Will Africans take COVID-19 vaccination?

Attitudes towards COVID-19 vaccination: A cross sectional study in the Federal Capital Territory, Nigeria

Vaccine acceptance is complex and context-specific, varying across time, place and perceived behavioural nature of the community involved. A high vaccine acceptance rate is important to achieve herd immunity, however, vaccine hesitancy is a possible barrier to this. This study aimed to assess attitudes towards COVID-19 vaccination and associated factors. A cross-sectional survey was undertaken to investigate the attitudes of Federal Capital Territory residents towards COVID-19 vaccine uptake in Nigeria. Data were collected using questionnaires which were administered to respondents physically and online through random and snowball sampling strategies respectively. Data received were then analysed using Statistical Package for Social Sciences (SPSS). A total of 1767 responses were received with males representing 57.8% of the sample. More than half (54.9%) of the respondents were between the ages of 18-30 years. A third (35.4%) of the study participants indicated that a vaccine was not necessary for COVID-19, and 56.5% indicated willingness to accept COVID-19 vaccination. The majority of the sample (56.9%) indicated that the government decision-making was in their best interest, whilst close to two-thirds of the respondents (61%) were of the view that COVID-19 vaccination should not be made compulsory. Older respondents as represented by those over 60 years were more likely to accept COVID-19 vaccination (p = 0.039). This study however revealed negative attitudes towards COVID-19 vaccination, indicating the urgent need for government, policymakers, and other stakeholders to prioritise the development of strategies that can appropriately address vaccine hesitancy in the study setting. Contextual interventions indicated include strategic public enlightenment campaigns targeting populations with less favourable dispositions towards being vaccinated.

Despite misinformation, low trust, and conflict in Somalia, high demand for vaccines and a negative endorsement effect of non-state authorities

Expanding vaccination coverage in conflict regions is crucial to the prevention of further mutations and outbreaks of COVID-19, as well as of future pandemics, worldwide. However, scholars' suppositions that low levels of trust and control over the flow of misinformation in these regions may necessitate tailored solutions-in particular, that health advice come from trusted non-state authorities-remain largely untested. To better understand the levels and drivers of COVID-19 vaccine receptivity in conflict regions, we partnered with the United Nations and the Somali Ministry of Justice to field a three-wave panel survey ([Formula: see text] = 1672; [Formula: see text] = 880; [Formula: see text] = 908) and vaccine endorsement experiment in South Central Somalia. We observe high overall demand for vaccines (between 90 and 94%), particularly among those who have experienced violence and illness, who perceive high economic disruption due to the pandemic, and who report more favorable views of and exposure to the West and Western-affiliated organizations. The high overall demand is particularly striking given respondents' low interpersonal trust and considerable exposure to vaccine disinformation. Contrary to scholars' and policymakers' expectations, we find that whereas endorsements from government health authorities increase vaccine receptivity, endorsements from non-state customary authorities and extremist militant group Al-Shabaab decrease support for vaccination (- 8 and - 16% points, respectively). Our findings caution against presupposing a need for different approaches to increasing vaccination coverage in conflict regions, and suggest that at least in the short-term, constraints on vaccine supply and access are more likely to bind than those on demand.

COVID-19 Vaccine Hesitancy Among Older Adults in a Geriatric Centre in Nigeria

Introduction Despite the proven efficacy of COVID-19 vaccines, there is a significant level of hesitancy, particularly among the elderly population in Nigeria. The research investigates factors associated with COVID-19 vaccine hesitancy among older persons attending Geriatric Centers in southwestern Nigeria. Methods This was a cross-sectional study of 332 older adults (≥60 years). Sociodemographic characteristics, attitudes, beliefs, psychological antecedents, sources of information, and perceived sensitivity to the COVID-19 vaccine were explored. Bivariate and multivariate analyses were performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 27.0, Armonk, NY) at a 0.05 significance level. Results The mean age of the respondents was 71.8±7.3 years. The prevalence of COVID-19 vaccine hesitancy was 43.1%. Predictors of COVID-19 hesitancy were not knowing where to get vaccination OR=7.058 (1.745-28.542), did not think vaccines are safe OR=8.767 (2.250-34.159), worries about unforeseen future effects OR=1.111 (1.004-1.227), preference for natural immunity OR=1.170 (1.036-1.321). Discussion COVID-19 vaccine hesitancy was high in our study. Our study underscores the importance of community engagement, education, and communication strategies tailored to the needs and perceptions of the older population in Nigeria.

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.

Predictors of willingness to accept COVID-19 vaccine among adults

Background

Vaccines are an effective and ultimate solution that can decrease the burden of coronavirus disease 2019 worldwide. However, poor knowledge and unwillingness to accept this vaccine are key barriers to manage the COVID-19 pandemic in different countries including Ethiopia. Control of the pandemic will depend on the acceptance of coronavirus disease vaccine. However, there is a paucity of evidence on coronavirus disease vaccine acceptance in the study area. The current study was aimed to assess willingness to accept the COVID-19 vaccine and associated factors among adult clients attending Bule Hora University Teaching Hospital, West Guji Zone, southern Ethiopia.

Methods

An institution-based cross-sectional study was conducted among 385 study participants selected by a systematic random sampling technique. Data was collected through observation and structured questionnaires from April 10 to May 30, 2022. The collected data was cleaned and entered into EpiData 3.1 software before being exported to SPSS 25 statistical software for analysis. Bi-variable and multi-variable binary logistic regression model was used to identify the predictors of COVID-19 vaccine acceptance. The strength of association was measured using AOR with 95% confidence interval and significance was declared at p- value < 0.05.

Result

Magnitude of willingness to accept coronavirus disease-19 vaccine was 67.5% (95%Cl: 63-72). Good knowledge [AOR = 2.07, (1.17-3.64)], history of chronic disease [AOR = 2.59, (1.4-4.78)], being a government employee [AOR = 2.35 (1.1-5)], having a favorable attitude [AOR = 14.15 (5.25-37.46)], and good adherence [AOR = 1.74 (1.02-2.97)] were factors that significantly associated with willingness to accept the coronavirus disease 2019 vaccine.

Conclusion

Magnitude of willingness to accept the COVID-19 vaccine was considerable and needs to be improved. Knowledge, attitude, chronic illness, adherence, and being a government employee were factors that associated with willingness to accept the vaccine. Community awareness, advocacy, social mobilization and health education should be given at different levels.

Understanding Sociodemographic Factors and Reasons Associated with COVID-19 Vaccination Hesitance among Adults in Tanzania: A Mixed-Method Approach

Although studies on COVID-19 vaccine hesitancy are being undertaken widely worldwide, there is limited evidence in Tanzania. This study aims to assess the sociodemographic factors associated with COVID-19 vaccine hesitancy and the reasons given by unvaccinated study participants. We conducted a mixed-method cross-sectional study with two components-health facilities and communities-between March and September 2022. A structured questionnaire and in-depth interviews were used to collect quantitative and qualitative data, respectively. A total of 1,508 individuals agreed to participate in the survey and explained why they had not vaccinated against COVID-19. Of these participants, 62% indicated they would accept the vaccine, whereas 38% expressed skepticism. In a multivariate regression analysis, adult study participants 40 years and older were significantly more likely to report not intending to be vaccinated (adjusted odds ratio [AOR], 1.28; 95% CI, 1.01-1.61; P = 0.04) than youth and middle-aged study participants between 18 and 40 years. Furthermore, female study participants had a greater likelihood of not intending to be vaccinated (AOR, 1.51; 95% CI, 1.19-1.90; P = 0.001) than male study participants. The study identified fear of safety and short-term side effects, and lack of trust of the COVID-19 vaccine; belief in spiritual or religious views; and belief in local remedies and other precautions or preventive measures as the major contributors to COVID-19 vaccine hesitancy in Tanzania. Further empirical studies are needed to confirm these findings and to understand more fully the reasons for vaccine hesitancy in different demographic groups.

Validation of the vaccination attitudes examination scale in a South African context in relation to the COVID-19 vaccine: quantifying dimensionality with bifactor indices

BACKGROUND

The COVID-19 pandemic represented a global public health emergency. Existing studies support the view that vaccination and mass immunization are among the most effective means of containing the outbreak and promoting health. However, negative attitudes toward vaccination and the related vaccine hesitancy among many groups have created a significant barrier to effectively managing the health crisis. Having a valid and reliable tool to assess attitudes toward vaccination remains imperative so that factors underlying vaccine refusal can be identified and public health interventions can be facilitated. The current study examined the psychometric properties of the Vaccination Attitudes Examination Scale (VAX) in South Africa.

METHODS

Participants (n = 322) completed the VAX. Confirmatory factor analysis and ancillary bifactor indices were used to examine the hypothesized factor structure (a total scale and four subscales) of the scale. Inter-item correlations, factor loadings, and average variance extracted were used to examine the validity of the scale. Predictive validity was examined by comparing those who had received the COVID-19 vaccine and those who had not. The reliability of the scale was examined in terms of both Cronbach's alpha and composite reliability.

RESULTS

Confirmatory factor analysis provided support for the conceptualization of the scale as consisting of a total scale and four subscales, and ancillary bifactor indices indicated that the subscales accounted for a sufficient amount of variance (44%) after the variance explained by the total scale was considered. Overall, the analysis indicated that the scale had satisfactory reliability (alpha and composite reliability = 0.70) and provided evidence for the construct, convergent, and predictive validity of the VAX.

CONCLUSIONS

The sound psychometric qualities of the scale, when used in a low- to middle-income country, have the potential to advance research and immunization policy within these settings and facilitate more targeted interventions to promote vaccine uptake.

Correlates of COVID-19 vaccination intentions and opinions about mandates among four groups of adults in South Africa with distinct vaccine intentions: evidence from a large national survey

INTRODUCTION

Despite a high number of recorded COVID-19 infections and deaths in South Africa, COVID-19 vaccine coverage remained low in March 2022, ten months into the national vaccine roll-out. This study provides evidence on the correlates of vaccine intentions, attitudes towards vaccination and opinions about mandates.

METHODS

We used data from the second COVID-19 Vaccine Survey (CVACS), a telephone survey conducted February-March 2022 among 3,608 South African adults who self-reported not being vaccinated against COVID-19. The survey instrument was designed in consultation with government, policymakers, and civil society; and segmented the sample into four distinct groups with different vaccine intentions (synonymous with vaccine hesitancy levels). Kruskal-Wallis and Mann-Whitney tests were used to examine the sociodemographic characteristics, attitudes and behaviours associated with the different vaccination intentions groups. Thematic coding of responses to open-ended questions elicited insights on reasons for not being vaccinated and attitudes towards mandates.

RESULTS

Intentions to get vaccinated were greater among individuals with lower socio-economic status (Mann-Whitney Z = -11.3, p < 0.001); those believing the vaccine protects against death (Kruskal-Wallis Χ2 = 494, p < 0.001); and those who perceived themselves at risk of COVID-19-related illness (Χ2 = 126, p < 0.01). Vaccine intentions were lower among individuals who believed that the vaccine causes death (Χ2 = 163, p < 0.001); believed that the vaccine is unsafe for the babies of pregnant/breastfeeding mothers, or the chronically ill (Χ2 = 123, p < 0.01); those not trusting government health information about COVID-19 and the COVID-19 vaccine (Kendall's τ = -0.41, p < 0.01); and those in opposition to mandates (τ = 0.35, p < 0.001). Only 25% supported mandates, despite 48% thinking mandates would work well, with 54% citing individual rights as their main reason for mandate opposition.

CONCLUSION

The profile of individuals not vaccinated against COVID-19 as of March 2022 varied markedly by self-reported vaccination intentions, underscoring the importance of tailored demand-creation efforts. This paper highlights several factors which differ significantly across these groups. These findings could inform the design of future vaccination campaigns, potentially increasing their likelihood of success. This is an important policy objective given widespread vaccine hesitancy, and further work is required on this topic. Mandates remain an option to increase coverage but need to be carefully considered given extensive opposition.

Hesitancy toward vaccination against COVID-19: A scoping review of prevalence and associated factors in the Arab world

Despite widespread availability of vaccines against SARS-CoV-2 virus, the cause of Coronavirus Disease 2019 (COVID-19), its uptake in many Arab countries is relatively low. This literature review aimed to scope evidence on COVID-19 vaccine hesitancy (VH) in the Arab world. A total of 134 articles reporting prevalence of COVID-19 VH and associated factors, conducted in any of the 22 Arab League countries, were reviewed. COVID-19 VH prevalence ranged from 5.4% to 83.0%. Female gender, young age, low education level and lack of previous influenza vaccine uptake were most commonly reported to be associated with COVID-19 VH. The most-reported personal concerns contributing toward VH were related to the rapid development, safety and side effects of vaccine, as well as an overall lack of trust in government policies toward pandemic control and widespread conspiracy theories. Tailored interventions to enable the distribution of trusted information and enhance public acceptance of immunization are warranted.

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.

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.

Is knowledge about COVID-19 associated with willingness to receive vaccine, vaccine uptake, and vaccine booster uptake in rural Malang, Indonesia?

Background

Lack of knowledge regarding the coronavirus disease (COVID-19) and COVID-19 vaccines is a key barrier to COVID-19 vaccine uptake in low- and middle-income countries (LMICs).

Aims

To examine factors associated with knowledge about COVID-19 and the association between knowledge of COVID-19, willingness to receive a COVID-19 vaccine, and vaccine uptake in Malang, East Java, Indonesia.

Method

A cross-sectional study among individuals aged 15-99 years was conducted in Malang, Java Timur, Indonesia between November 2022 and January 2023. Of 10,050 potential respondents, 10,007 were able to complete the survey. The main independent variable was knowledge about COVID-19, which was assessed using a six-item questionnaire. The dependent variables were COVID-19 vaccine uptake and COVID-19 booster vaccine uptake. The mediating variable was respondent's willingness to receive a COVID-19 vaccine. Linear regression was used to examine factors associated with knowledge about COVID-19. Logistic regression was employed to examine the association of knowledge about COVID-19 with vaccine uptake. Generalized structural equation modeling (GSEM) was performed to examine whether willingness to receive a vaccine mediated the association between knowledge about COVID-19 and vaccination uptake.

Findings

The percentage of respondents who reported having received at least one dose of a COVID-19 vaccine was 94.8%, while the percentage of those who reported having received at least three doses was 88.5%. These numbers are higher than the national average for COVID-19 vaccine and booster vaccine uptake. Most respondents answered about four of six knowledge items correctly (M = 4.60, SD = 1.1). Among respondents who had not received a vaccine, 83.1% expressed willingness to receive a vaccine when it became available to them. Older, more educated, employed respondents, and those with higher economic status, demonstrated more accurate knowledge about COVID-19 than younger, less educated, unemployed respondents and those with lower economic status. Respondents who demonstrated more accurate knowledge about COVID-19 were more likely to have received a vaccine (OR = 1.528, 95% CI = 1.428-1.634) and a booster vaccine (OR = 1.260, 95% CI = 1.196-1.328). Willingness to receive a vaccine mediated the association between knowledge about COVID-19 and vaccine uptake (coef. = 0.426, 95% CI = 0.379-0.473).

Implications

Interventions and public health programs aiming to improve knowledge about COVID-19 can be implemented to improve individual willingness to receive COVID-19 vaccination and to improve COVID-19 vaccine uptake among the general population.

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.

Mistrust in government and COVID-19 vaccination acceptance in Nigeria: investigating the indirect roles of attitudes towards vaccination

BACKGROUND

Research shows that trust in government is associated with the acceptance of COVID-19 vaccination. However, there is no empirical evidence suggesting the pathway by which this association is formed. This study examines how dimensional attitudes towards vaccination explain the relationship between mistrust in government and COVID-19 vaccination acceptance.

METHODS

The study was an online cross-sectional survey involving 1026 adults (of which 58.9% are female) resident in Nigeria with a mean age of 26.09 (±8.46) years. Data were collected using structured questionnaires assessing the level of mistrust in government, dimensional attitudes towards vaccination, and acceptance to be vaccinated for COVID-19. Structural equation modeling was used to analyze data.

RESULTS

Results show that 56.8% of participants mistrust the government, while COVID-19 vaccination acceptance rate was 28.2%. Mistrust in government was significantly associated with low acceptance of COVID-19 vaccination. Furthermore, mistrust in the government was predictive of negative attitudes towards COVID-19 vaccination which include worries about unforeseen future effects of vaccines, mistrust of vaccine benefits (MVB), concerns about commercial profiteering (CCP), and preference for natural immunity. The outcomes of indirect effect analyses indicated that mistrust in government was associated with high mistrust in vaccine benefits (MVB) and increased concerns about commercial profiteering (CCP), which in turn lead to low acceptance of COVID-19 vaccination.

CONCLUSIONS

Mistrust in the government was high and was coupled with low vaccination acceptance. It is important to initiate culturally relevant awareness programs aiming at combating false notions about COVID-19 vaccination such as MVB and CCP arising from mistrust in government.

Acceptance of COVID-19 vaccine among sub-Saharan Africans (SSA): a comparative study of residents and diasporan dwellers

BACKGROUND

The COVID-19 vaccines are being rolled out across all the sub-Saharan Africa (SSA) countries, with countries setting targets for achieving full vaccination rates. The aim of this study was to compare the uptake of, resistance and hesitancy to the COVID-19 vaccine between SSA locally residents and in the diasporan dwellers.

METHODS

This was a cross-sectional study conducted using a web and paper-based questionnaire to obtain relevant information on COVID-19 vaccine acceptance. The survey items included questions on demography, uptake and planned acceptance or non-acceptance of the COVID-19 vaccines among SSAs. Multinomial logistic regression was used to determine probabilities of outcomes for factors associated with COVID-19 vaccination resistance and hesitancy among SSA respondents residing within and outside Africa.

RESULTS

Uptake of COVID-19 vaccines varied among the local (14.2%) and diasporan (25.3%) dwellers. There were more locals (68.1%) who were resistant to COVID-19 vaccine. Participants' sex [adjusted relative risk (ARR) = 0.73, 95% CI: 0.58 - 0.93], education [primary/less: ARR = 0.22, CI:0.12 - 0.40, and bachelor's degree: ARR = 0.58, CI: 0.43 - 0.77]), occupation [ARR = 0.32, CI: 0.25-0.40] and working status [ARR = 1.40, CI: 1.06-1.84] were associated with COVID-19 vaccine resistance among locals. Similar proportion of local and diasporan dwellers (~ 18% each) were hesitant to COVID-19 vaccine, and this was higher among health care workers [ARR = 0.25, CI: 0.10 - 0.62 and ARR = 0.24, CI:0.18-0.32, diaspora and locals respectively]. After adjusting for the potential confounders, local residents aged 29-38 years [ARR = 1.89, CI: 1.26-2.84] and lived in East Africa [ARR = 4.64, CI: 1.84-11.70] were more likely to report vaccine hesitancy. Knowledge of COVID vaccines was associated with hesitancy among local and diasporan dwellers, but perception was associated with vaccine resistance [ARR = 0.86,CI: 0.82 - 0.90] and hesitancy [ARR = 0.85, CI: 0.80 - 0.90], only among the local residents.

CONCLUSIONS

Differences exist in the factors that influence COVID-19 vaccine acceptance between local SSA residents and thediasporan dwellers. Knowledge about COVID-19 vaccines affects the uptake, resistance, and hesitancy to the COVID-19 vaccine. Information campaigns focusing on the efficacy and safety of vaccines could lead to improved acceptance of COVID-19 vaccines.

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.

COVID-19 vaccine inequity in African low-income countries

Equitable access and utilization of the COVID-19 vaccine is the main exit strategy from the pandemic. This paper used proceedings from the Second Extraordinary Think-Tank conference, which was held by the Health Economics and Policy Unit at the Kamuzu University of Health Sciences in collaboration with the Malawi Ministry of Health, complemented by a review of literature. We found disparities in COVID-19 vaccine coverage among low-income countries. This is also the case among high income countries. The disparities are driven mainly by insufficient supply, inequitable distribution, limited production of the vaccine in low-income countries, weak health systems, high vaccine hesitancy, and vaccine misconceptions. COVID-19 vaccine inequity continues to affect the entire world with the ongoing risks of emergence of new COVID-19 variants, increased morbidity and mortality and social and economic disruptions. In order to reduce the COVID-19 vaccination inequality in low-income countries, there is need to expand COVAX facility, waive intellectual property rights, transform knowledge and technology acquired into vaccines, and conduct mass COVID-19 vaccination campaigns.

Uptake of public health measures and vaccine acceptance during the COVID-19 pandemic in rural Zambia

Vaccines are effective tools to prevent COVID-19-related morbidity. However, coverage is low throughout sub-Saharan Africa. Uptake of public health measures, perceptions of COVID-19 illness and vaccines, and intention to vaccinate were evaluated in 2021-2022 in rural Zambia. Adherence to public health measures, perceptions of COVID-19 risk and severity, and vaccine acceptance increased significantly over time, particularly in December 2021, coinciding with the fourth pandemic wave and relaunch of the national vaccine campaign. Vaccine acceptance was associated with perceptions of vaccine safety and effectiveness, but not disease severity. These findings highlight the importance of strong pandemic response and public communication for increased uptake of mitigatory measures, including vaccine acceptance.

"I Would Rather Take the Vaccine Than Undergo Weekly Testing": Correlates of Health Workers' Support for COVID-19 Vaccine Mandates

This study examined the support for vaccine mandates and uptake among clinical and non-clinical staff at a tertiary hospital in northern Nigeria, focusing on variation of survey responses based on job position, socio-demographic characteristics, and perceived risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Using an explanatory, sequential, mixed-methods design and deploying a pragmatic paradigm, 370 healthcare workers were administered structured questionnaires. This was followed by in-depth interviews with a sub-sample of respondents to further clarify the responses regarding support for the coronavirus disease 2019 (COVID-19) vaccine mandate. Findings demonstrated that less than one-half of respondents supported the COVID-19 mandate, and only one in three had received the recommended COVID-19 vaccine doses. Support for the vaccine mandate and vaccine uptake were predicted by profession, work experience, number of children, health status, and risk perception. Support for the vaccine mandate was ascribed to ethical and professional duty, whereas opposition was associated with respect for autonomy and human rights. This study documents the need to enhance support for vaccine mandates and uptake among healthcare workers through sustainable strategies, as Nigeria's healthcare workers are considered a source of trust and role models for the rest of society.

What Contributes to COVID-19 Vaccine Hesitancy? A Systematic Review of the Psychological Factors Associated with COVID-19 Vaccine Hesitancy

Vaccine hesitancy plays a crucial role in worldwide pandemic-control efforts. The multifaceted nature of vaccine hesitancy entails many psychological factors that are widely discussed in the literature, although few studies specifically compile these factors. Thus, this systematic review aims to synthesize the psychological factors contributing to vaccine hesitancy. As per the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, a systematic search was conducted on electronic databases PubMed, Scopus, Science Direct, PsycNET, and Web of Science, and a manual search was conducted on Google Scholar. Out of the 2289 articles obtained, 79 studies that met the inclusion criteria were deemed eligible for the review. The findings highlight appraisals of the COVID-19 pandemic, vaccine safety and side effects, vaccine confidence/trust, trust in government and healthcare professionals, scepticism around vaccine production, conspiracy beliefs, emotions, and information and knowledge about the vaccine as the major psychological factors contributing to vaccine hesitancy. Concerningly, misinformation on COVID-19 vaccination spread through social media platforms, increasing vaccine hesitancy. Recommendations for government authorities, healthcare professionals, and implications for future research are also outlined.

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.

To Trust or not to Trust: An Exploratory Qualitative Study of Personal and Community Perceptions of Vaccines Amongst a Group of Young Community Healthcare Workers in Soweto, South Africa

As South Africa debates the implementation of mandatory vaccination policies to address coronavirus disease 2019 (COVID-19) vaccine hesitancy, many adults remain unpersuaded of the need and benefits of vaccination. Several surveys suggest that this is particularly true for younger adults and for those living in low-income communities. Therefore, we sought the views of youth training to become community health workers (CHWs) as a youth group at the intersection of the community and the health system. This research was conducted in a township of South Africa, a country with a long history of political mistrust. Using semi-structured interviews and an interview guide, we explored young CHWs’ perceptions (n = 20) of vaccine hesitancy for themselves, their peers and the community. Audio-recorded interviews were transcribed, and thematic analysis was undertaken. Findings suggest widespread COVID-19 vaccine hesitancy in this community, especially amongst young people. Reported reasons for this hesitancy appear linked to a complex interrelated network of factors, including ‘uncertainty’ about the outcome and effectiveness of the vaccines; ‘fear’ of the vaccines, driven by a myriad of rumours and conspiracy theories within the community; a ‘lack of control’ over other people’s behaviour and a desire not to be controlled especially by the government but at the same time a resignation towards impending mandatory vaccine policies and a ‘lack of trust’ particularly in the government’s intentions with vaccine roll-out and their health messaging. While mandatory vaccination policies in several organizations have shown success, with South Africa’s complex social history and recent civil unrest, the roll-out of any mandatory vaccination policy will require careful health messaging with a focus on trust-building between communities, health systems and authorities through more personalized approaches that consider contextual nuances.

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.

A study of COVID-19 vaccination in the US and Asia: The role of media, personal experiences, and risk perceptions

The COVID-19 pandemic presents an opportunity to assess the relationship between personal experiences and vaccine decision-making. The aim of this study was to examine the associations between experiences with COVID-19 and COVID-19 vaccination status. We administered 28 repeated cross-sectional, online surveys between June 2020 and June 2021 in the US and Asia. The main exposure was media showing COVID-19 cases, and we distinguished those with no such experience, those seeing a not severe case of disease, and those seeing a severe case of disease. Logistic regression models estimated the association between experience and acceptance of a hypothetical COVID-19 vaccine (pre-rollout) or actual vaccination (post-rollout). We explored perceived susceptibility as a potential mediator. Intent to vaccinate was lowest in the US and Taiwan, and highest in India, Indonesia, and China. Across all countries, seeing a severe case of COVID-19 in the media was associated with 1.72 times higher odds of vaccination intent in 2020 (95% CI: 1.46, 2.02) and 2.13 times higher odds of vaccination in 2021 (95% CI: 1.70, 2.67), compared to those not seeing a case or a less severe case. Perceived susceptibility was estimated to mediate 25% of the relationship with hypothetical vaccination (95% CI: 18%, 31%, P<0.0001), and 16% of the relationship with actual vaccination 16% (95% CI: 12%, 19%, P<0.0001). Seriousness of experiences could relate to intention to vaccinate against COVID-19. Media exposures are a modifiable experience, and this study highlights how this experience can relate to risk perceptions and eventual vaccination, across a variety of countries where the course of the pandemic differed.

Early Impact of SARS-CoV-2 Pandemic on Immunization Services in Nigeria

Background: By 11 March 2022, there were 450,229,635 coronavirus disease (COVID-19) cases and 6,019,085 deaths globally, with Nigeria reporting 254,637 cases and 3142 deaths. One of the essential healthcare services that have been impacted by the pandemic is routine childhood immunization. According to the 2018 National Demographic and Health Survey, only 31% of children aged 12–23 months were fully vaccinated in Nigeria, and 19% of eligible children in the country had not received any vaccination. A further decline in coverage due to the pandemic can significantly increase the risk of vaccine-preventable-disease outbreaks among children in Nigeria. To mitigate such an occurrence, it is imperative to urgently identify how the pandemic and the response strategies have affected vaccination services, hence, the goal of the study. Methods: The research method was qualitative, including in-depth interviews of healthcare workers and focus group discussions (FGDs) with caregivers of children aged 0–23 months. We selected one state from each of the three zones of Nigeria: northern, central, and southern. Within each state, 10 local government areas and 20 healthcare facilities were purposively selected. In each facility, 10 healthcare workers were invited for interviews. Overall, 517 healthcare workers were interviewed. For the focus group discussion, 30 communities were selected. Within each selected community, six consenting caregivers were included. Overall, 180 caregivers participated. The data were analyzed using thematic inductive content analysis. Results: Three significant impacts that were observed are: difficulties in accessibility to immunization services, declining immunization demand and uptake among caregivers due to varying factors, and erosion of vaccine confidence among both caregivers and healthcare workers. Movement restriction and lockdown had numerous major impacts, such as decreased general healthcare service delivery, increased transportation costs, fewer engagements that promote vaccine uptake, and cessation of mobile vaccination campaigns that target hard-to-reach communities. Moreover, misinformation, conspiracy beliefs about the pandemic and COVID-19 vaccines, and risk perception negatively influenced general vaccine confidence. Conclusion: The results of this early impact study show that immunization was directly affected by the pandemic and provide insights into areas where interventions are needed for recovery.

Attitudes to Vaccine Mandates among Late Adopters of COVID-19 Vaccines in Zimbabwe

Despite sufficient supply, <25% of the population in sub-Saharan Africa has received at least one dose of COVID-19 vaccine. Vaccine mandates have previously been effective in increasing vaccine uptake. Attitudes to COVID-19 vaccine mandates and vaccines for children in African populations are not well understood. We surveyed late-adopters presenting for COVID-19 vaccination one year after program initiation in Zimbabwe. Logistic regression models were developed to evaluate factors associated with attitudes to mandates. In total, 1016 adults were enrolled; 690 (67.9%) approved of mandating vaccination for use of public spaces, 686 (67.5%) approved of employer mandates, and 796 (78.3%) approved of mandating COVID-19 vaccines for schools. Individuals of lower economic status were twice as likely as high-income individuals to approve of mandates. Further, 743 (73.1%) participants indicated that they were extremely/very likely to accept vaccines for children. Approval of vaccine mandates was strongly associated with perceptions of vaccine safety, effectiveness, and trust in regulatory processes that approved vaccines. Vaccine hesitancy is an important driver of low vaccine coverage in Africa and can be mitigated by vaccine mandates. Overall, participants favored vaccine mandates; however, attitudes to mandates were strongly associated with level of education and socioeconomic status.

Role of literacy, fear and hesitancy on acceptance of COVID-19 vaccine among village health volunteers in Thailand

BACKGROUND

The roles of literacy, fear and hesitancy were investigated for acceptance of COVID-19 vaccine (AV) types among village health volunteers (VHVs) in Thailand.

MATERIALS AND METHODS

A cross-sectional study was conducted using an unidentified online questionnaire to assess literacy, fear and hesitancy of COVID-19 vaccine acceptance among Thai VHVs between 1 and 15 October 2021. The questionnaire was developed based on the HLVa-IT (Health Literacy Vaccinale degli adulti in Italiano) for vaccine literacy (VL), using an adult Vaccine Hesitancy Scale (aVHS) for COVID-19 vaccine hesitancy (VH) and Fear of COVID-19 scale (FCoV-19S) for the distress of COVID-19 vaccine. The effects of VL, VH and vaccine fear (VF) on AV were estimated using multivariable logistic regression.

RESULTS

A total of 5,312 VHVs completed the questionnaire. After adjustment with variables in the multivariable analysis, the VL score was insignificantly associated with increased vaccination (aOR = 1.002; (95%CI: 0.994-1.01)), while VF and VH significantly decreased the chance of vaccination, aOR = 0.966 (95%CI: 0.953-0.978) and aOR = 0.969; (95%CI: 0.960-0.979), respectively and VF and VH were negatively associated with AV for all types of vaccine preference, with VL showing a reverse relationship only for mRNA-based vaccines.

CONCLUSION

VL may not increase AV among VHVs. To increase attitudes toward receiving COVID-19 vaccination in Thailand, the government and health-related organizations should instigate policies to significantly reduce VF and VH among Thai VHVs.

Identification of Aloe-derived natural products as prospective lead scaffolds for SARS-CoV-2 main protease (Mpro) inhibitors

In the past two years, the COVID-19 pandemic has caused over 5 million deaths and 250 million infections worldwide. Despite successful vaccination efforts and emergency approval of small molecule therapies, a diverse range of antivirals is still needed to combat the inevitable resistance that will arise from new SARS-CoV-2 variants. The main protease of SARS-CoV-2 (M^pro) is an attractive drug target due to the clinical success of protease inhibitors against other viruses, such as HIV and HCV. However, in order to combat resistance, various chemical scaffolds need to be identified that have the potential to be developed into potent inhibitors. To this end, we screened a high-content protease inhibitor library against M^proin vitro, in order to identify structurally diverse compounds that could be further developed into antiviral leads. Our high-content screening efforts retrieved 27 hits each with > 50% inhibition in our M^pro FRET assay. Of these, four of the top inhibitor compounds were chosen for follow-up due to their potency and drugability (Lipinski's rules of five criteria): anacardic acid, aloesin, aloeresin D, and TCID. Further analysis via dose response curves revealed IC₅₀ values of 6.8 μM, 38.9 μM, 125.3 μM, and 138.0 μM for each compound, respectively. Molecular docking studies demonstrated that the four inhibitors bound at the catalytic active site of M^pro with varying binding energies (-7.5 to -5.6 kcal/mol). Furthermore, M^pro FRET assay kinetic studies demonstrated that M^pro catalysis is better represented by a sigmoidal Hill model than the standard Michaelis-Menten hyperbola, indicating substantial cooperativity of the active enzyme dimer. This result suggests that the dimerization interface could be an attractive target for allosteric inhibitors. In conclusion, we identified two closely-related natural product compounds from the Aloe plant (aloesin and aloeresin D) that may serve as novel scaffolds for M^pro inhibitor design and additionally confirmed the strongly cooperative kinetics of M^pro proteolysis. These results further advance our knowledge of structure-function relationships in M^pro and offer new molecular scaffolds for inhibitor design.

Perceptions and Knowledge towards COVID-19 Vaccine Hesitancy among a Subpopulation of Adults in Kenya: An English Survey at Six Healthcare Facilities

Background: Vaccine hesitancy, as defined by the WHO, is the reluctance or refusal to vaccinate despite the availability of vaccines and is one of the ten threats to global health in 2019. Vaccine hesitancy remains a complex matter influenced by multiple factors, especially in sub-Saharan Africa. Methods: We conducted a cross-sectional study between November 2021 and January 2022 among the general adult public seeking care at six different healthcare facilities in Kenya. The survey, in English, consisted of questions based on demographics, knowledge, and attitudes, including hesitancy towards the COVID-19 vaccine. Results: Of the 3996 surveys collected, 55.1% were from private, 19.5% from faith-based and 25.3% from government facilities., Approximately 81.0% of all the participants reported it was important to get a vaccine to protect other people from COVID-19, 79.9% reported they would take a vaccine to protect against COVID-19, yet 40.5% reported being hesitant to take the vaccine primarily due to side effects. Most of the variables were associated with receiving a vaccine. Only 52.1% of those seeking care from the government facility and 54.5% of those seeking care from the faith-based facility were vaccinated, compared to 81.5% seeking care from the private facilities (p < 0.001). More participants from private facilities felt that vaccines are safe as compared to those at the faith-based and government facilities (p < 0.001). Conclusion: Vaccine hesitancy in Kenya, even though much lower than reported in other countries, remains a dynamic problem. Mitigating strategies specific to Africa need to be developed to help address vaccine hesitancy in this part of the continent.

Public Health Surveillance for Adverse Events Following COVID-19 Vaccination in Africa

Local, national, and international health agencies have advocated multi-pronged public health strategies to limit infections and prevent deaths. The availability of safe and effective vaccines is critical in the control of a pandemic. Several adverse events have been reported globally following reception of different vaccines, with limited or no data from Africa. This cross-sectional epidemiological study investigated adverse events following COVID-19 vaccination in Africans from April-June, 2021 using a structured online questionnaire. Out of 1200 participants recruited, a total of 80.8% (n = 969) respondents from 35 countries, including 22 African countries and 13 countries where Africans live in the diaspora, reported adverse events. Over half of the vaccinees were male (53.0%) and frontline healthcare workers (55.7%), respectively. A total of 15.6% (n = 151) reported previous exposure to SARS-CoV-2, while about one-fourth, 24.8% (n = 240), reported different underlying health conditions prior to vaccination. Fatal cases were 5.1% (n = 49), while other significant heterogenous events were reported in three categories: very common, common, and uncommon, with the latter including enlarged lymph nodes 2.4% (n = 23), menstrual disorder 0.5% (n = 5), and increased libido 0.2% (n = 2). The study provided useful data for concerned authorities and institutions to prepare plans that will address issues related to COVID-19 vaccines.

Assessment of Attitudes, Main Concerns and Sources of Knowledge Regarding COVID-19 Vaccination in Poland in the Unvaccinated Individuals-A Nationwide Survey

Vaccination is the most effective tool to combat the COVID-19 pandemic. However, it is ineffective without appropriate public acceptance. In Poland, 53% of the country's population is vaccinated, which puts us in the last position among the EU countries. Therefore, this study aims to assess the main concerns regarding vaccination in the unvaccinated population of Poland. The study was based on an original questionnaire that was distributed online. There were three phases of the study: Phase 1-before the preventive vaccination plan, Phase 2-2 months after implementation of the programme, Phase 3-after 4 months when the immunisation rate in Poland was 42%. A total of 4459 individuals participated in the study. As many as 1943 participants were excluded from the analysis due to lack of consent (30 subjects) or COVID-19 vaccination (1913 subjects). Out of the remaining 2516 unvaccinated individuals, 463 were participants in the first phase of the study, 1137 in the second phase of the study, and 916 in the third phase. As the preventive vaccination plan in Poland continued, concerns about vaccine adverse events, safety and efficacy were raised. The only lower concern was that about the vaccine transportation rules. Moreover, as the vaccination programme continued, there was an increase in the percentage of individuals declaring their full reluctance towards vaccination against COVID-19. Conclusions: The Internet is the main source of knowledge about the COVID-19 vaccination, so it should be focused on during vaccination campaigns. The public is primarily concerned about adverse events of vaccines and the lack of appropriate tests of the products used. Therefore, it is advisable to popularise the current state of knowledge and promote reliable information concerning the COVID-19 vaccination.

Predictors of COVID-19 Vaccine Hesitancy in South African Local Communities: The VaxScenes Study

South Africa launched a mass COVID-19 vaccination campaign in May 2021, targeting 40 million adults. Understanding predictors of COVID-19 vaccine intentions was required to achieve this goal. We conducted a population-based survey in June–July 2021 using the WHO Behavioral and Social Drivers (BeSD) of COVID-19 Vaccination tool to determine predictors of vaccine hesitancy, defined as intention to refuse or uncertainty whether to accept COVID-19 vaccination. There were 1193 participants, mean age 39 (standard deviation 15) years, and 53% women, of whom 58% trusted information provided by healthcare workers and 32% were vaccine hesitant. Independent predictors of vaccine hesitancy included concerns about side effects (odds ratio (OR) 11.41; 95% confidence interval (CI) 3.5–50.80), lack of access to the online vaccine registration platform (OR 4.75; CI 2.15–10.37), distrust of government (OR 3.0; CI 1.33–6.77), belief in conspiracy theories (OR 3.01; CI 1.32–6.77), having no monthly income (OR 1.84; CI 1.12–3.07), and depending on someone else to make vaccination decision (OR 2.47; CI 1.06–5.77). We identified modifiable predictors of vaccine hesitancy at the start of South Africa’s COVID-19 vaccination rollout. These factors should be addressed by different stakeholders involved in the national immunization program through tailored communication and other effective strategies that increase vaccine literacy, reach low-income households, and engender confidence in government.

COVID-19 vaccines for children and adolescents in Africa: aligning our priorities to situational realities

The evolving COVID-19 pandemic is an unprecedented global public health crisis that continues to have a major impact on the African continent. Most countries within Africa are facing significant challenges vaccinating their populations for COVID-19. Inadequate COVID-19 vaccine supply, weaknesses in health system infrastructure, COVID-19 misinformation and disinformation, and ineffective health risk communication are contributing to low adult vaccination rates on the continent. Without sufficient COVID-19 vaccine coverage on the African continent, the prolonged social, economic and health impacts of this public health crisis are likely to exacerbate pre-existing social-structural issues in this part of the world. In this paper, we highlight trends in SARS-CoV-2 infections among children and adolescents (CA), compare COVID-19 vaccination patterns in Africa to those in high-income countries, and discuss some of the benefits, challenges and unknowns associated with vaccinating CA for COVID-19. In light of ongoing COVID-19 vaccine supply challenges and the slow progress that the African continent is making towards vaccinating the adult population, we suggest that the immediate priority for Africa is to accelerate COVID-19 vaccinations among adults (particularly high-risk populations) and vulnerable CA (ie, those who are immunocompromised and/or living with certain medical conditions). Accelerating the roll-out of COVID-19 vaccines and rapidly achieving high levels of vaccination coverage in the adult population will free up capacity to vaccinate CA sooner rather than later. While we hope that COVID-19 vaccines will soon become available to CA throughout Africa, countries must continue to prioritise non-pharmaceutical interventions.

Barriers and facilitators of childhood COVID-19 vaccination among parents: A systematic review

BACKGROUND

The acceptance of vaccination against COVID-19 among parents of young children plays a significant role in controlling the current pandemic. A wide range of factors that influence vaccine hesitancy in adults has been reported worldwide, but less attention has been given to COVID-19 vaccination among children. Vaccine hesitancy is considered a major challenge in achieving herd immunity, and it is more challenging among parents as they remain deeply concerned about their child's health. In this context, a systematic review of the current literature is inevitable to assess vaccine hesitancy among parents of young children to ensure a successful ongoing vaccination program.

METHOD

A systematic search of peer-reviewed English literature indexed in Google Scholar, PubMed, Embase, and Web of science was performed using developed keywords between 1 January 2020 and August 2022. This systematic review included only those studies that focused on parental concerns about COVID-19 vaccines in children up to 12 years without a diagnosis of COVID-19. Following PRISMA guidelines, a total of 108 studies were included. The quality appraisal of the study was performed by Newcastle-Ottawa Scale (NOS).

RESULTS

The results of 108 studies depict that vaccine hesitancy rates differed globally with a considerably large number of factors associated with it. The highest vaccine hesitancy rates among parents were reported in a study from the USA (86.1%) and two studies from Saudi Arabia (>85%) and Turkey (89.6%). Conversely, the lowest vaccine hesitancy rates ranging from 0.69 and 2% were found in two studies from South Africa and Switzerland, respectively. The largest study (n = 227,740) was conducted in Switzerland while the smallest sample size (n = 12) was represented by a study conducted in the USA. The most commonly reported barriers to childhood vaccination were mothers' lower education level (N = 46/108, 43%), followed by financial instability (N = 19/108, 18%), low confidence in new vaccines (N = 13/108, 12%), and unmonitored social media platforms (N = 5/108, 4.6%). These factors were significantly associated with vaccine refusal among parents. However, the potential facilitators for vaccine uptake among respondents who intended to have their children vaccinated include higher education level (N = 12/108, 11%), followed by information obtained through healthcare professionals (N = 9/108, 8.3%) and strong confidence in preventive measures taken by the government (N = 5/81, 4.6%).

CONCLUSION

This review underscores that parents around the globe are hesitant to vaccinate their kids against COVID-19. The spectrum of factors associated with vaccine hesitancy and uptake varies across the globe. There is a dire need to address vaccine hesitancy concerns regarding the efficacy and safety of approved vaccines. Local context is inevitable to take into account while developing programs to reduce vaccine hesitancy. There is a dire need to devise strategies to address vaccine hesitancy among parents through the identification of attributing factors.