Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.

Background As vaccination campaigns are deployed worldwide, addressing vaccine hesitancy is of critical importance to ensure sufficient immunization coverage. We analyzed COVID-19 vaccine acceptance across 15 samples covering ten low- and middle- income countries (LMICs) in Asia, Africa, and South America, and two higher income countries (Russia and the United States). Methods Standardized survey responses were collected from 45,928 individuals between June 2020 and January 2021. We estimate vaccine acceptance with robust standard errors clustered at the study level. We analyze stated reasons for vaccine acceptance and hesitancy, and the most trusted sources for advice on vaccination, and we disaggregate acceptance rates by gender, age, and education level. Findings We document willingness to take a COVID-19 vaccine across LMIC samples, ranging from 67% (Burkina Faso) to 97% (Nepal). Willingness was considerably higher in LMICs (80%) than in the United States (65%) and Russia (30%). Vaccine acceptance was primarily explained by an interest in personal protection against the disease (91%). Concern about side effects (40%) was the most common reason for reluctance. Health workers were considered the most trusted sources of information about COVID-19 vaccines. Interpretation Given high levels of stated willingness to accept a COVID-19 vaccine across LMIC samples, our study suggests that prioritizing efficient and equitable vaccine distribution to LMICs will yield high returns in promoting immunization on a global scale. Messaging and other community-level interventions in these contexts should be designed to help translate intentions into uptake, and emphasize safety and efficacy. Trusted health workers are ideally positioned to deliver these messages.

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Lack of trust in state institutions, often due to poor service provision, is a pervasive problem in many developing countries. It may also be one of the reasons citizens turn to non-state actors for services. This paper investigates whether information about improved public services can help build trust in state institutions and move people away from non-state actors. We focus on dispute resolution in rural Pakistan. We find that (truthful) information about reduced delays in state courts leads to citizens reporting higher likelihood of using them and to greater allocations to the state in two high-stakes lab-in-the-field games designed to measure belief in the e˙ectiveness of state courts and willingness to contribute resources for others to access them. More interestingly, we find indirect negative e˙ects on non-state actors in the same high-stakes settings. We show that the positive direct and negative indirect e˙ects are both mediated by changes in beliefs about the e˙ectiveness of these actors. Our preferred interpretation explains these behaviors as a response to improved beliefs about state actors which then motivate individuals to interact less with non-state actors and as a result downgrade their beliefs about them. We provide additional checks bolstering this interpretation and alleviating concerns about potential social experimenter e˙ects or mechanical contrasts between the two actors. These results indicate that, despite distrust of the state in Pakistan, credible new information can change beliefs and behavior.

The article is the first comprehensive attempt at estimating the variation in the incidence, intensity and severity of poverty in the Punjab at the level of sub-provincial regions and districts. This estimation has been made possible because of the availability of the Multiple Indicators Cluster Survey , which has a sample that is representative at the district-level. Estimates suggest the existence of a high poverty enclave in the south and the west regions of the Punjab. The incidence and severity of poverty in a majority of districts in this enclave, with a few exceptions, is extremely high with one out of every two households being poor on average. The high levels of poverty in this enclave contrast with the relatively low poverty in the more urbanized north, where households are well integrated into the national and international labor market. The paper also argues that there is tremendous variation in the poverty experience of the districts in the centre. Poverty incidence in the more urbanized and industrialized northern districts of the centre contrasts sharply with the experience of Kasur, Okara and Pakpattan, where the incidence and severity of poverty is extremely high. Finally, we find that in nine districts rural households do much worse in terms of poverty incidence than their urban counterparts. The gap between urban and rural poverty incidence and severity is highest within the district of Lahore suggesting that urbanization co-exists with a large poor population that inhabits the periurban areas of the district. An important aim of development policy and poverty targeting is to bridge these multi-faceted divides in the geography of poverty. JEL Classification: D33, I32

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How can we close persistent gender gaps in political participation? We develop a theory highlighting the role of male household members as “gatekeepers” of women’s participation in patriarchal settings and argue that the answer involves targeting these men. We conduct a field experiment in Pakistan and find that targeting women with a nonpartisan get-out-the-vote campaign has no effect on their turnout in a national election. However, women’s turnout increases substantially when male household members are canvassed to support women’s participation. Households where both men and women are canvassed see the largest increases in women’s turnout and additional increases in political discussion and men’s practical support to help women vote. Using a costly behavioral measure, we also demonstrate lasting effects on men’s supportive behavior in these households two months after the election. Our results address the importance, and tangible benefits, of engaging men to ease constraints that hinder equal participation.

Easier said than done High-profile instances of police brutality in the last few years have brought attention to patterns of abuse that have existed since the inception of modern policing. There have been many calls for police reform, a process that in many countries has taken the form of increased police engagement with communities. Blair et al . report the results of a large-scale experiment testing the effectiveness of this approach across six countries in the Southern Hemisphere (see the Perspective by Tobon). They found that such community engagement did not increase trust in the police and it did not reduce crime. Improving relationships between police and community may require deeper structural changes before or in addition to approaches such as community policing. —SNV