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.

Objective To study the U.S. public’s attitudes toward surveillance measures aimed at curbing the spread of COVID-19, particularly smartphone applications (apps) that supplement traditional contact tracing. Method We deployed a survey of approximately 2,000 American adults to measure support for nine COVID-19 surveillance measures. We assessed attitudes toward contact tracing apps by manipulating six different attributes of a hypothetical app through a conjoint analysis experiment. Results A smaller percentage of respondents support the government encouraging everyone to download and use contact tracing apps (42%) compared with other surveillance measures such as enforcing temperature checks (62%), expanding traditional contact tracing (57%), carrying out centralized quarantine (49%), deploying electronic device monitoring (44%), or implementing immunity passes (44%). Despite partisan differences on a range of surveillance measures, support for the government encouraging digital contact tracing is indistinguishable between Democrats (47%) and Republicans (46%), although more Republicans oppose the policy (39%) compared to Democrats (27%). Of the app features we tested in our conjoint analysis experiment, only one had statistically significant effects on the self-reported likelihood of downloading the app: decentralized data architecture increased the likelihood by 5.4 percentage points. Conclusion Support for public health surveillance policies to curb the spread of COVID-19 is relatively low in the U.S. Contact tracing apps that use decentralized data storage, compared with those that use centralized data storage, are more accepted by the public. While respondents’ support for expanding traditional contact tracing is greater than their support for the government encouraging the public to download and use contact tracing apps, there are smaller partisan differences in support for the latter policy.

As COVID-19 continues to spread, some public health authorities have implemented or plan to implement smartphone apps to supplement traditional contact tracing. These apps are more effective if a higher percentage of the public downloads and uses them. Yet fears that these apps would violate users' privacy by expanding governments' and tech companies' surveillance capacity may limit adoption. We conducted a study of American attitudes (N≈2,000) toward public health surveillance policies, focusing on smartphone contact tracing apps. We find widespread reluctance among the public: support for contact tracing apps is lower than for expanding traditional contact tracing or introducing new measures like temperature checks. Using a conjoint experiment embedded in the survey, we found that decentralized data storage increased the public's acceptance of contact tracing apps. Only a minority of respondents support the government, employers, and places of religious worship requiring smartphone users to download and use these apps. Despite partisan splits on traditional contact tracing and wearing face masks, Democrats and Republicans converge on levels of support for contact tracing apps, suggesting that bipartisan elite cues could work to augment support. Lastly, the prevalence of misunderstanding about the technology suggests that public education campaigns are needed before states deploy contact tracing apps. (Note: This paper is based on a new survey that we conducted in late June 2020. We identified a software issue that affected the results of our previous survey and fixed this problem in our new survey.)

As countries begin to vaccinate their populations against COVID-19, creating systems to verify vaccine records will be vital to reopening businesses, educational institutions, and travel. We consider the challenges of building vaccine record verification (VRV) systems that involve data sharing by health care providers, methods for verifying vaccine records, and regulation of how entities (e.g., workplaces, schools, businesses, and airlines) may request proof of vaccination. In particular, we focus on the opportunities and risks associated with digital vaccine passport apps. We propose three ethical principles to guide the building of VRV systems: 1) aligning systems with vaccine prioritization, 2) upholding fairness and equity, and 3) building trustworthy technology that protects the public's health data.