Institutional mistrust and child vaccination coverage in Africa

Abstract

IntroductionDespite considerable improvements in vaccination coverage over the last decade, half of the world’s unvaccinated and undervaccinated children are located in Africa. The role of institutional trust in explaining vaccination gaps has been highlighted in several qualitative reports but so far has only been quantified in a small number of high-income countries.MethodsWe matched information on child vaccination status from the Demographic Health Surveys with information on institutional trust from the Afrobarometer surveys at the subnational level. A total of 166 953 children from 41 surveys administered in 22 African countries covering 216 subnational regions were used. Based on a principal component analysis, we constructed an institutional mistrust index that combined the level of mistrust in the head of state, parliament, electoral system, courts and local government. Associations between institutional mistrust and child vaccination uptake were assessed with multivariable fixed effects logistic regressions that controlled for time-invariant subnational region characteristics and various child, caregiver, household and community characteristics.ResultsA 1 SD increase in the institutional mistrust index was associated with a 10% (95% CI of ORs: 1.03 to 1.18) increase in the likelihood that a child had not received any of eight basic vaccines and with a 6% decrease in the likelihood a child had received all of the basic vaccines (95% CI: 0.92 to 0.97). Institutional mistrust was negatively associated with the likelihood that a child had received each of the eight basic vaccinations (p<0.05).ConclusionsChild vaccination rates in Africa are considerably lower in areas in which the local population displays high levels of mistrust towards local authorities. Institutional mistrust is an important dimension of vaccine hesitancy, considered as one of the most important threats to global health. Empowering local authorities with resources and communication strategies to address institutional mistrust may be needed to close the remaining vaccination gaps in Africa.

Acceptance of COVID-19 Vaccines in Sub-Saharan Africa: Evidence from Six National Phone Surveys

“…For example, more skeptical individuals toward the government or those dissatisfied with its crisis management may be more reluctant to accept a state-provided vaccine. [20,21] We only have data on trust in the government's crisis management in Malawi and satisfaction in Mali and Nigeria but find our hypotheses are confirmed in bivariate logistic regressions (Table A.6). However, after controlling for all other factors in Table 1, the coefficients are no longer significant.…”

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

“…For example, more skeptical individuals toward the government or those dissatisfied with its crisis management may be more reluctant to accept a state-provided vaccine. [20,21] We only have data on trust in the government's crisis management in Malawi and satisfaction in Mali and Nigeria but find our hypotheses confirmed in bivariate logistic regressions (Table A.6). However, after controlling for all other factors in Table 1, coefficients are no longer significant.…”

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

“…Vaccination uptake in Africa is associated with the level of trust communities have for government. For example, one study of child vaccination rates in Africa found a significantly reduced rate of vaccination in regions where the local population was distrustful of local authorities, with a one standard deviation increase in the institutional mistrust index being associated with a 10% increase in the likelihood that a child had missed any of the eight basic vaccines [ 42 ].…”