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.