Determinants of COVID-19 vaccine hesitancy and uptake in sub-Saharan Africa: a scoping review

Abstract

ObjectiveTo identify, describe and map the research tools used to measure COVID-19 vaccine hesitancy, refusal, acceptance and access in sub-Saharan Africa (SSA).DesignScoping review.MethodsIn March 2022, we searched PubMed, Scopus, Web of Science, Cochrane, Academic Search Premier, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Health Source Nursing, Africa Wide and APA PsychInfo for peer-reviewed literature in English related to COVID-19 vaccine hesitancy, refusal, acceptance and access in SSA. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews to guide evidence gathering and as a template to present the evidence retrieval process.ResultsIn the studies selected for review (n=72), several measurement tools were used to measure COVID-19 vaccine hesitancy, acceptance and refusal. These measurements were willingness and intent to vaccinate from the perspectives of the general population, special population groups such as mothers, students and staff in academic institutions and healthcare workers and uptake as a proxy for measuring assumed COVID-19 vaccine acceptance. Measurements of access to COVID-19 vaccination were cost and affordability, convenience, distance and time to travel or time waiting for a vaccine and (dis)comfort. Although all studies measured COVID-19 vaccine hesitancy, acceptance and refusal, relatively few studies (n=16, 22.2%) included explicit measurements of access to COVID-19 vaccination.ConclusionsBased on the gaps identified in the scoping review, we propose that future research on determinants of COVID-19 vaccination in SSA should further prioritise the inclusion of access-related variables. We recommend the development and use of standardised research tools that can operationalise, measure and disentangle the complex determinants of vaccine uptake in future studies throughout SSA and other low- and middle-income country (LMIC) settings.

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“…53 54 55 One reason for this is the lack of access to intellectual property, although other factors contributed as well. 56 57 Although the US licensed some of its technology to the World Health Organization’s Covid-19 Technology Access Pool (C-TAP) 17 months after emergency use authorization was granted in the US, no mRNA patents were shared. 58 59 Instead, the American strategy for global vaccine equity has been focused primarily on vaccine donations, with more than 1.2 billion doses promised by 2023 and about 500 million delivered to more than 110 countries as of March 2022.…”

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“…Vaccine inequality during the COVID-19 pandemic in Africa is reflected in the form of vaccine hesitancy/acceptance factors as determined in this review. A cross-sectional study reported in rural and urban West Africa that despite the respondents being worried about getting infected with SARS-CoV-2, half of those interviewed were unsure about the safety of the vaccine, leading to their unwillingness to get vaccinated [ 65 , 66 ]. Indeed, in an explanatory, sequential, mixed-methods design study carried out in Senegal between December 24, 2020 and January 16, 2021 for quantitative data collection and February 19 to March 30, 2021 for the qualitative data, it was reported that the proportion of those who refused to be vaccinated due to the belief the vaccine could endanger their health was 67.9% [ 67 , 68 ].…”

Four Years Since COVID-19 Day Zero: A Time to Evaluate Past and Future Pandemic Control Policies and Practices in Sub-Saharan Africa?

“…Despite the aspiration to complete this by mid-2022 it has not been achieved, due in large part to confounding of the vaccination campaigns in some African countries by the dual obstacles of poor vaccine supply and high hesitancy rates. 56 This contrasts with the situation in many developed nations where the latest vaccines are now routinely available, with some individuals receiving four or even five immunizations. 57 It is, therefore, arguably belatedly, time to rethink vaccine accessibility and distribution, reimagine vaccination strategies, and strive to ensure equity of immunization between nations.…”