Assessing COVID-19 vaccine hesitancy and barriers to uptake in Sub-Saharan Africa.

BACKGROUND: Despite improved availability of COVID-19 vaccines in Sub-Saharan Africa, vaccination campaigns in the region have struggled to pick up pace and trail the rest of the world. Yet, a successful vaccination campaign in Sub-Saharan Africa will be critical to containing COVID-19 globally. METHODS: Here, we present new descriptive evidence on vaccine hesitancy, uptake, last-mile delivery barriers, and potential strategies to reach those who remain unvaccinated. Our data comes from national high frequency phone surveys in six countries in East and West Africa with a total population of 415 million people. Samples were drawn from nationally representative samples of households interviewed in recent in-person surveys. Our estimates are based on a survey module harmonized across countries and are re-weighted to mitigate potential sample selection biases. RESULTS: We show that vaccine acceptance remains generally high among respondents in Sub-Saharan Africa (between 95.1% and 63.3%) even though hesitancy is non-negligible among those pending vaccination. Many who are willing to get vaccinated are deterred by a lack of easy access to vaccines at the local level. Furthermore, social ties and perceptions as well as intra-household power relations matter for vaccine take-up. Among the unvaccinated population, radio broadcasts have widespread reach and medical professionals are highly trusted. CONCLUSIONS: Our findings highlight that creating a positive social norm around COVID-19 vaccination, messaging that leverages trusted and accessible information sources and channels, and more easily accessible vaccination sites at the community level are promising policy options to boost vaccination campaigns in the region and end the pandemic everywhere.

COVID-19 vaccine coverage in Sub-Saharan Africa is behind the rest of the world. As the region is home to nearly 1.2 billion people (15% of the world population), achieving high levels of COVID-19 vaccination in Sub-Saharan Africa is important to containing the pandemic globally. We conduct national phone surveys in six countries in East and West Africa to learn how to best promote COVID-19 vaccine uptake in the region. Our surveys focus on peoples' willingness to get vaccinated, barriers that prevent them from accessing COVID-19 vaccines, and strategies to reach out to those who have not been vaccinated yet. We find that vaccine acceptance is high but that poor access to vaccines at a local level prevents many from getting vaccinated. Our findings can help policymakers design more effective vaccination campaigns.

The evolution of COVID-19 vaccine hesitancy in Sub-Saharan Africa: evidence from panel survey data.

BACKGROUND: COVID-19 vaccination efforts are lagging in Sub-Saharan Africa, as just over 20 percent of the population has been fully vaccinated. COVID-19 vaccine hesitancy is considered important as a prerequisite for widespread vaccine take-up. Here, we study the dynamics of vaccine acceptance, its correlates, and reasons for hesitancy over time, drawing on two years of panel survey data. METHODS: In this observational study, we use multiple rounds of data from national High Frequency Phone Surveys (HFPS) in five countries in East and West Africa (Burkina Faso, Ethiopia, Malawi, Nigeria, and Uganda), covering a period between 2020 and 2022. The surveys are cross-country comparable and draw their samples from nationally representative sampling frames. Based on this data source, the study presents population-weighted means and performs multivariate regression analysis. RESULTS: COVID-19 vaccine acceptance was high throughout the study period (68% to 98%). However, acceptance levels were lower in 2022 than in 2020 in three countries (Burkina Faso, Malawi, Nigeria), and higher in one country (Uganda). Moreover, individuals are observed to change their stated vaccine attitudes between survey rounds, to a limited extent in some countries (Ethiopia) and more frequently in others (Burkina Faso, Malawi, Nigeria, Uganda). Vaccine hesitancy is higher in richer households, and those residing in urban areas; among women and those better educated. Hesitancy is lower in larger households and among heads of the household. The main reasons for hesitancy are concerns about side effects of the vaccine, its safety and efficacy, as well as assessments of COVID-19 risk, though these reasons fluctuate over time. CONCLUSIONS: Reported COVID-19 vaccine acceptance levels remain far above vaccination rates in the study countries, suggesting that vaccine hesitancy is not the primary obstacle to reaching greater vaccine coverage, which may instead be related to access and delivery barriers as well as supply shortages. Nevertheless, vaccine attitudes appear malleable so that continued efforts are needed to retain high levels of vaccine acceptance.

Acceptance of COVID-19 vaccines in sub-Saharan Africa: evidence from six national phone surveys.

OBJECTIVES: To estimate the willingness to accept a COVID-19 vaccine in six sub-Saharan African countries and identify differences in acceptance across countries and population groups. DESIGN: Cross-country comparable, descriptive study based on a longitudinal survey. SETTING: Six national surveys from countries representing 38% of the sub-Saharan African population (Burkina Faso, Ethiopia, Malawi, Mali, Nigeria and Uganda). PARTICIPANTS: Respondents of national high-frequency phone surveys, aged 15 years and older, drawn from a nationally representative sample of households. MAIN OUTCOME MEASURES: Willingness to get vaccinated against COVID-19 if an approved vaccine is provided now and for free, disaggregated by demographic attributes and socioeconomic factors obtained from national household surveys. Correlates of and reasons for vaccine hesitancy. RESULTS: Acceptance rates in the six sub-Saharan African countries studied are generally high, with at least four in five people willing to be vaccinated in all but one country. Vaccine acceptance ranges from nearly universal in Ethiopia (97.9%, 95% CI 97.2% to 98.6%) to below what would likely be required for herd immunity in Mali (64.5%, 95% CI 61.3% to 67.8%). We find little evidence for systematic differences in vaccine hesitancy by sex or age but some clusters of hesitancy in urban areas, among the better educated, and in richer households. Safety concerns about the vaccine in general and its side effects specifically emerge as the primary reservations toward a COVID-19 vaccine across countries. CONCLUSIONS: Our findings suggest that inadequate demand is unlikely to represent the key bottleneck to reaching high COVID-19 vaccine coverage in sub-Saharan Africa. To turn intent into effective demand, targeted information, sensitisation and engagement campaigns bolstering confidence in the safety of approved vaccines and reducing concerns about side effects will be crucial to safeguard the swift progression of vaccine rollout in one of the world's poorest regions.

Viewpoint: High-frequency phone surveys on COVID-19: Good practices, open questions.

Following the onset of the COVID-19 pandemic, face-to-face survey data collection efforts came to a halt due to lockdowns, limitations on mobility and social distancing requirements. What followed was a surge in phone surveys to fulfill rapidly evolving needs for timely and policy-relevant microdata for understanding the socioeconomic impacts of and responses to the pandemic. Even as the face-to-face survey data collection efforts are resuming in different parts of the world with COVID-19 safety protocols, the rapidly-acquired experience with phone surveys on the part of national statistical offices and survey practitioners in low- and middle-income countries appears to have formed the foundation for phone surveys to be more commonly implemented in the post-pandemic era, in response to other shocks and as complementary efforts to face-to-face surveys. Informed by the practical experience with the high-frequency phone surveys that have been implemented with support from the World Bank Living Standards Measurement Study (LSMS) to monitor the socioeconomic impacts of the COVID-19 pandemic, this paper provides an overview of options for the design and implementation of phone surveys to collect representative data from households and individuals. Further, the discussion identifies the requirements for phone surveys to be a mainstay in the toolkits of national statistical offices and the directions for future research on the design and implementation of phone surveys.

Physical activity and sedentary time in a rural adult population in Malawi compared with an age-matched US urban population.

OBJECTIVES: This study was designed to assess patterns of objectively measured physical activity (PA) and sedentary behaviour in a sample of adults in a rural setting from a low-income Sub-Saharan African country (Malawi). The patterns of PA and sedentary behaviour in Malawi were compared with US data collected and analysed using the same methodology. METHODS: The Malawi PA data were collected as part of a survey experiment on the measurement of agricultural labor conducted under the World Bank Living Standards Measurement Study program. ActiGraph accelerometers (model GT3X) were worn on the right hip in a household-based sample of 414 working-age adults (15-85 years). RESULTS: Mean total and 95% CIs for PA by category in min/day for Malawi adults were: sedentary 387.6 (377.4-397.8), low-light 222.1 (214.7-229.5), high-light 136.3 (132.7-139.9), moderate 71.6 (68.8-74.5), vigorous 1.1 (0.5-1.8) and moderate-to-vigorous physical activity (MVPA) 72.8 (69.7-75.9). Mean of PA and sedentary behavior (min/day) summed across age and sex groups are compared between Malawi and US samples: sedentary behaviour, 387.6 vs 525.8 (p<0.001); low-light, 222.1 vs 217.0 (p=ns); high-light, 136.3 vs 45.6 (p<0.001); moderate, 71.6 vs 28.0 (p<0.001); vigorous, 1.1 vs 2.5 (p<0.001); MVPA, 72.8 vs 30.5 (p<0.001). Compared with the USA, Malawi participants averaged consistently less sedentary time/day and more minutes/day in all intensity levels of PA, except for low-light and vigorous PA. CONCLUSION: Overall, levels of MVPA and high-light activity in adults in Malawi were substantially higher and sedentary time was substantially lower than those observed in US samples using near identical data collection, scoring and analysis.

Are African households (not) leaving agriculture? Patterns of households' income sources in rural Sub-Saharan Africa.

This paper uses comparable income aggregates from 41 national household surveys from 22 countries to explore the patterns of income generation among rural households in Sub-Saharan Africa, and to compare household income strategies in Sub-Saharan Africa with those in other regions. The paper seeks to understand how geography drives these strategies, focusing on the role of agricultural potential and distance to urban areas. Specialization in on-farm activities continues to be the norm in rural Africa, practiced by 52 percent of households (as opposed to 21 percent of households in other regions). Regardless of distance and integration in the urban context, when agro-climatic conditions are favorable, farming remains the occupation of choice for most households in the African countries for which the study has geographically explicit information. However, the paper finds no evidence that African households are on a different trajectory than households in other regions in terms of transitioning to non-agricultural based income strategies.

Milking the data: Measuring milk off-take in extensive livestock systems. Experimental evidence from Niger.

Milk is an important source of cash and nutrients for many households in developing countries. Yet, our understanding of the role of dairy production in livelihoods and nutritional outcomes is hindered by the lack of decent quality household survey data. Data on milk off-take for human consumption are difficult to collect in household surveys for a number of reasons which make accurate recall challenging for the respondent (continuous production and seasonality among others), introducing possibly severe biases in the computation of full household incomes and farm sales, as well as in the estimation of the contribution of livestock (specifically dairy) production to agricultural value added and the livelihoods of rural households. This paper presents results from a validation exercise implemented in Niger, where alternative survey instruments based on recall methods were administered to randomly selected households, and compared to a 12-month system of physical monitoring and recording of milk production. The results of the exercise show that reasonably accurate estimates via recall methods are possible, and provide a clear ranking of questionnaire design options that can inform future survey operations.