Assess & Understanding of Vaccine Hesitancy in Sub-Saharan Africa

Challenge

Although the early months of the global COVID-19 vaccination roll out was hamstrung by limited vaccine supply, vaccine nationalism and access inequities for low- and middle-income countries (LMICs), the situation has since changed to one of COVID-19 vaccine supply glut and low absorptive capacity of LMIC immunization programs. The Johns Hopkins International Vaccine Access Centre was commissioned to conduct policy, programmatic and behavioral research to understand what drives COVID-19 vaccination delivery, demand, and uptake in sub-Saharan Africa, using Nigeria, Ethiopia, and Kenya as case studies. Findings from the study will inform more effective country deployment and demand-generation strategies.

Approach

Using a mixed methods approach, we sought to describe the drivers of COVID-19 vaccine acceptance and hesitancy as well as the client journey to vaccination – looking at COVID-19 vaccination rate by different demographics, the correlation of vaccine uptake with known socio-behavioral drivers, the level of COVID-19 vaccine hesitancy and the reasons for non-vaccination. The second set of objectives were to describe the health care workers’ vaccination journey; and their disposition and capacity to promote the COVID-19 vaccination. The third set of objectives was to describe the COVID-19 vaccination policy and program strategies, and the status of implementation of those strategies.

Across the three countries, we conducted nationally representative household surveys of 4601 individuals aged 18 years and older, who were systematically sampled using a probability-based multi-stage cluster sampling approach. We also conducted online surveys of 1800 healthcare workers via convenience/snowball sampling of healthcare workers within a set of health facilities which were systematically selected from the states, counties and regions in a ratio reflecting the national distribution of health facilities at the primary, secondary and tertiary levels. Data was collected between February and June 2022.

To provide qualitative insights, we conducted key informant interviews, focus group discussions, with immunization stakeholders at national, regional, district, health facility and community levels, representing government, partners, CSOs, immunization managers, immunization providers, caregivers, community leaders. Data was collected from six states in Nigeria representing all six geo-political zones; eight counties in Kenya representing former regions, and eight regions and city administrations in Ethiopia.

Results

Bivariate and multivariate logistics regressions were run to assess the mains associations of interest. Our primary outcome was vaccine acceptance among the survey population, and the secondary outcome was vaccine hesitancy among the non-vaccinated subgroup. Control variables were socio-demographic characteristics and predictor variables were derived from three widely accepted vaccine behavioral models – the 3C model (confidence, convenience, and complacency), UNICEF’s vaccination journey and WHO’s BeSD framework.