COVID-19 perceptions and vaccine hesitancy: Acceptance, attitude and barriers among Cameroonians

COVID-19 vaccine acceptance and hesitancy in Cameroon: a systematic review and meta-analysis

BACKGROUND

The development of effective vaccines was a promising tool for ending the pandemic. However, the success of a vaccination programme hinges on achieving substantial community acceptance. In Cameroon, numerous studies have investigated the level of acceptance, hesitancy, and perception of COVID-19 vaccines, with mixed results. To provide a comprehensive understanding of these parameters, this meta-analysis aimed to estimate the pooled proportion of COVID-19 vaccine acceptance, hesitancy and perception in Cameroon.

METHODS

A systematic search of online databases, including PubMed, Google Scholar, and ScienceDirect, was conducted to identify relevant research articles. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The extracted data were compiled in a Microsoft Excel spreadsheet and analyzed using R statistical software (version 4.3.3). The pooled proportion of COVID-19 vaccine acceptance, hesitancy, and perception was calculated using a random-effects meta-analysis. Funnel plots, Egger's, and Begg's tests were used to assess publication bias.

RESULTS

Of the 1,346 records identified through the database search, 20 research articles were included in the systematic review and meta-analysis. The random-effects model showed that approximately 31.21% (95% CI: 23.49-38.94) of the participants was willing to accept the COVID-19 vaccine. More than two-thirds of the population (68.49%; 95% CI: 60.65-76.34) were vaccine hesitant. Half of the participants (51.81%; 95% CI: 42.70-60.93), had a negative perception of the COVID-19 vaccine. The acceptance rate progressed from the first semester of 2021 (27.21%; 95% CI: 10.38-44.05) to the first semester of 2022 (45.56%; 95% CI: 25.00-66.12). The pooled vaccine acceptance rate was 29.29% (95% CI: 19.86-38.72) for the general population and 39.24% (95% CI: 22.84-55.64) for healthcare workers. The pooled vaccine hesitancy rate was 70.39% (95% CI: 61.30-79.80) for the general population and 57.42% (95% CI: 4.05-71.80) for healthcare workers.

CONCLUSION

Although progress in vaccine acceptance, targeted interventions remain necessary to address vaccine hesitancy in the country. Strategies such as enhancing access to accurate information, fostering trust in institutions, and strengthening community engagement remain crucial for increasing COVID-19 vaccine uptake.

Acceptance-Hesitancy of COVID-19 Vaccination and Factors Affecting It in Adults: Systematic Review Study

BACKGROUND

Despite the advent of vaccines against COVID-19, there is considerable variation in the acceptance and hesitancy towards the vaccination program across different countries. The objective of this study was to ascertain the prevalence of hesitancy and acceptance regarding the use of the vaccine against the novel coronavirus, also known as COVID-19, and to identify the factors that influence these attitudes.

MATERIALS AND METHODS

All the cross-sectional studies were retrieved from the PubMed databases, the Web of Science ISI, Scopus, and the Cochrane Library. Papers published in English between 2 November 2019 and 23 May 2023 were subjected to further assessment based on their title, abstract, and main text, with a view to ensuring their relevance to the present study.

RESULTS

Following an exhaustive investigation, 59 studies were selected for screening in this systematic review. The most frequently employed method of data collection was the online survey. The study sample comprised 59.12% women and 40.88% men, with ages ranging from 16 to 78 years. The proportion of individuals accepting the vaccine ranged from 13% to 96%, while the proportion of those exhibiting hesitancy ranged from 0% to 57.5%. The primary reasons for accepting the COIVD-19 vaccine were a heightened perception of risk associated with the virus and a general trust in the healthcare system. The most frequently cited reasons for vaccine hesitancy in the context of the ongoing pandemic include concerns about the potential dangers of the vaccines, the rapid pace of their development, the possibility of adverse effects (such as infertility or death), and the assumption that they have been designed to inject microchips.

DISCUSSION

A variety of socio-demographic factors are implicated in determining the rate of vaccine acceptance. A number of socio-demographic factors have been identified as influencing vaccine acceptance. These include high income, male gender, older age, marriage, the presence of older children who have been vaccinated and do not have chronic diseases, high education, and health insurance coverage.

CONCLUSION

Eliminating vaccine hesitancy or increasing vaccine acceptance is a crucial factor that should be addressed through various means and in collaboration with regulatory and healthcare organizations.

Quantitative Synthesis of Factors Associated with COVID-19 Vaccine Acceptance and Vaccine Hesitancy in 185 Countries

Mass vaccination against COVID-19 is the best method to ensure herd immunity in order to curb the effect of the pandemic on the global economy. It is therefore important to assess the determinants of COVID-19 vaccine acceptance and hesitancy on a global scale. Factors were recorded from cross-sectional studies analyzed with t-Test, ANOVA, correlation, and meta-regression analyses and synthesized to identify global trends in order to inform policy. We registered the protocol (ID: CRD42022350418) and used standard Cochrane methods and PRISMA guidelines to collect and synthesize cross-sectional articles published between January 2020 and August 2023. A total of 67 articles with 576 studies from 185 countries involving 3081,766 participants were included in this synthesis. Global COVID-19 vaccine acceptance was 65.27% (95% CI; 62.72-67.84%), while global vaccine hesitancy stood at 32.1% (95% CI; 29.05-35.17%). One-Way ANOVA showed that there was no significant difference in the percentage Gross Domestic Product spent on vaccine procurement across the World Bank income levels (p < 0.187). There was a significant difference of vaccine acceptance (p < 0.001) and vaccine hesitancy (p < 0.005) across the different World Bank Income levels. World Bank income level had a strong influence on COVID-19 vaccine acceptance (p < 0.0004) and hesitancy (p < 0.003) but percentage Gross Domestic Product spent on vaccine procurement did not. There was no correlation between percentage Gross Domestic Product spent on vaccine procurement and COVID-19 vaccine acceptance (r = -0.11, p < 0.164) or vaccine hesitancy (r = -0.09, p < 0.234). Meta-regression analysis showed that living in an urban setting (OR = 4.83, 95% CI; 0.67-212.8), rural setting (OR = 2.53, 95% CI; 0.29-119.33), older (OR = 1.98, 95% CI; 0.99-4.07), higher education (OR = 1.76, 95% CI; 0.85-3.81), and being a low income earner (OR = 2.85, 95% CI; 0.45-30.63) increased the odds of high COVID-19 vaccine acceptance. Factors that increased the odds of high COVID-19 vaccine hesitancy were no influenza vaccine (OR = 33.06, 95% CI; 5.03-1395.01), mistrust for vaccines (OR = 3.91, 95% CI; 1.92-8.24), complacency (OR = 2.86, 95% CI; 1.02-8.83), pregnancy (OR = 2.3, 95% CI; 0.12-141.76), taking traditional herbs (OR = 2.15, 95% CI; 0.52-10.42), being female (OR = 1.53, 95% CI; 0.78-3.01), and safety concerns (OR = 1.29, 95% CI; 0.67-2.51). We proposed a number of recommendations to increase vaccine acceptance and ensure global herd immunity against COVID-19.

Factors Associated with COVID-19 Vaccine Refusal: A Community-Based Study in the Menoua Division in Cameroon

COVID-19, which was named in March 2020 as a global pandemic by the WHO, remains a serious public health threat worldwide. Despite the adoption of vaccines as an effective strategy to counter this pandemic, the vaccination rate in Cameroon is far lower than that planned by the Cameroonian government and its partners. The main objective of this study was to determine the factors limiting COVID-19 vaccine acceptance in the Menoua Division in the West Region of Cameroon. A community-based cross-sectional and analytical study was conducted between March and April 2022 in the Menoua Division. A pre-tested questionnaire was filled out by willing participants of more than 18 years old, and data were further expressed in order to estimate the knowledge of participants on COVID-19, vaccine status, and the factors associated with vaccine refusal. A Pearson test was performed in order to identify the associated factors, with a p-value < 0.05 considered as significant. A total of 520 participants with a mean age of 33.27 ± 12.78 were included. Most had a secondary education level (56.15%), and trade and informal sectors (34.04%) were the main occupations. Knowledge on COVID-19 was average, and it was significantly associated (p < 0.05) with gender and education level. The vaccination rate was 10%, which was six times less than the national target. A lack of information, confidence, and medicinal plant use were all factors significantly associated with vaccine refusal. This pioneer community-based study in Cameroon identified a lack of knowledge, confidence, and medicinal plant use as the leading factors limiting COVID-19 vaccine acceptance in Cameroon. Health authorities should therefore strengthen sensitization in order to tackle the lack of information and the misinformation among the target groups.

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

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.