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

Abstract

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 confidence 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.

Presidents and vaccines: head of state inoculation as a tool for vaccine promotion

“…In sharp contrast, only 22% of respondents indicated they would accept the COVID-19 vaccine if it was available to them. This is much lower than the mean stated COVID-19 acceptance rate of 80% found in a sample of 10 low- and middle-income countries in Asia, Africa and South America, but in line with other studies reporting lower COVID-19 vaccine acceptance and confidence in African countries and the DR Congo in particular ( 2 , 9 , 62 ).…”

“…In ( 2019 ), the WHO listed vaccine hesitancy among the main threats to global health ( 2023 ). Since then, COVID-19 caused a severe regress in global vaccination coverage and a sharp decrease in vaccine confidence ( 2 , 15 ). To turn the tide and restore immunization progress, WHO, UNICEF, and other health partners announced “The Big Catch-Up” during the World Immunization Week ( 16 ).…”

“…This study aims to fill this gap by providing experimental evidence on vaccine role modelling for a country in Africa – the region that is most lagging behind in achieving universal immunization coverage ( 1 ). We turn to the Democratic Republic of Congo, a country that has been particularly affected by declining vaccine confidence during the COVID-19 pandemic ( 2 ).…”

Attitudes towards COVID-19 vaccines may have “spilled over” to other, unrelated vaccines along party lines in the United States

“…The COVID-19 pandemic created strong, intricate changes in NVAs worldwide. On the one hand, several countries showed overall increases in NVAs (de Figueiredo et al, 2023;UNIFCEF, 2023). These increases were not uniform across cultures but resulted from complex interactions between political ideology (e.g., in France, Wang et al, 2020), science literacy (e.g., in Britain, , and the salience of COVID-19's possible zoonotic origins (e.g., in the United States, LaCour et al, 2022), to name just a few examples.…”

Recent trends in vaccine coverage and confidence: A cause for concern

“…In a cross-sectional modeling study in eight sub-Saharan African settings conducted between 2020 and 2022, declines in the perceived importance of vaccines for children were identified across all eight countries. 49 COVID-19 vaccines were also perceived to be less important in 2022 than in 2020 in six countries, with increases in confidence detected for only Ivory Coast (Côte d’Ivoire).…”