaccine types. Enablers of handwashing practices encompassed hand hygiene programs and access to soap and water while those of COVID-19 vaccine uptake included improved access to vaccine knowledge and, socio-economic factors like a higher level of education. This review underscores the pivotal role of addressing these barriers while capitalizing on enablers to promote vaccination and handwashing practices. Stakeholders should employ awareness campaigns and community engagement, ensure vaccine and hygiene resources' accessibility, and leverage socio-economic incentives for effective COVID-19 prevention and control. Clinical trial registration: [https://clinicaltrials.gov/], identifier [CRD42023396303].

Public Perception Toward the Malaysian National COVID-19 Immunisation Programme (PICK) in the State of Sabah, Malaysia: A Cross-Sectional Survey

The Malaysian Government has initiated the National COVID-19 Immunisation Programme, known as PICK, to be a national strategy for addressing the spread of the coronavirus disease (COVID-19) pandemic across the country. Although the government intensified public awareness to increase program registration, the total number that registered in the state of Sabah, located in East Malaysia, was relatively low during August 2021, accounting for only 42.9% as compared to that of Peninsular Malaysia. Therefore, this paper examines the public perception toward the PICK program in Sabah based on 4 main components: safety, communication, psychology, and milieu. This study is based on the empirical findings drawn from 1024 respondents across Sabah using online Google Form surveys. This study adopts 5 methodologies for data analysis by using K-means clustering, mean score, Mann-Whitney U test, spatial analysis, and frequency analysis. It has been revealed that the percentage of respondents (categorized as Cluster 1) who have a negative perception toward the vaccination program is higher (55.9%) than those who have a positive perception (44.1%). This study further discovered that Cluster 1 has shown high skepticism regarding the vaccination program, which can be explained through the communication component (M = 3.33, SD = 0.588), especially Co2, Co3, Co1, and Co4. Following the communication factor, a chain of negative perceptions also affects other components such as safety, psychology, and milieu among Cluster 1, all of which contribute to poor participation in the PICK program. The study outcomes are extremely useful for informing local authorities to establish policies related to public interests, primarily in the areas of public health. Understanding the community's perspectives and their obstacles in participating in such programs may assist local authorities in developing or implementing public policies and campaigns that ensure such related public programs can be conducted more effectively in the future.

COVID-19 vaccine hesitancy and conspiracy beliefs in Togo: Findings from two cross-sectional surveys

Togo is a low-income country in West Africa. Estimates from Our World in Data suggest that only 25% of the Togolese population have received at least one dose of any COVID-19 vaccine by June 2023. Whilst the early phase of the pandemic vaccine rollout across 2021 was dominated by higher-income countries taking much of the available supply, there have long been sufficient supplies for all nations. Thus, there remains a need to understand reasons for low uptake in countries such as Togo, here focusing on population confidence and trust, essentially characteristics that could potentially be addressed within health promotion strategies. Two cross-sectional telephone surveys of Togo residents were conducted in December 2020 and January 2022. These surveys asked questions around perceptions of COVID-19, trust in public health messaging, belief in conspiracy theories, and hesitancy around COVID-19 vaccination. Analyses here focus on unvaccinated respondents. Across Survey 1 (N = 1430) and Survey 2 (N = 212), 65% of respondents were men, and 47% lived in Lomé (capital city of Togo). Between Surveys 1 and 2, overall hesitancy (33.0% to 58.0% respectively) and beliefs in conspiracy theories (29% to 65%) significantly increased. Using logistics regression, governmental mistrust was the strongest significant predictor of hesitancy (OR: 2.90). Participants who indicated agreement or uncertainty with at least one conspiracy belief also predicted greater vaccine hesitancy (OR: 1.36). Proactive approaches to public health messaging, that better understand reasons for hesitancy across different demographics, can support uptake of COVID-19 vaccinations within Togo. This includes health promotion campaigns that use locally and nationally trusted knowledge providers (e.g. the health service or religious leaders) for greatest effectiveness at reducing impact of misinformation. Key future research should focus around knowledge gaps and areas of mistrust created by the pandemic, such as the impact of misinformation upon routine immunisation uptake.

Perceptions of the COVID-19 Vaccine and Other Adult Vaccinations in Malawi: A Qualitative Assessment

In Malawi, various brands of the COVID-19 vaccine have been offered to the population, but factors including fear of side effects or other risks, uncertainty about benefits, and misinformation created hesitancy toward them. In early 2022, 4% of Malawians were fully vaccinated for COVID-19. Despite multiple promotion efforts, by August 2022, COVID-19 vaccination nationwide was around 15%. To increase COVID-19 vaccination uptake, the research team collected qualitative data in 4 districts with vaccine coverage levels ranging from 1% to 11%. This data collection happened during a cholera outbreak that began in March 2022 and the vaccination efforts to address it. Study participants included male and female members of the general population, social workers, people with comorbidities, health workers, and community leaders (224 participants total, 47% female). In focus group discussions (n=27) and in-depth interviews (n=17), participants compared COVID-19 vaccines with other adult vaccines, such as cholera and tetanus toxoid. A thematic analysis identified themes related to 3 research questions on COVID-19 vaccine concerns, confidence, and delivery affecting uptake. Differences in promotion, delivery (oral versus injection), COVID-19 vaccine card structure, the various brands and boosters, and vaccines being described as required or optional all played a role in distinguishing COVID-19 vaccines from other vaccines and creating suspicion or indifference. Barriers to vaccination in general, such as rumors or knowledge gaps, were amplified by how novel the COVID-19 vaccines were perceived to be and the changing guidance provided over time. By April 2023, more targeted campaign efforts helped increase vaccination rates to 28%. The findings contribute information about how individuals conceptualize and make decisions about adult vaccination, which can, in turn, inform strategies to integrate COVID-19 promotion and delivery with other disease responses in Malawi as well as routine health services in similar settings.

Perceptions and hesitancy towards the COVID-19 vaccination campaign among three vulnerable populations in the Democratic Republic of the Congo: A qualitative study

Background

To deal with COVID-19, vaccination is a strategy adopted by many countries including the Democratic Republic of the Congo (DRC). The first phase of vaccination was conducted in 2021 as part of the country's Expanded Program on Immunization (EPI). To evaluate it, an intra-action review was conducted. It identified a low proportion of vaccinated vulnerable populations, namely health professionals (1.8%), chronically ill (0.09%), and older adults aged ≥ 55 (0.4%). The objective was to explore perceptions and barriers to acceptance of the COVID-19 vaccine in the DRC among the vulnerable populations targeted by the EPI.

Methodology

A qualitative study was conducted between September 2021 and June 2022 in Kinshasa, DRC. Semi-structured focus groups were conducted with each group separately using a single interview guide. It included five categories: socio-demographic information, COVID-19 vaccine status, perceptions towards the COVID-19 vaccination, vaccine hesitancy and perceptions towards the COVID-19 vaccination campaign.

Results

Three focus groups were conducted. In total, we had 16 participants with eight health professionals, four chronically ill participants, and four older adults. The majority were married (68.7%) and came from urban areas (68.7%). The sex ratio was at 1 and more than one-third had an education level equivalent to a master's degree (37.5%). Half were vaccinated against the COVID-19 (50.0%). The main perceptions and hesitancy factors were the lack of trust and knowledge of the vaccine's properties, benefits, and risks. Adjustment of the information messages which, according to participants, were not clear and poorly adapted to the needs of each group is the main element to improve the vaccination campaign.

Conclusion

This study represents an important step to improve the COVID-19 vaccination campaign in the DRC. It showed the different barriers to the COVID-19 vaccines acceptance among vulnerable populations.

COVID-19 vaccine acceptance and adherence to non-pharmaceutical interventions among employees of public transportations company in Addis Ababa, Ethiopia

This study examined the acceptability of the COVID-19 vaccines and measured adherence to non-pharmaceutical interventions among employees in public transportations in Addis Ababa, Ethiopia. In a public transportation company-based cross-sectional study, a self-administered questionnaire or a structured face-to-face interview was used to obtain information about willingness to get vaccinated, adherence to recommended non-pharmaceutical interventions, and source and quality of information about COVID-19 vaccines. Overall, 23.8% of 412 responding employees were willing to receive a COVID-19 vaccine. A majority (75.2%) never used facemasks, had poor knowledge about COVID-19 vaccines (82.3%), and had the opinion not to be susceptible to COVID-19 (81.1%). Better education increased the odds of being willing to get vaccinated (OR = 3.28, CI: (1.24-8.63)), male sex (OR = 2.45 (1.08-5.58)), history of chronic disease (OR = 3.01 (1.38-6.56)), watching TV for information on COVID-19 (OR = 14.79 (2.53-86.62)) or considering COVID-19, a severe disease (OR = 9.12 (3.89-21.35)). In addition, the opinion that vaccination can prevent COVID-19, trust in the vaccines, and assuming COVID-19 has an impact at the workplace increased the odds to accept vaccination significantly. In contrast, poor knowledge about the COVID-19 vaccines reduced accepting vaccination significantly (OR = 0.20 (0.09-0.44)). Acceptance of COVID-19 vaccines among public transportations workers in Addis Ababa is very low, which may be due to insufficient knowledge about the vaccines, cultural factors, religious beliefs, and a lack of or distorted information about the disease. Therefore, stakeholders should provide credible and tailored information to transportation workers on the severity and impact of COVID-19 and inform them about the effectiveness of the vaccines.

Quantitative Synthesis of Factors Associated with COVID-19 Vaccine Acceptance and Vaccine Hesitancy in 185 Countries

Mass vaccination against COVID-19 is the best method to ensure herd immunity in order to curb the effect of the pandemic on the global economy. It is therefore important to assess the determinants of COVID-19 vaccine acceptance and hesitancy on a global scale. Factors were recorded from cross-sectional studies analyzed with t-Test, ANOVA, correlation, and meta-regression analyses and synthesized to identify global trends in order to inform policy. We registered the protocol (ID: CRD42022350418) and used standard Cochrane methods and PRISMA guidelines to collect and synthesize cross-sectional articles published between January 2020 and August 2023. A total of 67 articles with 576 studies from 185 countries involving 3081,766 participants were included in this synthesis. Global COVID-19 vaccine acceptance was 65.27% (95% CI; 62.72-67.84%), while global vaccine hesitancy stood at 32.1% (95% CI; 29.05-35.17%). One-Way ANOVA showed that there was no significant difference in the percentage Gross Domestic Product spent on vaccine procurement across the World Bank income levels (p < 0.187). There was a significant difference of vaccine acceptance (p < 0.001) and vaccine hesitancy (p < 0.005) across the different World Bank Income levels. World Bank income level had a strong influence on COVID-19 vaccine acceptance (p < 0.0004) and hesitancy (p < 0.003) but percentage Gross Domestic Product spent on vaccine procurement did not. There was no correlation between percentage Gross Domestic Product spent on vaccine procurement and COVID-19 vaccine acceptance (r = -0.11, p < 0.164) or vaccine hesitancy (r = -0.09, p < 0.234). Meta-regression analysis showed that living in an urban setting (OR = 4.83, 95% CI; 0.67-212.8), rural setting (OR = 2.53, 95% CI; 0.29-119.33), older (OR = 1.98, 95% CI; 0.99-4.07), higher education (OR = 1.76, 95% CI; 0.85-3.81), and being a low income earner (OR = 2.85, 95% CI; 0.45-30.63) increased the odds of high COVID-19 vaccine acceptance. Factors that increased the odds of high COVID-19 vaccine hesitancy were no influenza vaccine (OR = 33.06, 95% CI; 5.03-1395.01), mistrust for vaccines (OR = 3.91, 95% CI; 1.92-8.24), complacency (OR = 2.86, 95% CI; 1.02-8.83), pregnancy (OR = 2.3, 95% CI; 0.12-141.76), taking traditional herbs (OR = 2.15, 95% CI; 0.52-10.42), being female (OR = 1.53, 95% CI; 0.78-3.01), and safety concerns (OR = 1.29, 95% CI; 0.67-2.51). We proposed a number of recommendations to increase vaccine acceptance and ensure global herd immunity against COVID-19.

Assessment of willingness and determinants to receive the COVID-19 vaccine among the general population of the Somali region, Eastern Ethiopia: a 2021 cross-sectional study

OBJECTIVE

This research aimed to assess COVID-19 vaccine acceptance and the factors influencing it among the population of the Somali region in Ethiopia through a cross-sectional COVID-19 survey.

DESIGN

Community-based cross-sectional study.

SETTING

The survey was conducted in eight selected districts of the Somali region in Ethiopia from 20 October 2021 to 30 October 2021.

PARTICIPANTS

Participants were chosen using simple random sampling and data analysis used Stata V.14. Both bivariable and multivariable binary logistic regression methods were applied, with variables having a p value below 0.2 considered for inclusion in the final model, where statistically significant factors were identified at p<0.5.

PRIMARY OUTCOME MEASURE

Willingness to take the vaccine.

RESULTS

A total of 1010 respondents participated in this study. The proportion of people's willingness to take the vaccine was 65% (95% CI 62 to 68). When you believe moderately or highly that getting a COVID-19 vaccine will protect others (AOR=6.2, 95% CI 1.43 to 26.6) and (AOR=7.2, 95% CI 1.7 to 29.7), then you will protect others as well. Whereas, a desire to get vaccinated little, moderately and highly (AOR=4.3, 95% CI 1.77 to 10.4), (AOR=20, 95% CI 8.5 to 47) and (AOR=147, 95% CI 55 to 392), respectively, was significantly associated with willingness to take the vaccine. Moreover having close family and friends who want them to get a COVID-19 vaccine (AOR=2, 95% CI 1.2 to 3.57) and religious leaders or community leaders (AOR=1.8, 95% CI 1 to 3.1) were significant factors in the multivariable logistic regression model.

CONCLUSION

This study found that COVID-19 vaccine acceptance was low in the Somali region. Factors positively linked to one's willingness to get vaccinated included the belief that it protects others, personal desire for vaccination and support from family, friends, community and religious leaders.

Vaccination willingness, vaccine hesitancy, and estimated coverage of SARS-CoV-2 vaccine among healthcare workers in Tanzania: A call for action

BACKGROUND

The global COVID-19 pandemic presented an immense obstacle to public health, with vaccination emerging as a crucial measure to curb transmission. This study aimed to evaluate the willingness, hesitancy, and coverage of SARS-CoV-2 vaccines among healthcare workers (HCWs) in Tanzania and reveal their concerns about SARS-CoV-2 vaccines and the reasons that might prevent them from getting vaccinated.

METHODS

We conducted a cross-sectional study using an anonymous online survey from October to November 2022. The multivariate logistic regression model explored the factors associated with SARS-CoV-2 vaccine willingness, hesitancy, and coverage.

RESULTS

The study included 560 HCWs, with the largest group being doctors (47.9%), followed by nurses (26.9%) and other HCWs (25.2%). A total of 70.5% of HCWs reported being vaccinated against SARS-CoV-2. The primary driver for SARS-CoV-2 vaccination was collective responsibility. A total of 81.4% of HCWs reported being willing to accept SARS-CoV-2 vaccines, while 62.5% of HCWs reported vaccine hesitancy. HCWs with higher educational qualifications were likelier to take the vaccine, while the respondents aged 18-30 years had the highest SARS-CoV-2 vaccination refusal (71.9%). We also investigated the role of HCWs as a source of information to promote COVID-19 vaccine uptake. 79.4% of HCWs provided information and advice on SARS-CoV-2 vaccines.

CONCLUSION

To increase vaccine acceptance among HCWs and the general population, targeted messaging is needed to deliver transparent information on vaccine safety, efficacy, and development.

Levels of handwashing and vaccine uptake in Kenya, Uganda, and Tanzania to prevent and control COVID-19: a systematic review and meta-analysis

Introduction

Coronavirus Disease 2019 (COVID-19) presents a massive challenge in Africa due to overwhelmed and underresourced health systems, as well as the existing burden of communicable and non- communicable diseases. Self-inoculation may occur when an individual touches their mucous membrane following direct contact between their hands and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-contaminated surfaces. Therefore, handwashing can be used along with COVID-19 vaccines to reduce the spread of SARS-CoV-2 and the burden of COVID-19. We were interested in investigating the levels of handwashing and vaccine uptake to control and prevent COVID-19 in Kenya, Uganda and Tanzania using a systematic review and meta-analysis.

Methods

We searched PubMed, African Index Medicus and African Journals Online for studies published since inception to 31st January 2023. We included all studies that assessed: the levels of COVID-19 vaccine acceptance and hesitance as indicators of vaccine uptake; and studies on the levels of handwashing to prevent and control COVID-19 in Kenya, Uganda and Tanzania. Study findings were synthesized by meta-analysis to get the pooled effect measure. Three studies were synthesized qualitatively due to high level of heterogeneity in effect measure precluding a quantitative meta-analysis.

Results

Our search identified 128 articles of which 17 studies with 18,305 participants and 622 vaccination sites were reviewed with 14 of them being meta-analyzed. This systematic review and meta-analysis reports high levels of COVID-19 vaccine acceptance and handwashing in Kenya, Uganda and Tanzania at 67% (95% CI: 55, 78) and 88% (95% CI: 73, 97), respectively. Vaccine hesitance among the participants was low at 31% (95% CI: 15, 49).

Discussion

Despite their importance in the control and prevention of COVID-19, some countries do not implement handwashing and vaccination effectively. There is a need for public health strategies to raise awareness about the importance of handwashing and the uptake of the COVID-19 vaccine.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, PROSPERO ID CRD42023394698.

How prevalent is COVID-19 vaccine hesitancy in low-income and middle-income countries and what are the key drivers of hesitancy? Results from 53 countries

OBJECTIVES

This study aims to estimate the levels of COVID-19 vaccine hesitancy in 53 low-income and middle-income countries, differences across population groups in hesitancy, and self-reported reasons for being hesitant to take the COVID-19 vaccine.

METHODS

This paper presents new evidence on levels and trends of vaccine hesitancy in low-income and middle-income countries based on harmonised high-frequency phone surveys from more than 120 000 respondents in 53 low-income and middle-income countries collected between October 2020 and August 2021. These countries represent a combined 53% of the population of low-income and middle-income countries excluding India and China.

RESULTS

On average across countries, one in five adults reported being hesitant to take the COVID-19 vaccine, with the most cited reasons for hesitancy being concerns about the safety of the vaccine, followed by concerns about its efficacy. Between late 2020 and the first half of 2021, there tended to be little change in hesitancy rates in 11 of the 14 countries with available data, while hesitancy increased in Iraq, Malawi and Uzbekistan. COVID-19 vaccine hesitancy was higher among female, younger adults and less educated respondents, after controlling for selected observable characteristics.

CONCLUSIONS

Country estimates of vaccine hesitancy from the high-frequency phone surveys are correlated with but lower than those from earlier studies, which often relied on less representative survey samples. The results suggest that vaccine hesitancy in low-income and middle-income countries, while less prevalent than previously thought, will be an important and enduring obstacle to recovery from the pandemic.

Shaping global vaccine acceptance with localized knowledge: a report from the inaugural VARN2022 conference

The first conference of the Vaccination Acceptance Research Network, VARN2022: Shaping Global Vaccine Acceptance with Localized Knowledge, was held virtually, from March 1st to 3rd 2022. This inaugural event brought together a global representation of experts to discuss key priorities and opportunities emerging across the ecosystem of vaccine acceptance and demand, from policies to programs and practice. Convened by the Sabin Vaccine Institute, VARN aims to support dialogue among multidisciplinary stakeholders to enhance the uptake of social and behavioral science-based solutions for vaccination decision-makers and implementers. The conference centered around four key themes: 1) Understanding vaccine acceptance and its drivers; 2) One size does not fit all: community- and context-specific approaches to increase vaccine acceptance and demand; 3) Fighting the infodemic and harnessing social media for good; and 4) Frameworks, data integrity and evaluation of best practices. Across the conference, presenters and participants considered the drivers of and strategies to increase vaccine acceptance and demand relating to COVID-19 vaccination and other vaccines across the life-course and across low-, middle- and high-income settings. VARN2022 provided a wealth of evidence from around the world, highlighting the need for human-centered, multi-sectoral and transdisciplinary approaches to improve vaccine acceptance and demand. This report summarizes insights from the diverse presentations and discussions held at VARN2022, which will form a roadmap for future research, policy making, and interventions to improve vaccine acceptance and demand globally.

Correlates of COVID-19 Vaccine Acceptance and Hesitancy in Rural Communities in Western Kenya

Vaccine hesitancy is a significant global public health concern. This study sought to determine the correlates of acceptance and hesitancy regarding COVID-19 vaccines in rural populations of selected counties in Western Kenya and assess the strategies that can be used to improve COVID-19 vaccine acceptance in Kenya. The study used a quantitative research strategy with a sample of 806 individuals in the Kisumu, Vihiga, and Kakamega counties. Descriptive statistics, correlations and regression analyses were used. Of the 806 study participants, 55% were males and 45% females. Vaccine acceptance was significantly associated with being a male (AOR: 1.46, 95% CI: 1.24-1.59, p < 0.031), having no formal education (AOR: 2.25, 95% CI: 1.16-4.40, p < 0.02), working in the private sector (AOR: 5.78, 95% CI: 3.28-10.88 p < 0.02), and have low income (KES 0-999 (USD 0-9.16)), (AOR: 2.35, 95% CI: 1.13-3.47, p < 0.02). Conclusions: The current study suggests that male gender, no formal education, working in the private sector, and low income KES 0-999 (USD 0-9.6) are significant factors influencing awareness of and possible acceptance of COVID-19 vaccination.

Assessing COVID-19 vaccine hesitancy and barriers to uptake in Sub-Saharan Africa

BACKGROUND

Despite improved availability of COVID-19 vaccines in Sub-Saharan Africa, vaccination campaigns in the region have struggled to pick up pace and trail the rest of the world. Yet, a successful vaccination campaign in Sub-Saharan Africa will be critical to containing COVID-19 globally.

METHODS

Here, we present new descriptive evidence on vaccine hesitancy, uptake, last-mile delivery barriers, and potential strategies to reach those who remain unvaccinated. Our data comes from national high frequency phone surveys in six countries in East and West Africa with a total population of 415 million people. Samples were drawn from nationally representative samples of households interviewed in recent in-person surveys. Our estimates are based on a survey module harmonized across countries and are re-weighted to mitigate potential sample selection biases.

RESULTS

We show that vaccine acceptance remains generally high among respondents in Sub-Saharan Africa (between 95.1% and 63.3%) even though hesitancy is non-negligible among those pending vaccination. Many who are willing to get vaccinated are deterred by a lack of easy access to vaccines at the local level. Furthermore, social ties and perceptions as well as intra-household power relations matter for vaccine take-up. Among the unvaccinated population, radio broadcasts have widespread reach and medical professionals are highly trusted.

CONCLUSIONS

Our findings highlight that creating a positive social norm around COVID-19 vaccination, messaging that leverages trusted and accessible information sources and channels, and more easily accessible vaccination sites at the community level are promising policy options to boost vaccination campaigns in the region and end the pandemic everywhere.

Attitudes toward COVID-19 Vaccination: Staff and Patient Perspectives at Six Health Facilities in Sierra Leone

Sierra Leone is a West African country with a population of over 8 million. With more than half of Sierra Leone's population living in rural areas, it is important to understand rural populations' access to and attitudes toward the COVID-19 vaccine. In November 2021, the rate of vaccination coverage in Sierra Leone was only 7% for one dose and 4% for two doses. Understanding perspectives of health facility staff and patients can help strengthen future vaccine campaigns. We conducted a cross-sectional study, between March 2022 and May 2022, of clinical staff, non-clinical staff, and adult (>18 years) patients/caregivers attending six Ministry of Health and Sanitation (MoHS) facilities supported by Partners In Health, four in the Kono district and two in the Western Urban Area district, the capital of Sierra Leone. We assessed the opportunity to vaccinate, vaccine uptake, and intention to vaccinate. Out of the 2015 participants, 11.4% were clinical staff, 18.8% were non-clinical staff, and 69.8% were patients/caregivers. Less than half of the patients/caregivers had the opportunity to be vaccinated (42%), and 22% of patients/caregivers were fully vaccinated. Among the unvaccinated population, 44% would refuse a vaccine if offered to them at no cost. Lack of access to COVID-19 vaccines and to official education messaging, especially for patients and caregivers, is still an underlying problem in Sierra Leone for vaccine uptake, rather than a lack of willingness to be vaccinated.

COVID-19 vaccine hesitancy in Latin America and Africa: a scoping review

Vaccination has played an important role in the containment of COVID-19 pandemic advances. However, SARS-CoV-2 vaccine hesitancy has caused a global concern. This scoping review aims to map the scientific literature on COVID-19 vaccine hesitancy in Latin America and Africa from a Global Health perspective, observing the particularities of the Global South and using parameters validated by the World Health Organization (WHO). The review reporting observes the recommendations of the PRISMA for Scoping Reviews (PRISMA-ScR) model. Search was conducted in PubMed, Scopus, Web of Science, and Virtual Health Library (VHL) databases, selecting studies published from January 1, 2020 to January 22, 2022. Selected studies indicate that COVID-19 vaccine hesitancy involves factors such as political scenario, spread of misinformation, regional differences in each territory regarding Internet access, lack of access to information, history of vaccination resistance, lack of information about the disease and the vaccine, concern about adverse events, and vaccine efficacy and safety. Regarding the use of conceptual and methodology references from the WHO for vaccine hesitancy, few studies (6/94) use research instruments based on these references. Then, the replication in Global South of conceptual and methodological parameters developed by experts from the Global North contexts has been criticized from the perspective of Global Health because of it may not consider political and sociocultural particularities, the different nuances of vaccine hesitancy, and issues of access to vaccines.

Choice preference and willingness to pay for COVID-19 vaccination in Namibia

Background

Namibia has not been spared from the coronavirus (COVID-19) pandemic, and as intervention the Namibian government has rolled out vaccination programmes. This study was conducted before the roll out of these vaccines to assess the preference for COVID-19 vaccinations. Stated preference studies provide information about social demand, access, willingness-to-pay and financing for future COVID-19 vaccination.

Methods

A stated choice experiment (SCE) survey was administered to a sample of 506 participants from Namibia's general population between October 2020 and December 2020. Participants were asked to make a series of hypothetical choices and estimate their preference for different attributes of a vaccine. A latent class model was used to analyse the SCE data. The study also assessed anti-vaccination behaviour, past vaccination behaviour, impacts of COVID-19 on mental and physical health and Willingness-To-Pay (WTP) measures. The WTP measures were captured as out-of-pocket and further calculated using the marginal rate of substitution method in SCE.

Results

Data from 269 participants was included in the analysis. Vaccine side effects (40.065), population coverage (4.688), payment fee to receive vaccine immediately (3.733) were the top three influential attributes for vaccine preferences. Accordingly, increases in mild and severe side effects of vaccine options had negative impacts on utility; with an average WTP of N$728.26 to reduce serious side effects. The average WTP to receive a high-quality vaccine with 90% efficient was found to be N$233.11 (US$15.14). Across classes, there was a strong preference for vaccines with high effectiveness over longer durations of time.

Conclusions

The results provide useful information for the Namibian government to improve the current strategies for vaccine rollout interventions.

Volatility of the COVID-19 vaccine hesitancy: sentiment analysis conducted in Brazil

Background

Vaccine hesitancy is a phenomenon that can interfere with the expansion of vaccination coverage and is positioned as one of the top 10 global health threats. Previous studies have explored factors that affect vaccine hesitancy, how it behaves in different locations, and the profile of individuals in which it is most present. However, few studies have analyzed the volatility of vaccine hesitancy.

Objective

Identify the volatility of vaccine hesitancy manifested in social media.

Methods

Twitter's academic application programming interface was used to retrieve all tweets in Brazilian Portuguese mentioning the COVID-19 vaccine in 3 months (October 2020, June 2021, and October 2021), retrieving 1,048,576 tweets. A sentiment analysis was performed using the Orange software with the lexicon Multilingual sentiment in Portuguese.

Results

The feelings associated with vaccine hesitancy were volatile within 1 month, as well as throughout the vaccination process, being positioned as a resilient phenomenon. The themes that nurture vaccine hesitancy change dynamically and swiftly and are often associated with other topics that are also affecting society.

Conclusion

People that manifest the vaccine hesitancy present arguments that vary in a short period of time, what demand that government strategies to mitigate vaccine hesitancy effects be agile and counteract the expressed fear, by presenting scientific arguments.

The evolution of COVID-19 vaccine hesitancy in Sub-Saharan Africa: evidence from panel survey data

BACKGROUND

COVID-19 vaccination efforts are lagging in Sub-Saharan Africa, as just over 20 percent of the population has been fully vaccinated. COVID-19 vaccine hesitancy is considered important as a prerequisite for widespread vaccine take-up. Here, we study the dynamics of vaccine acceptance, its correlates, and reasons for hesitancy over time, drawing on two years of panel survey data.

METHODS

In this observational study, we use multiple rounds of data from national High Frequency Phone Surveys (HFPS) in five countries in East and West Africa (Burkina Faso, Ethiopia, Malawi, Nigeria, and Uganda), covering a period between 2020 and 2022. The surveys are cross-country comparable and draw their samples from nationally representative sampling frames. Based on this data source, the study presents population-weighted means and performs multivariate regression analysis.

RESULTS

COVID-19 vaccine acceptance was high throughout the study period (68% to 98%). However, acceptance levels were lower in 2022 than in 2020 in three countries (Burkina Faso, Malawi, Nigeria), and higher in one country (Uganda). Moreover, individuals are observed to change their stated vaccine attitudes between survey rounds, to a limited extent in some countries (Ethiopia) and more frequently in others (Burkina Faso, Malawi, Nigeria, Uganda). Vaccine hesitancy is higher in richer households, and those residing in urban areas; among women and those better educated. Hesitancy is lower in larger households and among heads of the household. The main reasons for hesitancy are concerns about side effects of the vaccine, its safety and efficacy, as well as assessments of COVID-19 risk, though these reasons fluctuate over time.

CONCLUSIONS

Reported COVID-19 vaccine acceptance levels remain far above vaccination rates in the study countries, suggesting that vaccine hesitancy is not the primary obstacle to reaching greater vaccine coverage, which may instead be related to access and delivery barriers as well as supply shortages. Nevertheless, vaccine attitudes appear malleable so that continued efforts are needed to retain high levels of vaccine acceptance.

Declining trends in vaccine confidence across sub-Saharan Africa: A large-scale cross-sectional modeling study

Current WHO/UNICEF estimates of routine childhood immunization coverage reveal the largest sustained decline in uptake in three decades with pronounced setbacks across Africa. Although the COVID-19 pandemic has induced significant supply and delivery disruptions, the impact of the pandemic on vaccine is less understood. We here examine trends in vaccine confidence across eight sub-Saharan countries between 2020 and 2022 via a total of 17,187 individual interviews, conducted via a multi-stage probability sampling approach and cross-sectional design and evaluated using Bayesian methods. Multilevel regression combined with poststratification weighting using local demographic information yields national and sub-national estimates of vaccine confidence in 2020 and 2022 as well as its socio-demographic associations. We identify declines in perceptions toward the importance of vaccines for children across all eight countries, with mixed trends in perceptions toward vaccine safety and effectiveness. We find that COVID-19 vaccines are perceived to be less important and safe in 2022 than in 2020 in six of the eight countries, with the only increases in COVID-19 vaccine confidence detected in Ivory Coast. There are substantial declines in vaccine confidence in the Democratic Republic of Congo and South Africa, notably in Eastern Cape, KwaZulu-Natal, Limpopo, and Northern Cape (South Africa) and Bandundu, Maniema, Kasaï-Oriental, Kongo-Central, and Sud-Kivu (DRC). While over 60-year-olds in 2022 have higher vaccine confidence in vaccines generally than younger age groups, we do not detect other individual-level socio-demographic associations with vaccine confidence at the sample sizes studied, including sex, age, education, employment status, and religious affiliation. Understanding the role of the COVID-19 pandemic and associated policies on wider vaccine confidence can inform post-COVID vaccination strategies and help rebuild immunization system resilience.

Trust and COVID precautionary measures during the early days of the COVID-19 pandemic: Evidence from two African countries

This study examines how trust was associated with social distancing during the early days of the COVID-19 pandemic in Burkina Faso and Kenya. It fills gaps in previous research on trust and health by 1) simultaneously considering the relationship of individual- and aggregate-level indicators of trust, and 2) evaluating trust in local government and national government separately. Performance Monitoring for Action (PMA) data on COVID-precautionary measures and individual-level trust measures were spatially linked with aggregated trust data from the Afrobarometer to create a multilevel dataset. PMA data show that women in Kenya were generally more likely to report taking COVID-precautionary measures relative to Burkinabé women, although levels of these measures were high in both countries. Hierarchical logistic models for each country show levels of interpersonal trust mattered more in Burkina Faso. Although the association between individual-level trust in government and social distancing was not statistically significant, overall levels of trust in the region where an individual lived were associated with social distancing. We found a significant interaction effect between regional trust in the national government and regional trust in local government: individuals in regions where trust was high in both national and local government were the most likely to socially distance; individuals in regions with low local government trust but high national government trust were less likely to report social distancing. We unpack possible implications of these findings; they point to the importance of a unified government front within African countries in promoting health safety measures during a pandemic.

Assessing the Impact of Vaccination on the Dynamics of COVID-19 in Africa: A Mathematical Modeling Study

Several effective COVID-19 vaccines are administered to combat the COVID-19 pandemic globally. In most African countries, there is a comparatively limited deployment of vaccination programs. In this work, we develop a mathematical compartmental model to assess the impact of vaccination programs on curtailing the burden of COVID-19 in eight African countries considering SARS-CoV-2 cumulative case data for each country for the third wave of the COVID-19 pandemic. The model stratifies the total population into two subgroups based on individual vaccination status. We use the detection and death rates ratios between vaccinated and unvaccinated individuals to quantify the vaccine's effectiveness in reducing new COVID-19 infections and death, respectively. Additionally, we perform a numerical sensitivity analysis to assess the combined impact of vaccination and reduction in the SARS-CoV-2 transmission due to control measures on the control reproduction number (Rc). Our results reveal that on average, at least 60% of the population in each considered African country should be vaccinated to curtail the pandemic (lower the Rc below one). Moreover, lower values of Rc are possible even when there is a low (10%) or moderate (30%) reduction in the SARS-CoV-2 transmission rate due to NPIs. Combining vaccination programs with various levels of reduction in the transmission rate due to NPI aids in curtailing the pandemic. Additionally, this study shows that vaccination significantly reduces the severity of the disease and death rates despite low efficacy against COVID-19 infections. The African governments need to design vaccination strategies that increase vaccine uptake, such as an incentive-based approach.

COVID-19 vaccine hesitancy: a systematic review of barriers to the uptake of COVID-19 vaccine among adults in Nigeria

Background

Since the outbreak of coronavirus (COVID-19) disease was reported in 2019, huge human and material resources have been expended globally to combat the spread of the disease. Achieving herd immunity through mass vaccination remains an important strategy to adopt in the war against this disease since it is practically impossible for 60-70% of the population to achieve immunity through natural infection alone. Unfortunately, there have been widespread reports of COVID-19 vaccine hesitancy. This study aims to systematically review the literature to provide an up-to-date assessment of COVID-19 vaccine acceptance rates and also explore factors impacting COVID-19 vaccine hesitancy among adults in Nigeria.

Main body of the abstract

A systematic search of indexed electronic peer-reviewed literature published from 2019 onwards was conducted in Science Direct, PubMed, ProQuest, and EBSCOhost databases and reported according to the PRISMA checklist and Synthesis without meta-analysis (SWiM) in systematic review reporting guidelines. Fifteen out of the 148 studies retrieved, met the inclusion criteria and these were critically appraised using the Centre for Evidence-Based Medicine Critical Appraisal checklist and Mixed Methods Appraisal Tool, version 2018. Basic descriptive statistic (percentage) was employed in the analysis of acceptance rates of the COVID-19 vaccine among various subgroups of adults in Nigeria, while a thematic analysis of the facilitators and barriers to the uptake of the COVID-19 vaccine in Nigeria was conducted. Acceptance rates ranging from 24.3% to 49.5% were observed across the four studies conducted among the high-risk populations in Nigeria, while the acceptance rates among the low-risk populations ranged from 26.0% to 86.2%. Themes such as socio-demographic factors, perception of risk factors, and concerns about the vaccine's safety and efficacy act interchangeably as facilitators and barriers to the uptake of COVID-19 vaccines, whereas political factors, conspiracy theories, and cost primarily act as barriers to vaccine uptake.

Short conclusion

Substantial heterogeneity was observed in COVID-19 vaccine acceptance rates among adults in Nigeria. More than half of the studies reviewed reported acceptance rates below 60.0%. A multidisciplinary approach is recommended in engaging important stakeholders, to effectively address COVID-19 vaccine hesitancy in Nigeria.

Examining confidence and hesitancy towards COVID-19 vaccines: A cross-sectional survey using in-person data collection in rural Ghana

BACKGROUND

In Ghana, as of 30 July 2022, around one-third of the eligible population are considered fully-vaccinated against COVID-19, and efforts are being made to increase coverage. Vaccine hesitancy is defined by the World Health Organization (WHO) as the delay in the acceptance, or blunt refusal of, vaccines. This study assesses vaccine hesitancy and confidence in Nkwanta South, a rural municipal in Oti region, Ghana.

METHODS

Data collection within Nkwanta South took place in sub-municipalities of Alokpatsa (11,028 population), Brewaniase (14,483), and Tutukpene (15,453). Data was collected by 47 local residents, known as Community-Based Surveillance Volunteers (CBSVs), using Kobo Toolbox forms on electronic devices (tablets). Information collected included numerous demographic variables, including age, gender, relationship status, and religion. Further questions covered reasons for vaccine hesitancy and COVID-19 vaccine status. Descriptive and inferential statistics assessed the association between variables to identify predictors of hesitancy.

FINDINGS

Across 1500 respondents, 700 (46.7%) reported having received at least one COVID-19 vaccine dose, and 800 (53.3%) reported being unvaccinated against COVID-19. Among unvaccinated respondents, 556 (69.4%) reported willingness to receive the vaccine once available, 190 (23.7%) said they would not be willing to be vaccinated, and 55 (6.9%) said they were unsure. Overall, this represented 30.6% hesitancy within the currently-unvaccinated group. Common reasons for hesitancy included believing that they did not need the vaccine (33.8%), believing the vaccine to be dangerous (30.6%), concerns about side effects (25.3%), and not having enough information (20.1%). Key predictors of hesitancy among our participants included high levels of mistrust, being female, greater years of education, and being Christian.

INTERPRETATION

The information gathered here can inform how best to target national and local health promotion strategies. Locally-tailored efforts, that understand local context and social dynamics, must remain a core component of public health activity to achieve a high vaccine uptake.

COVID-19 vaccine acceptance and associated factors in 13 African countries: A systematic review and meta-analysis

Background

The COVID-19 pandemic has severely affected the entire world, especially sub-Saharan Africa. As a result, researchers and government agencies are working to create effective COVID-19 vaccinations. While vaccination campaigns are moving rapidly in high-income nations, COVID-19 is still ruthlessly affecting people in low-income nations. However, this difference in the spread of the disease is not because of a lack of a COVID-19 vaccine but mainly due to people's reluctance. As a result, this review summarized the data on COVID-19 vaccination adoption and factors related among nations in sub-Saharan Africa.

Method

Comprehensive searches were conducted using PubMed, Embase, Medline, Web of Science, Google Scholar, and the Cochrane Library databases. The risk of bias and methodological quality of each published article that fit the selection criteria were evaluated using Critical Appraisal Checklist tools. All statistical analysis was done by STATA 16.

Results

This review was based on 29 studies with 26,255 participants from sub-Saharan Africa. Using a random-effects model, the pooled prevalence of COVID-19 vaccine acceptance among study participants was 55.04% (95 % CI: 47.80-62.27 %), I2 = 99.55%. Being male [POR = 1.88 (95% CI: 1.45, 2.44)], having a positive attitude toward the COVID-19 vaccine [POR = 5.56 (95% CI: 3.63, 8.51)], having good knowledge in the COVID-19 vaccine [POR = 4.61 (95% CI: 1.24, 8.75)], having government trust [POR = 7.10 (95% CI: 2.37, 21.32)], and having undergone COVID-19 testing in the past [POR = 4.41 (95%CI: (2.51, 7.75)] were significant predictor variables.

Conclusion

This analysis showed that respondents had a decreased pooled prevalence of COVID-19 vaccination acceptance. Sex, attitude, knowledge, government trust, and COVID-19 testing were statistically significantly correlated characteristics that affected the acceptability of the COVID-19 vaccine. All stakeholders should be actively involved in increasing the uptake of the COVID-19 vaccine and thereby reducing the consequences of COVID-19. The acceptance of the COVID-19 vaccination can be increased by using this conclusion as an indicator for governments, healthcare professionals, and health policymakers in their work on attitude, knowledge, government trust, and COVID-19 testing.

COVID-19 vaccine acceptance in sub-Saharan African countries: A systematic review and meta-analysis

Vaccination is the most effective intervention for the primary prevention of COVID-19. Several studies have been conducted in sub-Saharan African countries on the acceptance and associated factors of COVID-19 vaccine. This review and meta-analysis aimed to recapitulate the pooled magnitude of vaccine acceptance and its favoring factors in sub-Saharan African countries. PUBMED, MEDLINE, Science Direct, Web of Science, and SCOPUS were the main databases searched from 15 March to 5 June 2022; and all the articles written in the English language were included. Also, some articles were retrieved from biomedical peer-reviewed journal sites and Google scholar. The quality of thirty-five selected articles was evaluated using an adapted scale for evaluating cross-sectional studies based on the Newcastle-Ottawa Scale. The result of the review and meta-analysis revealed that COVID-19 vaccine acceptance rate varied across studies. In a pooled analysis, factors such as; higher-level perception of infection risk (OR (95% CI (2.7 (2.1, 3.4))), perceived vaccine safety (13.9 (9.2, 20.9)), virus-related good knowledge (2.7 (2.3, 3.2)) and appropriate attitude (5.9 (4.4, 7.8)), adherence to safety precautions (5.5 (4.8, 6.2)), and infection experience (4.4 (2.8, 6.9)) were positively affected the COVID-19 vaccine acceptance. Also, vaccine acceptance was found to be high among males and chronically ill individuals. Thus, understanding factors that enhance vaccine acceptance would support planners to augment vaccine uptake in the region.

Predictors of COVID-19 vaccine hesitancy in Chad: A cross-sectional study

Vaccination against the COVID-19 virus is currently the best option to combat the SARS-CoV-2 pandemic worldwide. However, in addition to logistical and economic barriers, hesitancy to be vaccinated threatens to jeopardize efforts to contain the disease. An increasing number of people in Africa are delaying or rejecting recommended vaccines. Since their launch, COVID-19 vaccines have frequently faced rejection worldwide. In this study, we interviewed 5,174 participants from Chad that were representative of the general population, on their perception of COVID-19 vaccines. The survey was conducted from April to May 2021, before the rollout of the COVID-19 vaccination. We found that 47.9% of respondents were willing to receive the COVID-19 vaccine, 29.8% were undecided and 22.3% would not accept the vaccine. We found that urban residents were much more likely to refuse the vaccine than rural residents. We also observed that distrust of COVID-19 vaccines and mistaken beliefs played a crucial role in the reluctance to be vaccinated. Hesitancy to vaccinate against COVID-19 was strongly associated with lack of knowledge, and acceptance of vaccination was primarily associated with fear of the disease. Finally, we identified population profiles among the undecided and the refractors, which will help in developing strategies to combat COVID-19 vaccine resistance.

Factors Associated with Fatal COVID-19 Outcomes among People Living with HIV: A Cohort Study

BACKGROUND

People living with HIV (PLHIV) are at increased risk of COVID-19 death. However, information about whether factors related to the HIV-infection influence the COVID-19 outcome still remains conflicting.

OBJECTIVE

Here, we evaluate the risk factors for fatal COVID-19 in a cohort of PLHIV from the Moscow region, aged >18 years and diagnosed with COVID-19 between March 2020 and December 2021.

METHODS

Demographic, clinical and laboratory data were compared between different COVID-19 outcomes. To analyze the risk factors associated with COVID-19 death, we employed the logistic regression method. A total of 566 PLHIV were included in the analysis.

RESULTS

The majority of individuals, 338 (59.7%), were male; 194 (34.3%) were on antiretroviral therapy; 296 (52.3%) had a comorbidity; 174 (30.7%) of patients had drug and/or alcohol dependence; 160 (33.1%) patients had CD4 counts <200 cells/μl; 253 (51.9%) had undetectable viral load. Our analysis revealed that PLHIV >55 years old (OR, 12.88 [95% CI, 2.32-71.62]), patients with a viral load of more than 1000 copies/ml (OR, 2.45 [95%CI, 1.01-5.98]) and with CD4 counts <200 cell/μl (OR, 2.54 [95%CI, 1.02-6.28]), as well as with a history of cachexia (OR, 3.62 [95%CI, 1.26-10.39]) and pneumocystis pneumonia (OR, 2.47 [95%CI, 1.03-5.92]), and drug/alcohol dependence (OR, 2.70 [95%CI, 1.36-5.39]) were significantly more likely to die from COVID-19.

CONCLUSION

These data show that people with advanced HIV-1 infection have an increased risk of fatal COVID-19 outcomes and that there is a need to improve this population's access to health services and, hence, increase their survival rates.

Social media use and COVID-19 vaccine status among a nationally representative population sample in Uganda

Objectives

The effect of social media on COVID-19 vaccination behavior is sub-Saharan Africa is unclear. We conducted a study to determine social media use among a random nationally representative sample of adults in Uganda and assessed the association between recent social media use and COVID-19 vaccination uptake.

Methods

We used data from the 2020 general population survey in Uganda, the Population-based HIV Impact Assessment Survey, to identify a probability sample for a mobile phone survey and included nonphone owners in the phone survey by asking phone owners to pass the phone.

Results

In March 2022, of the 1022 survey participants, 213 (20%) did not own a mobile phone, 842 (80%) owned a mobile phone, of whom 199 (24%) indicated social media use, and 643 (76%) of whom did not use social media. Among all participants, the most frequent source of COVID-19 vaccine information was radio. Overall, 62% reported receiving the COVID-19 vaccination. The multivariable logistic regression model found that social media use was not associated with vaccination status.

Conclusion

Social media users in this population sample from Uganda-who were mainly young, urban residents with higher educational attainment-continue to utilize TV, radio and health care workers for public health messages, thus the Government of Uganda should continue to conduct public health communication through these mediums.

Views on COVID-19 vaccination among residents of Eldoret, Kenya during the 2021 vaccine rollout

The Government of Kenya initiated COVID-19 vaccination program in March 2021. However, vaccine uptake remains low, especially in rural areas in Kenya. We interviewed 40 residents of Eldoret town to explore the knowledge, beliefs, and meanings they attach towards vaccines generally, and why they chose to vaccinate or not. Two-thirds of our participants perceived themselves to be at risk of COVID-19 infections. About half demonstrated willingness to be vaccinated and about a third had been vaccinated. All participants were knowledgeable about the broader benefits of vaccination. Yet, widespread beliefs that vaccination programmes target children and pregnant women decreased vaccine acceptance. Also, we found that concerns about vaccine safety, lack of knowledge, misinformation from social media, and conspiracy theories contributed to COVID-19 vaccine hesitancy in Eldoret. Low COVID-19 vaccination rates and hesitancy - even when the vaccines are accessible and free in Kenya - cannot be ignored. The current COVID-19 vaccination prioritisation schedule (distinct from the usual structure where children, childbearing women are prioritised) and beliefs that older people are targeted to test vaccines efficacy must be addressed through improved communication and mass education. More research is needed to investigate the socio-economic, political, and historical factors that influence vaccine hesitancy in Kenya.

Knowledge, Attitudes, and Acceptance of COVID-19 Vaccines among Secondary School Pupils in Zambia: Implications for Future Educational and Sensitisation Programmes

The coronavirus disease 2019 (COVID-19) pandemic resulted in the closure of schools to slow the spread of the virus across populations, and the administration of vaccines to protect people from severe disease, including school children and adolescents. In Zambia, there is currently little information on the acceptance of COVID-19 vaccines among school-going children and adolescents despite their inclusion in the vaccination programme. This study assessed the knowledge, attitudes, and acceptance of COVID-19 vaccines among secondary school pupils in Lusaka, Zambia. A cross-sectional study was conducted from August 2022 to October 2022. Of the 998 participants, 646 (64.7%) were female, and 127 (12.7%) would accept to be vaccinated. Those who were willing to be vaccinated had better knowledge (68.5% vs. 56.3%) and a positive attitude (79.1% vs. 33.7%) compared to those who were hesitant. Overall, the odds of vaccine acceptance were higher among pupils who had higher knowledge scores (AOR = 11.75, 95% CI: 6.51-21.2), positive attitude scores (AOR = 9.85, 95% CI: 4.35-22.2), and those who knew a friend or relative who had died from COVID-19 (AOR = 3.27, 95% CI: 2.14-5.09). The low vaccine acceptance among pupils is of public health concern, emphasising the need for heightened sensitisation programmes that promote vaccine acceptance among pupils in Zambia.

Determinants of COVID-19 vaccine hesitancy and uptake in sub-Saharan Africa: a scoping review

OBJECTIVE

To identify, describe and map the research tools used to measure COVID-19 vaccine hesitancy, refusal, acceptance and access in sub-Saharan Africa (SSA).

DESIGN

Scoping review.

METHODS

In March 2022, we searched PubMed, Scopus, Web of Science, Cochrane, Academic Search Premier, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Health Source Nursing, Africa Wide and APA PsychInfo for peer-reviewed literature in English related to COVID-19 vaccine hesitancy, refusal, acceptance and access in SSA. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews to guide evidence gathering and as a template to present the evidence retrieval process.

RESULTS

In the studies selected for review (n=72), several measurement tools were used to measure COVID-19 vaccine hesitancy, acceptance and refusal. These measurements were willingness and intent to vaccinate from the perspectives of the general population, special population groups such as mothers, students and staff in academic institutions and healthcare workers and uptake as a proxy for measuring assumed COVID-19 vaccine acceptance. Measurements of access to COVID-19 vaccination were cost and affordability, convenience, distance and time to travel or time waiting for a vaccine and (dis)comfort. Although all studies measured COVID-19 vaccine hesitancy, acceptance and refusal, relatively few studies (n=16, 22.2%) included explicit measurements of access to COVID-19 vaccination.

CONCLUSIONS

Based on the gaps identified in the scoping review, we propose that future research on determinants of COVID-19 vaccination in SSA should further prioritise the inclusion of access-related variables. We recommend the development and use of standardised research tools that can operationalise, measure and disentangle the complex determinants of vaccine uptake in future studies throughout SSA and other low- and middle-income country (LMIC) settings.

Persisting Vaccine Hesitancy in Africa: The Whys, Global Public Health Consequences and Ways-Out-COVID-19 Vaccination Acceptance Rates as Case-in-Point

Vaccine hesitancy (VH) is the seventh among the WHO's top 10 threats to global public health, which has continued to perpetuate the transmission of vaccine preventable diseases (VPDs) in Africa. Consequently, this paper systematically reviewed COVID-19 vaccine acceptance rates (VARs)-including the vaccine uptake and vaccination intention-in Africa from 2020 to 2022, compared the rates within the five African regions and determined the context-specific causes of VH in Africa. Generally, COVID-19 VARs ranged from 21.0% to 97.9% and 8.2% to 92.0% with mean rates of 59.8 ± 3.8% and 58.0 ± 2.4% in 2021 and 2022, respectively. Southern and eastern African regions had the top two VARs of 83.5 ± 6.3% and 68.9 ± 6.6% in 2021, and 64.2 ± 4.6% and 61.2 ± 5.1% in 2022, respectively. Based on population types, healthcare workers had a marginal increase in their mean COVID-19 VARs from 55.5 ± 5.6% in 2021 to 60.8 ± 5.3% in 2022. In other populations, the mean VARs decreased from 62.7 ± 5.2% in 2021 to 54.5 ± 4% in 2022. As of 25 October 2022, Africa lags behind the world with only 24% full COVID-19 vaccinations compared to 84%, 79% and 63% reported, respectively, in the Australian continent, upper-middle-income countries and globally. Apart from the problems of confidence, complacency, convenience, communications and context, the context-specific factors driving COVID-19 VH in Africa are global COVID-19 vaccine inequality, lack of vaccine production/maintenance facilities, insecurity, high illiteracy level, endemic corruption, mistrust in some political leaders, the spreading of unconfirmed anti-vaccination rumors and political instability. With an overall mean COVID-19 acceptance rate of 58%, VH still subsists in Africa. The low VARs in Africa have detrimental global public health implications, as it could facilitate the emergence of immune invading SARS-CoV-2 variants of concern, which may spread globally. Consequently, there is a need to confront these challenges frontally and engage traditional and religious leaders in the fight against VH in Africa, to restore public trust in the safety and efficacy of vaccines generally. As the availability of COVID-19 vaccines improves, the vaccination of pets and zoo-animals from which reverse zoonotic transmission of SARS-CoV-2 have been reported is recommended, to limit the evolution and spread of new variants of concern and avert possible SARS-CoV-2 epizootic or panzootic diseases in susceptible animal species.

Willingness to Accept COVID-19 Vaccine and Associated Factors Among Adult Household Members in Dire Dawa City Administration, East Ethiopia

Background

COVID-19 vaccine is a vital strategy to prevent and control this pandemic. This will depend principally on people's acceptance of COVID-19 vaccine. We aimed to determine the willingness to accept COVID vaccine among adult household members of Dire Dawa city administration.

Methods

A community-based cross-sectional study was conducted among randomly selected 634 adult household members in the Dire Dawa city administration during January 16-31/2022. Data were collected using face-to-face interview. Extent of willingness was estimated using participants' self-report. Bivariate and multivariate logistic regression models were fitted, and statistical significance was set at p-value <0.05.

Results

The estimated willingness to accept COVID-19 vaccine was 28.4% (95% CI 25.1, 31.5) in the study setting. The odds of willingness to accept COVID-19 vaccine was higher for household members living without at least one chronic disease (AOR 1.7, 95% CI 1.10, 2.70), who had good knowledge score (AOR 2.3, 95% CI 1.31, 2.18) and positive attitude score (AOR 5.5, 95% CI 2.1, 14.5) compared to their counterparts, respectively. The estimated willingness to accept COVID-19 vaccine among household members with good knowledge score was 47.4 (95% CI 42.1, 52.7) and 15.5 (95% CI 8.7, 22.2) among those with poor knowledge. Nearly, 90% of the study participants had limited knowledge about COVID 19 vaccine.

Conclusion

The estimated willingness to accept COVID-19 vaccine in the study setting is very low and far from the set target to be reached by the end of 2022. Being free from chronic disease, and having good knowledge and positive attitude about COVID-19 vaccine were the main drivers for willingness. Public awareness directed to increase knowledge about COVID-19 vaccine and attitude change strategies should be scaled up to increase the COVID-19 vaccine uptake. Moreover, those individuals with chronic diseases need special attention.

Perception towards vaccine effectiveness in controlling COVID-19 spread in rural and urban communities: A global survey

Introduction

Several studies exhibited varying reports of perception toward vaccine effectiveness, vaccine hesitancy, and acceptance of COVID-19 vaccines. As this fluctuated with evidence generation, this study explored the perception toward vaccine effectiveness in rural and urban communities among various countries.

Methods

A cross-sectional study was conducted online from April to August 2021 using convenience sampling among people from different countries approved by the Asia Metropolitan University Medical Research and Ethics. We adapted the questionnaire from the World Health Organization's (WHO) survey tool and guidance on COVID-19. The logistic regression models were performed to show perception toward vaccine effectiveness.

Results

A total of 5,673 participants responded to the online survey. Overall, 64% of participants agreed that the vaccine effectively controlled viral spread, and 23% agreed that there was no need for vaccination if others were vaccinated. Males had 14% higher odds of believing that there was no need for vaccination. Less social media users had 39% higher odds of developing the belief that there is no need for vaccination than all other people vaccinated.

Conclusion

People's perceptions toward vaccine acceptance have fluctuated with the information flow in various social media and the severity of COVID-19 cases. Therefore, it is important that the current scenario of peoples' perception toward vaccine acceptance and determinants affecting the acceptance are explored to promote the vaccination approach against COVID-19 prevention and transmission effectively.

Improving COVID-19 Vaccine Uptake among Black Populations: A Systematic Review of Strategies

Given the growing body of evidence on COVID-19 vaccine hesitancy among Black populations, the aim of this systematic review was to identify the interventions and strategies used to improve COVID-19 vaccine confidence and uptake among Black populations globally. To identify relevant studies, we conducted a systematic review of the literature based on a systematic search of 10 electronic databases: MEDLINE, Embase, PsycINFO, CINAHL, Scopus, Cochrane Library, Web of Science, Sociological Abstracts, Dissertations and Theses Global, and SocINDEX. We screened a total of 1728 records and included 14 peer-reviewed interventional studies that were conducted to address COVID-19 vaccine hesitancy among Black populations. A critical appraisal of the included studies was performed using the Newcastle-Ottawa Quality Assessment Scale. The intervention strategies for increasing COVID-19 vaccine uptake were synthesized into three major categories: communication and information-based interventions, mandate-based interventions, and incentive-based interventions. Interventions that incorporated communication, community engagement, and culturally inclusive resources significantly improved vaccine uptake among Black populations, while incentive- and mandate-based interventions had less impact. Overall, this systematic review revealed that consideration of the sociocultural, historical, and political contexts of Black populations is important, but tailored interventions that integrate culture-affirming strategies are more likely to decrease COVID-19 vaccine hesitancy and increase uptake among Black populations.

Coronavirus Disease 2019 (COVID-19) Pandemic across Africa: Current Status of Vaccinations and Implications for the Future

The introduction of effective vaccines in December 2020 marked a significant step forward in the global response to COVID-19. Given concerns with access, acceptability, and hesitancy across Africa, there is a need to describe the current status of vaccine uptake in the continent. An exploratory study was undertaken to investigate these aspects, current challenges, and lessons learnt across Africa to provide future direction. Senior personnel across 14 African countries completed a self-administered questionnaire, with a descriptive analysis of the data. Vaccine roll-out commenced in March 2021 in most countries. COVID-19 vaccination coverage varied from low in Cameroon and Tanzania and up to 39.85% full coverage in Botswana at the end of 2021; that is, all doses advocated by initial protocols versus the total population, with rates increasing to 58.4% in Botswana by the end of June 2022. The greatest increase in people being fully vaccinated was observed in Uganda (20.4% increase), Botswana (18.5% increase), and Zambia (17.9% increase). Most vaccines were obtained through WHO-COVAX agreements. Initially, vaccination was prioritised for healthcare workers (HCWs), the elderly, adults with co-morbidities, and other at-risk groups, with countries now commencing vaccination among children and administering booster doses. Challenges included irregular supply and considerable hesitancy arising from misinformation fuelled by social media activities. Overall, there was fair to reasonable access to vaccination across countries, enhanced by government initiatives. Vaccine hesitancy must be addressed with context-specific interventions, including proactive programmes among HCWs, medical journalists, and the public.

COVID-19 Vaccine Acceptance Level in Ethiopia: A Systematic Review and Meta-Analysis

Background

The coronavirus disease 2019 pandemic has had a devastating impact on the everyday lives of the world's population and to this end, the development of curative vaccines was upheld as a welcome panacea. Despite the undeniable negative impact of the disease on human beings, lower than expected proportions of people have taken up the vaccines, particularly in the developing non-Western world. Ethiopia represents an interesting case example, of a nation where COVID-19 vaccine acceptance levels have not been well investigated and a need exists to assess the overall level of vaccine acceptance.

Methods

A systematic multidatabase search for relevant articles was carried out across Google Scholar, Web of Science, Science Direct, Hinari, EMBASE, Boolean operator, and PubMed. Two reviewers independently selected, reviewed, screened, and extracted data by using a Microsoft Excel spreadsheet. The Joanna Briggs Institute prevalence critical appraisal tools and the modified NewcastleOttawa Scale (NOS) were used to assess the quality of evidence. All studies conducted in Ethiopia, reporting vaccine acceptance rates were incorporated. The extracted data were imported into the comprehensive meta-analysis version 3.0 for further analysis. Heterogeneity was confirmed using Higgins's method, and publication bias was checked by using Beggs and Eggers tests. A random-effects meta-analysis model with a 95% confidence interval was computed to estimate the pooled prevalence. Furthermore, subgroup analysis based on the study area and sample size was done. Results and Conclusion. After reviewing 67 sources, 18 articles fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of COVID-19 vaccine acceptance in Ethiopia was 57.8% (95% CI: 47.2%–67.8%). The level of COVID-19 vaccine acceptance in Ethiopia was at a lower rate than necessary to achieve herd immunity. The highest level of vaccine acceptance rate was reported via online or telephone surveys followed by the southern region of Ethiopia. The lowest vaccine acceptance patterns were reported in Addis Ababa.

COVID-19 vaccine hesitancy in Africa: a scoping review

Background

Vaccination against the novel coronavirus is one of the most effective strategies for combating the global Coronavirus disease (COVID-19) pandemic. However, vaccine hesitancy has emerged as a major obstacle in several regions of the world, including Africa. The objective of this rapid review was to summarize the literature on COVID-19 vaccine hesitancy in Africa.

Methods

We searched Scopus, Web of Science, African Index Medicus, and OVID Medline for studies published from January 1, 2020, to March 8, 2022, examining acceptance or hesitancy towards the COVID-19 vaccine in Africa. Study characteristics and reasons for COVID-19 vaccine acceptance were extracted from the included articles.

Results

A total of 71 articles met the eligibility criteria and were included in the review. Majority (n = 25, 35%) of the studies were conducted in Ethiopia. Studies conducted in Botswana, Cameroun, Cote D’Ivoire, DR Congo, Ghana, Kenya, Morocco, Mozambique, Nigeria, Somalia, South Africa, Sudan, Togo, Uganda, Zambia, Zimbabwe were also included in the review. The vaccine acceptance rate ranged from 6.9 to 97.9%. The major reasons for vaccine hesitancy were concerns with vaccine safety and side effects, lack of trust for pharmaceutical industries and misinformation or conflicting information from the media. Factors associated with positive attitudes towards the vaccine included being male, having a higher level of education, and fear of contracting the virus.

Conclusions

Our review demonstrated the contextualized and multifaceted reasons inhibiting or encouraging vaccine uptake in African countries. This evidence is key to operationalizing interventions based on facts as opposed to assumptions. Our paper provided important considerations for addressing the challenge of COVID-19 vaccine hesitancy and blunting the impact of the pandemic in Africa.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41256-022-00255-1.

Commentary on COVID-19 Vaccine Hesitancy in sub-Saharan Africa

Rates of vaccination against COVID-19 remain lower in sub-Saharan Africa than in other low and middle-income regions. This is, in part, attributed to vaccine hesitancy, mainly due to misinformation about vaccine origin, efficacy and safety. From August to December 2021, we gathered the latest experiences and opinions on four vaccine hesitancy-related areas (policies, perceived risk religious beliefs, and misinformation) from 12 sub-Saharan African researchers, four of whom have published about COVID-19 vaccine hesitancy. The authors included two political and business experts, six public health specialists, five epidemiologists, and four biostatisticians from ten sub-Saharan African countries( Cameroon, Ghana, Kenya, Liberia, Nigeria, Sierra Leone, South Africa, Tanzania, Uganda, and Zimbabwe). The authors’ overarching opinions were that political influences, religious beliefs and low perceived risk exists in sub-Saharan Africa, and they collectively contribute to COVID-19 vaccine hesitancy. Communication strategies should target populations initially thought by policy makers to be at low risk, use multiple communication avenues and address major concerns in the population.

COVID-19 vaccine acceptance and hesitancy in N'Djamena, Chad: A cross-sectional study of patients, community members, and healthcare workers

As of March 2022, the COVID-19 vaccination rate in Chad approximated 1%. There are no published reports of COVID-19 vaccine hesitancy or beliefs in Chad. We aimed to study COVID-19 vaccine acceptance and hesitancy among community members, patients, and health care workers in urban Chad. We recruited a prospective convenience sample of adult patients, community members, and healthcare workers from N'Djamena, Chad between August-October 2021. Participants completed a 15-minute, 25-question survey instrument exploring demographic, social, and clinical variables related to COVID-19 and an adapted WHO SAGE Vaccine Hesitancy Survey. Primary outcomes were vaccine acceptance and vaccine hesitancy. Regression models were fit to assess associations between Vaccine Hesitancy Scale (VHS) scores, ranging from 10 (least hesitant) to 50 (most hesitant) points, and pre-selected variables of interest. An inductive thematic analysis was used to analyze the qualitative vaccine hesitancy responses. Of 508 participants (32% female; mean age 32 years), 162 were patients, 153 were community members, and 193 were healthcare workers. COVID-19 vaccine acceptance was significantly higher among patients (67%) than community members (44%) or healthcare workers (47%), p < .001. The average VHS score was 29 points (patients = 27.0, community members = 28.9, healthcare workers = 29.4), and more than one-third of participants were classified as highly vaccine hesitant (score >30 points). Knowing someone who died from COVID-19, believing local healthcare workers support vaccination, trusting the government, having a higher socioeconomic status (i.e. having electricity), and reporting medical comorbidities were each associated with less vaccine hesitancy (all p < .05). The vaccine concerns most frequently endorsed were: vaccine side effects (48%), efficacy (38%), safety (34%), concerns about the pharmaceutical industry (27%), and lack of government trust (21%). Four main themes arose from qualitative vaccine hesitancy responses (n = 116): education, trust, clinical concerns, and misinformation and false beliefs. Overall, COVID-19 vaccine acceptance was low, including among health care workers, and reasons for vaccine hesitancy were broad. We detail the most commonly reported concerns of urban Chadians for receiving the COVID-19 vaccine; we also identify subgroups most likely to endorse vaccine hesitancy. These analyses may inform future vaccination outreach campaigns in N'Djamena.

Attitudes toward COVID-19 Vaccines among Patients with Complex Non-Communicable Disease and Their Caregivers in Rural Malawi

Current low COVID-19 vaccination rates in low- and middle-income countries reflect an inequitable global vaccine distribution; however, local attitudes towards the COVID-19 vaccine are an important factor to meet vaccination benchmarks. We describe attitudes toward the uptake of the COVID-19 vaccine and perceptions among patients with NCDs and their caregivers using cross-sectional data collected through telephone interviews in Neno, Malawi. Out of 126 survey respondents, 71% were patients, and 29% were caregivers. Twenty-two percent of respondents had received at least one dose at the interview (95% CI: 15–30%), with 19% being fully vaccinated. Only 24% (95% CI: 12–40%) of unvaccinated respondents reported that they would accept an approved vaccine if it were offered today. Vaccines were perceived as unsafe or designed to harm and commonly associated with death, severe disability, infertility, and evil. However, over two-thirds reported high levels of trust in health care workers (73%) and community health workers (72%) as sources of information for the COVID-19 vaccine. Although the uptake of COVID-19 vaccine in this vulnerable population was three times than the national average, a low intention to be vaccinated persists among the unvaccinated. Strong trust in health care workers suggests that community engagement could help increase vaccine acceptance.

Acceptance of COVID-19 Vaccines among Adults in Lilongwe, Malawi: A Cross-Sectional Study Based on the Health Belief Model

The COVID-19 pandemic has had a significant economic and social impact on Malawi. Promoting vaccination is a key protection measure against COVID-19. Employing the health beliefs model (HBM), this study explores various factors that influence COVID-19 vaccination acceptance (intentions and behavior) among adult residents of Malawi. A semi-structured questionnaire was used for data collection. A field-based survey was conducted among adult residents in Lilongwe, Malawi. Descriptive statistics, linear regression, the Chi-square test, and Pearson's correlation statistics were used for data analysis. A total of 758 questionnaires were involved. Respondents aged 18-24 (OR = 5.079, 95% CI 2.303-11.202), 25-34 (OR = 2.723, 95% CI 1.363-5.438), urban residents (OR = 1.915, 95% CI 1.151-3.187), graduates/professionals (OR = 1.193, 95% CI 0.857-1.651), health workers (OR = 4.080, 95% CI 1.387-12.000), perceived susceptibility (OR = 1.787, 95% CI 1.226-2.605), perceived benefit (OR = 2.992, 95% CI 1.851-4.834), and action cues (OR = 2.001, 95% CI 1.285-3.115) were predictors for "acceptance of COVID-19 vaccine". The health belief model structure can be used as a good predictor of vaccine acceptance, especially "perceived susceptibility," "perceived benefit," and "action cues". Strengthening COVID-19 vaccine education in these areas will be an important future intervention.

Progress with COVID-19 vaccination in the WHO African Region in 2021

INTRODUCTION

as of end 2021, ten different vaccines have received Emergency use listing by the World Health Organisation. The vaccination response to the COVID pandemic started in February 2021 in the WHO African Region. WHO proposed a national coverage target of fully vaccinated population of 40% by the end of December 2021. This manuscript attempts to review the progress in the roll-out of COVID-19 vaccination in the African Region.

METHODS

we analysed the aggregate COVID-19 vaccine uptake and utilization data from the immunisation monitoring databases set up by countries and shared with the WHO Regional Office for Africa.

RESULTS

as of 31 December 2021, a total of 340,663,156 doses of COVID-19 vaccine were received in 46 countries in the African Region. The weekly average doses administered was 4,069,934 throughout the year. In the same period, a total of 114,498,980 persons received at least one dose, and 71,862,108 people were fully vaccinated, amounting to 6.6% of the total population in the Region. Only 5 countries attained the target of 40% full vaccination coverage. Disaggregated information was not available from all countries on the number of persons vaccinated by gender, and according to the priority population groupings. A total of 102,046 cases of adverse events following immunisation (AEFIs) were reported among which 6,260 (6.1%) were labelled as severe AEFIs.

CONCLUSION

COVID-19 vaccination coverage remains very low in the African Region, with all but 5 countries missing the 40% coverage target as of December 2021. Countries, donors and partners should mobilise political will and resources towards the attainment of the coverage targets. Countries will need to implement vaccination efforts using tailored approaches to reach unreached populations. The reporting gaps indicate the need to invest on efforts to improve the capture, analysis and use of more granular program data.

The first year of COVID-19 vaccine roll-out in Africa: challenges and lessons learned

Introduction

in the first year following the introduction of COVID-19 vaccines, only 6.8% of the total population in the 47 countries in the WHO African Region have received full vaccination. In an emergency context, the intra-action review helps countries to assess their progress and document what has worked and not worked.

Methods

we reviewed and identified the key lessons and challenges documented in the reports from intra-action review of COVID vaccine roll out in 22 African countries.

Results

all countries documented high level political commitment, but a serious shortage of COVID-19 vaccines and funding. Seven countries identified gaps in microplanning because of lack of funding or due to the unpredictability in the type and volume of vaccine supplies. The shortage of operational funding also affected training of health workers and hampered the expansion of service delivery. The countries implemented multi-channel communications and social mobilisation activities, alongside social media engagement and social listening. However, country capacity was limited in terms of timely responding to infodemics. Hesitancy among health workers and the general population was a challenge in most of the countries.

Conclusion

countries have gained valuable experiences exploring various COVID-19 vaccination delivery models, including implementing the integration of COVID-19 vaccination within routine health care programs. There is a need to regularly monitor or do studies measuring public perceptions towards COVID-19 vaccination in order to drive the demand generation efforts, as well as use evidence in addressing hesitancy.