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

IntroductionRecent debates surrounding the lagging covid-19 vaccination campaigns in low-income countries center around vaccine supply and financing. Yet, relatively little is known about attitudes towards covid-19 vaccines in these countries and in Africa in particular. In this paper, we provide cross-country comparable estimates of the willingness to accept a covid-19 vaccine in six Sub-Saharan African countries. MethodsWe use data from six national high-frequency phone surveys from countries representing 38% of the Sub-Saharan African population (Burkina Faso, Ethiopia, Malawi, Mali, Nigeria, and Uganda). Samples are drawn from large, nationally representative sampling frames providing a rich set of demographic and socio-economic characteristics by which we disaggregate our analysis. Using a set of re-calibrated survey weights, our analysis adjusts for the selection biases common in remote surveys. ResultsAcceptance rates in the six Sub-Saharan African countries studied are generally high, with at least four in five people willing to be vaccinated in all but one country. Vaccine acceptance ranges from nearly universal in Ethiopia (97.9%, 97.2% to 98.6%) to below what would likely be required for herd immunity in Mali (64.5%, 61.3% to 67.8%). We find little evidence for systematic differences in vaccine hesitancy by sex or age but some clusters of hesitancy in urban areas, among the better educated, and in richer households. Safety concerns about the vaccine in general and its side effects emerge as the primary reservations toward a covid-19 vaccine across countries. ConclusionsOur findings suggest that limited supply, not inadequate demand, likely presents the key bottleneck to reaching high covid-19 vaccine coverage in Sub-Saharan Africa. To turn intent into effective demand, targeted communication campaigns bolstering confidence in the safety of approved vaccines and reducing concerns about side effects will be crucial to safeguard the swift progression of vaccine rollout in one of the worlds poorest regions. O_TEXTBOXWhat is already known?O_LIEstimates of vaccine acceptance in high- and middle-income countries have found rates to cluster around 70% with considerable cross-country variation. C_LIO_LIAs vaccine rollout is severely lagging, low-income countries and particularly Sub-Saharan Africa (SSA) with almost two thirds of the global poor population remain exposed to covid-19 and its impacts on lives and livelihoods. C_LIO_LIMuch of the current debate on vaccination campaigns in SSA focuses on supply-chain and financial factors, yet there is a dearth of robust, comparable evidence on covid-19 vaccine hesitancy in these countries. C_LI What are the key findings?O_LICovid-19 vaccine acceptance is high in six Sub-Saharan African countries with an estimated four in five people or more in all but one study country willing to take an approved, free vaccine. C_LIO_LIClusters of hesitancy vary by country but generally comprise urban areas, richer households, and those with more education. C_LI What do the new findings imply?O_LILimited supply, rather than inadequate demand, likely presents the key bottleneck to achieving high covid-19 vaccine coverage in Sub-Saharan Africa. C_LIO_LITo reach mass coverage, information campaigns should bolster confidence in vaccine safety and alleviate concerns about side effects. C_LI C_TEXTBOX