Introduction Africa has the slowest COVID-19 vaccination rate of any continent in the world, with only 29.8% of the population receiving at least one dose of the vaccine. This includes Ghana, where only 37.8% of the country have received at least one dose as of October, 2022. The key aims of this research were to determine levels of hesitancy in COVID-19 vaccines among unvaccinated individuals in Ghana and observe their trends across time, and to identify independent predictors associated with vaccine hesitancy among unvaccinated individuals. Methods four online cross-sectional surveys of Ghanaian citizens were conducted in August, 2020 (N = 3048), March, 2021 (N = 1558), June, 2021 (N = 1295), and February, 2022 (N = 424). Results overall hesitancy decreased from 36.8% (95% CI: 35.1%-38.5%) in August, 2020 to 17.2% (95% CI: 15.3%-19.1%) in March, 2021. However, hesitancy increased to 23.8% (95% CI: 21.5%-26.1%) in June, 2021, and then again to 52.2% (95% CI: 47.4%-57.0%) in February, 2022. Key reasons included not having enough vaccine-related information (50.6%) and concerns over vaccine safety (32.0%). Hesitant groups included Christians, urban dwellers, opposition political party voters, females, individuals who completed higher education, individuals who reported receiving COVID-19 information from internet sources, and individuals who expressed uncertainty about commonly-circulated COVID-19 misinformation beliefs. Conclusion hesitancy rates among unvaccinated individuals in Ghana continues to rise. However, vaccine awareness strategies are sensitive to subpopulation characteristics. Many are reachable through targeted communication strategies, to which campaigns must focus on resolving vaccine-related concerns to ensure high vaccine uptake across Ghana.

The vast majority of people in the world who are unvaccinated against COVID-19 reside in LMIC countries in sub-Saharan Africa. This includes Ghana, where only 14.4% of the country is considered fully vaccinated as of March 2022. A key factor negatively impacting vaccination campaigns is vaccine hesitancy, defined as the delay in the acceptance, or blunt refusal, of vaccines. Three online cross-sectional surveys of Ghanaian citizens were conducted in August 2020 (N = 3048), March 2021 (N = 1558), and June 2021 (N = 1295) to observe temporal trends of vaccine hesitancy in Ghana, and to examine key groups and predictors associated with hesitancy. Quantitative measurements of hesitancy and subjective reasons for hesitancy were assessed, including predictors such as misinformation beliefs, political allegiance, and demographic and socioeconomic factors. Descriptive statistics were employed to analyse temporal trends in hesitancy between surveys, and logistic regression analyses were conducted to observe key predictors of hesitancy. Findings revealed that overall hesitancy decreased from 36.8% (95% CI: 35.1%-38.5%) in August 2020 to 17.2% (95% CI: 15.3%-19.1%) in March 2021. However, hesitancy increased to 23.8% (95% CI: 21.5%-26.1%) in June 2021. Key reasons for refusing the vaccine in June 2021 included not having enough vaccine-related information (50.6%) and concerns over vaccine safety (32.0%). Groups most likely to express hesitancy included Christians, urban residents, opposition political party voters, people with more years of education, females, people who received COVID-19 information from internet sources, and people who expressed uncertainty about their beliefs in common COVID-19 misinformation. Groups with increased willingness to vaccinate included elected political party voters and people who reported receiving information about COVID-19 from the Ghana Health Service. This study provides knowledge on Ghanaian population confidence and concerns about COVID-19 immunisations, and can support development of locally-tailored health promotion strategies.

With the emergence of the highly transmissible Omicron variant, large-scale vaccination coverage is crucial to the national and global pandemic response, especially in populous Southeast Asian countries such as the Philippines and Malaysia where new information is often received digitally. The main aims of this research were to determine levels of hesitancy and confidence in COVID-19 vaccines among general adults in the Philippines and Malaysia, and to identify individual, behavioural, or environmental predictors significantly associated with these outcomes. Data from an internet-based cross-sectional survey of 2558 participants from the Philippines (N = 1002) and Malaysia (N = 1556) were analysed. Results showed that Filipino (56.6%) participants exhibited higher COVID-19 hesitancy than Malaysians (22.9%; p < 0.001). However, there were no significant differences in ratings of confidence between Filipino (45.9%) and Malaysian (49.2%) participants (p = 0.105). Predictors associated with vaccine hesitancy among Filipino participants included women (OR, 1.50, 95% CI, 1.03–1.83; p = 0.030) and rural dwellers (OR, 1.44, 95% CI, 1.07–1.94; p = 0.016). Among Malaysian participants, vaccine hesitancy was associated with women (OR, 1.50, 95% CI, 1.14–1.99; p = 0.004), social media use (OR, 11.76, 95% CI, 5.71–24.19; p < 0.001), and online information-seeking behaviours (OR, 2.48, 95% CI, 1.72–3.58; p < 0.001). Predictors associated with vaccine confidence among Filipino participants included subjective social status (OR, 1.13, 95% CI, 1.54–1.22; p < 0.001), whereas vaccine confidence among Malaysian participants was associated with higher education (OR, 1.30, 95% CI, 1.03–1.66; p < 0.028) and negatively associated with rural dwellers (OR, 0.64, 95% CI, 0.47–0.87; p = 0.005) and online information-seeking behaviours (OR, 0.42, 95% CI, 0.31–0.57; p < 0.001). Efforts should focus on creating effective interventions to decrease vaccination hesitancy, increase confidence, and bolster the uptake of COVID-19 vaccination, particularly in light of the Dengvaxia crisis in the Philippines.

Introduction: It is clear that medical science has advanced much in the past few decades with the development of vaccines and this is even true for the novel coronavirus outbreak. By late , COVID-vaccines were starting to be approved by national and global regulators, and across , there was Frontiers in Public Health frontiersin.org Marzo et al. . /fpubh. .Methods: An internet-based cross-sectional survey was conducted from April to August using convenience sampling among people from di erent countries. Participants were asked about their level of intention to the COVID-vaccine. Participants completed the Digital Health Literacy Instrument (DHLI), which was adapted in the context of the COVID Health Literacy Network. Cross-tabulation and logistic regression were used for analysis purpose.Results: Overall, the mean DHL score was . (SD = . , Range = -). The mean DHL score for those who answered "Yes" for "support for national vaccination schedule" was . (SD . ) compared to . (SD . ) for those who either answered "No" or "Don't know". Factors including country, place of residence, education, employment, and income were associated with the intention for vaccination. Odds of vaccine intention were higher in urban respondents (OR-. ; C.I.-. -. ) than in rural respondents. Further, higher competency in assessing the relevance of online information resulted in significantly higher intention for vaccine uptake. Conclusion:Priority should be given to improving DHL and vaccination awareness programs targeting rural areas, lower education level, lower income, and unemployed groups.

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