COVID-19 Vaccine Acceptance and Hesitancy in Low and Middle Income Countries, and Implications for Messaging (preprint)

ABSTRACT

BackgroundAs vaccination campaigns are deployed worldwide, addressing vaccine hesitancy is of critical importance to ensure sufficient immunization coverage. We analyzed COVID-19 vaccine acceptance across 15 samples covering ten low- and middle-income countries (LMICs) in Asia, Africa, and South America, and two higher income countries (Russia and the United States). MethodsStandardized survey responses were collected from 45,928 individuals between June 2020 and January 2021. We estimate vaccine acceptance with robust standard errors clustered at the study level. We analyze stated reasons for vaccine acceptance and hesitancy, and the most trusted sources for advice on vaccination, and we disaggregate acceptance rates by gender, age, and education level. FindingsWe document willingness to take a COVID-19 vaccine across LMIC samples, ranging from 67% (Burkina Faso) to 97% (Nepal). Willingness was considerably higher in LMICs (80%) than in the United States (65%) and Russia (30%). Vaccine acceptance was primarily explained by an interest in personal protection against the disease (91%). Concern about side effects (40%) was the most common reason for reluctance. Health workers were considered the most trusted sources of information about COVID-19 vaccines. InterpretationGiven high levels of stated willingness to accept a COVID-19 vaccine across LMIC samples, our study suggests that prioritizing efficient and equitable vaccine distribution to LMICs will yield high returns in promoting immunization on a global scale. Messaging and other community-level interventions in these contexts should be designed to help translate intentions into uptake, and emphasize safety and efficacy. Trusted health workers are ideally positioned to deliver these messages. FundingBeyond Conflict, Bill and Melinda Gates Foundation, Columbia University, Givewell.org, Ghent University, HSE University Basic Research Program, International Growth Centre, Jameel Poverty Action Lab Crime and Violence Initiative, London School of Economics and Political Science, Mulago Foundation, NOVAFRICA at the Nova School of Business and Economics, NYU Abu Dhabi, Oxford Policy Management, Social Science Research Council, Trinity College Dublin COVID19 Response Funding, UK Aid, UKRI GCRF/Newton Fund, United Nations Office for Project Services, Weiss Family Fund, WZB Berlin Social Science Center, Yale Institute for Global Health, Yale Macmillan Center, and anonymous donors to IPA and Y-RISE