COVID-19 Vaccine Acceptance and Hesitancy in Low and Middle Income Countries, and Implications for Messaging

Abstract

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.

Assessing the Level and Determinants of COVID-19 Vaccine Confidence in Kenya

“…However, findings in settings such as Ireland report those aged 35–44 years as being more likely to be vaccine hesitant or resistant than accepting [ 26 ]. We report no statistically significant association in the level of education and vaccine hesitancy, which is similarly reported in other low-and middle-income countries [ 27 ]. In contrast, other studies report that a higher level of education was associated with less likelihood of COVID-19 vaccine hesitancy [ 22 , 25 ].…”

The acceptance of covid-19 vaccines in Sub-Saharan Africa: Evidence from 6 national phone surveys

“…[21,28,36,38,40] Furthermore, the small systematic differences we observe according to gender and age are in line with most previous findings in low-income countries as is a tendency for higher acceptance in rural areas. [21,36,38,40] As with overall acceptance rates, our finding of higher hesitancy among the more educated is in line with two of the studies covering Sub-Saharan Africa [38,39] while another study finds mixed evidence. [21] No other study we are aware of across LMICs (and in fact few across countries of any income classification) assess vaccine acceptance according to economic status in a manner comparable with the expenditure data we can access from the pre-covid-19 sampling frames.…”

“…Assembling an amalgamation of data samples with different sources, sampling methodologies, and coverage, one study finds generally high acceptance rates in ten LMICs in Asia, Africa, and South America. [38] Among countries also covered in our study, acceptance rates are lower than what we find in Burkina Faso (66.5%, national phone sample obtained by random digit dialing) and Nigeria (76.2%, random sample of residents of one state from telephone list), close in urban Uganda (76.5%, random sample of households in Kampala), and very similar in rural Uganda (85.8%, nonrandom sample of women in 13 districts). [38] However, in those studies the ability to correct for various sample selection biases is likely limited in the absence of baseline nationally representative sampling frames.…”

COVID-19 Vaccine Hesitancy—A Scoping Review of Literature in High-Income Countries

“…Among non-high income countries or regions, results from the 2018 Wellcome Global monitor survey showed that vaccines were widely accepted [ 7 , 8 ], in contrast to high-income countries (defined by World Bank as countries having a 2019 Gross National Income (GNI) per capita of US$12,536 and more) [ 9 ]. A recent study by Arce et al showed that the average willingness to take COVID-19 vaccine was higher in the populace from non-high income countries or regions such as Nepal (97%) as compared to those in high-income countries or regions such as United States (6%) [ 10 ]. Similar findings were noted in a study by Sallam et al [ 11 ].…”