Persisting Vaccine Hesitancy in Africa: The Whys, Global Public Health Consequences and Ways-Out—COVID-19 Vaccination Acceptance Rates as Case-in-Point

Abstract

Vaccine hesitancy (VH) is the seventh among the WHO’s top 10 threats to global public health, which has continued to perpetuate the transmission of vaccine preventable diseases (VPDs) in Africa. Consequently, this paper systematically reviewed COVID-19 vaccine acceptance rates (VARs)—including the vaccine uptake and vaccination intention—in Africa from 2020 to 2022, compared the rates within the five African regions and determined the context-specific causes of VH in Africa. Generally, COVID-19 VARs ranged from 21.0% to 97.9% and 8.2% to 92.0% with mean rates of 59.8 ± 3.8% and 58.0 ± 2.4% in 2021 and 2022, respectively. Southern and eastern African regions had the top two VARs of 83.5 ± 6.3% and 68.9 ± 6.6% in 2021, and 64.2 ± 4.6% and 61.2 ± 5.1% in 2022, respectively. Based on population types, healthcare workers had a marginal increase in their mean COVID-19 VARs from 55.5 ± 5.6% in 2021 to 60.8 ± 5.3% in 2022. In other populations, the mean VARs decreased from 62.7 ± 5.2% in 2021 to 54.5 ± 4% in 2022. As of 25 October 2022, Africa lags behind the world with only 24% full COVID-19 vaccinations compared to 84%, 79% and 63% reported, respectively, in the Australian continent, upper-middle-income countries and globally. Apart from the problems of confidence, complacency, convenience, communications and context, the context-specific factors driving COVID-19 VH in Africa are global COVID-19 vaccine inequality, lack of vaccine production/maintenance facilities, insecurity, high illiteracy level, endemic corruption, mistrust in some political leaders, the spreading of unconfirmed anti-vaccination rumors and political instability. With an overall mean COVID-19 acceptance rate of 58%, VH still subsists in Africa. The low VARs in Africa have detrimental global public health implications, as it could facilitate the emergence of immune invading SARS-CoV-2 variants of concern, which may spread globally. Consequently, there is a need to confront these challenges frontally and engage traditional and religious leaders in the fight against VH in Africa, to restore public trust in the safety and efficacy of vaccines generally. As the availability of COVID-19 vaccines improves, the vaccination of pets and zoo-animals from which reverse zoonotic transmission of SARS-CoV-2 have been reported is recommended, to limit the evolution and spread of new variants of concern and avert possible SARS-CoV-2 epizootic or panzootic diseases in susceptible animal species.

Mpox in Nigeria: Perceptions and knowledge of the disease among critical stakeholders—Global public health consequences

“…Global inequity in access to vaccines and therapeutics against infectious diseases had continued to be a major challenge in the fight against infectious disease of global health importance [ 42 ]. High-income countries have been accused of stockpiling and administering the only available mpox vaccines, while low income countries have little or no access to the vaccine [ 43 ]. Unfortunately, the cessation of production and administration of smallpox vaccination in developing countries, which provided about 85% cross-protection against mpox, may have increased the virus transmission [ 4 , 6 ].…”

“…This is because the necessary steps and basic precautionary measure needed to limit the transmission of the diseases may be jettisoned, leading to increased national spread and hence massive global case exportation of MPXV from endemic countries. With increased international travel due to the removal of almost all COVID-19 restrictions globally [ 43 , 47 ], the international spread of MPXV, especially from traditionally endemic countries may be inevitable. Considering the rising level of mpox in Nigeria, her fragile health sector and high level of international travel between Nigeria and other countries, especially in the American, European and Asian continents; case exportation of the virus to these countries cannot be ruled out.…”

Confidence in COVID-19 vaccine effectiveness and safety and its effect on vaccine uptake in Tanzania: A community-based cross-sectional study

“…These findings emphasize the need for setting up specific educational campaigns to increase the level of knowledge, confidence, and COVID-19 vaccine uptake. 24 …”

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

“…Increasing vaccinations will reduce infection rates and subsequent consequences including hospitalisations, thereby reducing unnecessary prescribing of antimicrobials and associated AMR [ 96 , 97 , 98 , 105 , 106 ]. However, this requires comprehensive programs across Africa to address current high vaccine hesitancy [ 107 , 108 , 109 ].…”

“…We started with hospitals as more information is currently available regarding the prescribing of antibiotics in hospitals versus ambulatory care across Africa [ 70 ]. We will not discuss potential programs to address COVID-19 vaccine hesitancy across Africa as this has already been discussed [ 107 , 109 ]. Similarly, programs to reduce inappropriate use of antibiotics in agriculture and farming, with the emphasis on hospital in-patient prescribing.…”