COVID-19 vaccine hesitancy in Africa: a scoping review

Knowledge, attitudes and demographic drivers for COVID-19 vaccine hesitancy in Malawi

This study assessed the association among knowledge, attitudes and uptake of COVID-19 vaccine in Malawi, examining demographic factors influencing these variables. The study employed a quantitative research design. It thus sampled 394 participants from Malawi's three districts of Zomba, Dowa and Nkhatabay. Results showed that 163 (41.4%) participants had low levels of knowledge of COVID-19 vaccine, 231 (58.6%) had high levels of knowledge, 237 (60.2%) had a positive attitude, and 156 (39.8%) had a negative attitude towards the COVID-19 vaccine. On vaccine uptake, the study found that only 29 (17%) male and 52 (23%) female participants had received the vaccine. Further, participants with low levels of knowledge and a positive attitude towards the vaccine were 5.9 times more likely (p-value = 0.001) to be vaccinated than those with low levels of knowledge and negative attitudes towards the vaccine. On the other hand, those with high knowledge and a positive attitude towards the vaccine were 8.2 times more likely (p-value < 0.001) to be vaccinated compared to those with low knowledge and negative attitudes towards the vaccine. The findings highlight the importance of vaccine-related knowledge and attitudes in shaping uptake and reveal disparities across demographic groups. To improve vaccination coverage in Malawi, targeted interventions focusing on enhancing COVID-19 vaccine knowledge, addressing attitudinal barriers, and countering misinformation are needed. Strategies should be tailored to reach populations with lower uptake, such as males, younger adults, and those with lower education levels. Strengthening public health messaging, engaging community leaders, and building trust in healthcare systems are crucial for promoting widespread acceptance and uptake of COVID-19 vaccines in Malawi.

Attitudes towards COVID-19 vaccination: A cross sectional study in the Federal Capital Territory, Nigeria

Vaccine acceptance is complex and context-specific, varying across time, place and perceived behavioural nature of the community involved. A high vaccine acceptance rate is important to achieve herd immunity, however, vaccine hesitancy is a possible barrier to this. This study aimed to assess attitudes towards COVID-19 vaccination and associated factors. A cross-sectional survey was undertaken to investigate the attitudes of Federal Capital Territory residents towards COVID-19 vaccine uptake in Nigeria. Data were collected using questionnaires which were administered to respondents physically and online through random and snowball sampling strategies respectively. Data received were then analysed using Statistical Package for Social Sciences (SPSS). A total of 1767 responses were received with males representing 57.8% of the sample. More than half (54.9%) of the respondents were between the ages of 18-30 years. A third (35.4%) of the study participants indicated that a vaccine was not necessary for COVID-19, and 56.5% indicated willingness to accept COVID-19 vaccination. The majority of the sample (56.9%) indicated that the government decision-making was in their best interest, whilst close to two-thirds of the respondents (61%) were of the view that COVID-19 vaccination should not be made compulsory. Older respondents as represented by those over 60 years were more likely to accept COVID-19 vaccination (p = 0.039). This study however revealed negative attitudes towards COVID-19 vaccination, indicating the urgent need for government, policymakers, and other stakeholders to prioritise the development of strategies that can appropriately address vaccine hesitancy in the study setting. Contextual interventions indicated include strategic public enlightenment campaigns targeting populations with less favourable dispositions towards being vaccinated.

Willingness to receive COVID-19 vaccines, associated factors and reasons for not taking a vaccine: a cross sectional study among persons aged 13-80 years in Wakiso, Central Uganda

BACKGROUND

Vaccination has been recommended as one of the approaches for the control of COVID-19 pandemic. However, adequate vaccine coverage is critical to the effectiveness of the vaccine at population level. Data on acceptability of the vaccine in Ugandan urban areas are limited. This study examined the prevalence, factors associated with willingness to accept COVID-19 vaccine including reasons for not taking COVID-19 vaccine in a predominantly urban population of Wakiso, central Uganda.

METHODS

Data were obtained from a cross-sectional study conducted between March 1st, 2021 and September 30th, 2021 in the urban population-based cohort of the Africa Medical and behavioral Sciences Organization (AMBSO). A Multivariable modified Poisson regression analysis was used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals of willingness to accept the COVID-19 vaccine.

RESULTS

A total of 1,903 participants were enrolled in this study; 61% of whom were females. About 63% of participants indicated their willingness to accept the COVID-19 vaccine. Persons aged 13-19 years (aPR = 0.79; [95% CI: 0.74, 0.84]) or 20-29years (aPR = 0.93; [95% CI: 0.88, 0.98]) were less likely to accept the vaccine compared to persons aged 40-49 years. Persons with post-primary level of education (aPR = 1.05; [95% CI: 1.02, 1.09]) were more likely to accept the vaccine compared to persons with primary level of education. Additionally, students or individuals working in government (aPR = 1.13; [95% CI: 1.04, 1.23]) were more likely to accept the vaccine compared to individuals doing construction and Mechanic work as their main occupation. Reported reasons for not taking a COVID-19 vaccine included; concerns about side effects of the vaccine 154(57.0%), 64(23.7%) did not think the vaccines were effective, while 32(11.9%) did not like the vaccines.

CONCLUSION

A substantial proportion of individuals were not willing to accept the COVID-19 vaccine. Health education campaigns on vaccination within urban communities could help reduce COVID-19 vaccine misconceptions in the urban populations more especially the young and persons with low levels of formal education.

The Effectiveness of Public Awareness Initiatives Aimed at Encouraging the Use of Evidence-Based Recommendations by Health Professionals: A Systematic Review

OBJECTIVES

Public awareness initiatives have attracted growing attention globally, as a strategy to reduce low-value care and disinformation. However, knowledge gap remains in determining their effects. The aim of this systematic review was to summarize existing evidence to date on global effectiveness of public awareness initiatives.

METHODS

Primary quantitative studies focusing on passive delivery of public awareness initiatives that targeted health professionals were included. Eligible studies were identified through search of MEDLINE, Embase, Emcare, the Cochrane Library, PsycINFO, Business Source Complete, Emerald Insight, and Google (initially on December 19, 2018, followed by updated search between July 8-10, 2019, and then between March 8-9, 2022) and the reference list of relevant studies. Methodological quality of included studies was assessed using modified McMaster critical appraisal tool. A narrative synthesis of the study outcomes was conducted.

RESULTS

Twenty studies from United States, United Kingdom, Canada, Australia, and multicountry were included. Nineteen studies focused on Choosing Wisely initiative and one focused on National Institute of Clinical Excellence reminders. Most studies investigated one recommendation of a specialty. The findings showed conflicting evidence on the effectiveness of public awareness initiatives, suggesting passive delivery has limited success in reducing low-value care among health professionals.

CONCLUSIONS

This review highlights the complexity of change in an established practice pattern in health care. As passive delivery of public awareness initiatives has limited potential to initiate and sustain change, wide-ranging intervention components need to be integrated for a successful implementation.

Public Perception Toward the Malaysian National COVID-19 Immunisation Programme (PICK) in the State of Sabah, Malaysia: A Cross-Sectional Survey

The Malaysian Government has initiated the National COVID-19 Immunisation Programme, known as PICK, to be a national strategy for addressing the spread of the coronavirus disease (COVID-19) pandemic across the country. Although the government intensified public awareness to increase program registration, the total number that registered in the state of Sabah, located in East Malaysia, was relatively low during August 2021, accounting for only 42.9% as compared to that of Peninsular Malaysia. Therefore, this paper examines the public perception toward the PICK program in Sabah based on 4 main components: safety, communication, psychology, and milieu. This study is based on the empirical findings drawn from 1024 respondents across Sabah using online Google Form surveys. This study adopts 5 methodologies for data analysis by using K-means clustering, mean score, Mann-Whitney U test, spatial analysis, and frequency analysis. It has been revealed that the percentage of respondents (categorized as Cluster 1) who have a negative perception toward the vaccination program is higher (55.9%) than those who have a positive perception (44.1%). This study further discovered that Cluster 1 has shown high skepticism regarding the vaccination program, which can be explained through the communication component (M = 3.33, SD = 0.588), especially Co2, Co3, Co1, and Co4. Following the communication factor, a chain of negative perceptions also affects other components such as safety, psychology, and milieu among Cluster 1, all of which contribute to poor participation in the PICK program. The study outcomes are extremely useful for informing local authorities to establish policies related to public interests, primarily in the areas of public health. Understanding the community's perspectives and their obstacles in participating in such programs may assist local authorities in developing or implementing public policies and campaigns that ensure such related public programs can be conducted more effectively in the future.

Safety of AZD1222 COVID-19 vaccine and low Incidence of SARS-CoV-2 infection in Botswana following ChAdOx1(AZD1222) vaccination: A single-arm open-label interventional study - final study results

Objectives

We report the final analysis of the single-arm open-label study evaluating the safety and COVID-19 incidence after AZD1222 vaccination in Botswana conducted between September 2021 and August 2022.

Methods

The study included three groups of adults (>18 years), homologous AZD1222 primary series and booster (AZ2), heterologous primary series with one dose AZD1222, and AZD1222 booster (HPS), and primary series other than AZD1222 and AZD1222 booster (OPS). We compared the incidence of AEs in participants with and without prior COVID-19 infection using an exact test for rate ratios.

Results

Among 10,894 participants, 9192 (84.4%) were enrolled at first vaccine dose, 521 (4.8%) at second vaccine, and 1181 (10.8%) at the booster vaccine. Of 10,855 included in the full analysis set, 1700 received one dose of AZD1222; 5377 received two doses; 98 received a heterologous series including one AZD1222 and a booster; 30 in the HPS group; 1058 in the OPS group; and 2592 in the AZ2 group. No laboratory-confirmed COVID-19 hospitalizations or deaths were reported. The incidence of laboratory-confirmed symptomatic COVID infection for the AZ2 group was 6.22 (95% confidence interval: 2.51-12.78) per 1000 participant-years (1000-PY) and 3.5 (95% confidence interval: 0.42-12.57) per 1000-PY for AZ2+booster group. Most adverse events were mild, with higher incidence in participants with prior COVID-19 infection. Individuals with prior COVID-19 exposure exhibited higher binding antibody responses. No differences in outcomes were observed by HIV status.

Conclusion

AZD1222 is safe, effective, and immunogenic for people living with and without HIV.

Lay beliefs of COVID-19 vaccine refusal among intercity commercial drivers in the Volta region of Ghana: recommendations for improved vaccine uptake

BACKGROUND

The COVID-19 vaccine has faced increased hesitancy in Ghana and the Volta region in particular since its rollout. Acceptance of the vaccine among intercity commercial drivers is crucial, especially in the Volta region, as they transport people within and outside the country and could fuel the transmission of the virus if not vaccinated.

OBJECTIVE

We therefore established lay beliefs surrounding COVID-19 vaccine refusal among intercity commercial drivers in the Volta region of Ghana, as well as their recommendations for improved vaccine uptake.

METHODS

We purposively interviewed twenty-five (25) intercity commercial drivers who had not been vaccinated for COVID-19 in the Volta region of Ghana using a semi-structured interview guide and analysed their responses thematically using the ATLAS.ti software.

RESULTS

Various (ten) beliefs surrounding COVID-19 vaccine refusal were identified. These include the nonexistence of COVID-19, being immune to COVID-19, and the belief in the nonexistence of vaccines and vaccines being meant for the sick. Other beliefs identified were the belief that the COVID-19 vaccine is meant to reduce Africa's population, that the vaccine triggers other health complications leading to death, the belief that vaccination could cause financial loss, political mistrust, that the COVID-19 vaccine is not permitted by God, and the belief that prayer prevents COVID-19 infection. They also suggested that the adoption of persuasive communication techniques, the publication of information on those who died of COVID-19, providing evidence of tests conducted on the vaccine, testing people before vaccination, provision of care to those who may experience side effects from the vaccine, and being able to explain why varied vaccines are used for the same virus could help improve vaccine uptake.

CONCLUSION

Our findings show that there is a general lack of understanding and mistrust surrounding the COVID-19 vaccine among intercity commercial drivers in the Volta region. Hence, health promotion officers and communicators in the region need to be knowledgeable on the vaccine as well as on the conspiracy theories thwarting its uptake to provide comprehensive education to the public and intercity commercial drivers to improve its uptake.

Knowledge, risk perception and uptake of COVID-19 vaccination among internally displaced persons in complex humanitarian emergency setting, Northeast Nigeria

BACKGROUND

Owing to crowded and unsanitary conditions, internally displaced persons (IDPs) have an increased risk of COVID-19 infection. Adoption of COVID-19 preventive measures among this population is premised on accurate information, adequate knowledge, and risk perception. We assessed COVID-19 knowledge and risk perception and investigated the association between risk perception and COVID-19 preventive measures, including vaccination among IDPs in Northeast Nigeria.

METHODS

We conducted a cross-sectional study during July-December 2022 and sampled 2,175 IDPs using stratified sampling. We utilized a 12-point assessment tool to evaluate COVID-19 knowledge. Participants who scored ≥ 6 points were considered to have adequate knowledge. We used a 30-item Risk Behavior Diagnosis Scale to assess COVID-19 risk perception and evaluated each item on a 5-point Likert scale. Participants were divided into risk perception categories by the median of Likert scale scores. We performed weighted logistic regression analysis to identify factors associated with risk perception. Pearson's chi-squared with Rao-Scott adjustment was used to determine the relationship between risk perception and COVID-19 preventive measures.

RESULTS

Of 2,175 participants, 55.7% were 18-39 years old, 70.9% were females, and 81.7% had no formal education. Among the IDPs, 32.0% (95% CI: 28.8 - 35.0) were considered to have adequate COVID-19 knowledge, and 51.3% (95% CI: 47.8 - 54.8) perceived COVID-19 risk as high. Moreover, 46.3% (95% CI: 42.8 - 50.0) had received one dose of COVID-19 vaccine, and 33.1% (95% CI: 29.8 - 36.0) received two doses. Adequate knowledge (Adjusted Odds Ratio (AOR) = 2.10, [95% CI: 1.46 - 3.03]) and post-primary education (AOR = 3.20, [95% CI: 1.59 - 6.46]) were associated with risk perception. Furthermore, high risk perception was significantly associated with wearing face masks (χ2 = 106.32, p-value < .001), practicing hand hygiene (χ2 = 162.24, p-value < .001), physical distancing (χ2 = 60.84, p-value < .001) and vaccination uptake (χ2 = 46.85, p-value < .001).

CONCLUSIONS

This study revealed gaps in COVID-19 knowledge, risk perception, and vaccination uptake but demonstrated a significant relationship between risk perception and COVID-19 preventive practices. Health education and risk communication should be intensified to improve knowledge, elicit stronger risk perception, and enhance COVID-19 preventive practices.

Vaccine hesitancy and equity: lessons learned from the past and how they affect the COVID-19 countermeasure in Indonesia

INTRODUCTION

Indonesia has made progress in increasing vaccine coverage, but equitable access remains challenging, especially in remote areas. Despite including vaccines in the National Immunization Program (NIP), coverage has not met WHO and UNICEF targets, with childhood immunization decreasing during the COVID-19 pandemic. COVID-19 vaccination has also experienced hesitancy, slowing efforts to end the pandemic.

SCOPE

This article addresses the issue of vaccine hesitancy and its impact on vaccination initiatives amidst the COVID-19 pandemic. This article utilizes the vaccine hesitancy framework to analyze previous outbreaks of vaccine-preventable diseases and their underlying causes, ultimately providing recommendations for addressing the current situation. The analysis considers the differences between the pre-pandemic circumstances and the present and considers the implementation of basic and advanced strategies.

KEY FINDINGS AND CONCLUSION

Vaccine hesitancy is a significant challenge in the COVID-19 pandemic, and public health campaigns and community engagement efforts are needed to promote vaccine acceptance and uptake. Efforts to address vaccine hesitancy promote trust in healthcare systems and increase the likelihood of individuals seeking preventive health services. Vaccine hesitancy requires a comprehensive, culturally sensitive approach that considers local contexts and realities. Strategies should be tailored to specific cultural and societal contexts and monitored and evaluated.

HPV vaccination in Africa in the COVID-19 era: a cross-sectional survey of healthcare providers' knowledge, training, and recommendation practices

Introduction

Although the burden of cervical cancer in Africa is highest, HPV vaccination coverage remains alarmingly low in this region. Providers' knowledge and recommendation are key drivers of HPV vaccination uptake. Yet, evidence about providers' knowledge and recommendation practices about the HPV vaccine against a backdrop of emerging vaccine hesitancy fueled by the COVID-19 pandemic is lacking in Africa.

Methods

A cross-sectional study was conducted in 2021-2022 among healthcare providers involved in cervical cancer prevention activities in Africa. They were invited to report prior training, the availability of the HPV vaccine in their practice, whether they recommended the HPV vaccine, and, if not, the reasons for not recommending it. Their knowledge about the HPV vaccine was assessed through self-reporting (perceived knowledge) and with three pre-tested knowledge questions (measured knowledge).

Results

Of the 153 providers from 23 African countries who responded to the survey (mean age: 38.5 years, SD: 10.1), 75 (54.0%) were female and 97 (63.4%) were based In countries with national HPV immunization programs. Overall, 57 (43.8%) reported having received prior training on HPV vaccine education/counseling, and 40 (37.4%) indicated that the HPV vaccine was available at the facility where they work. Most respondents (109, 83.2%) reported recommending the HPV vaccine in their practice. Vaccine unavailability (57.1%), lack of effective communication tools and informational material (28.6%), and need for adequate training (28.6%) were the most commonly reported reasons for not recommending the HPV vaccine. While 63 providers (52.9%) reported that their knowledge about HPV vaccination was adequate for their practice, only 9.9% responded correctly to the 3 knowledge questions.

Conclusion

To increase HPV vaccination coverage and counter misinformation about this vaccine in Africa, adequate training of providers and culturally appropriate educational materials are needed to improve their knowledge of the HPV vaccine and to facilitate effective communication with their patients and the community.

COVID-19 vaccine hesitancy: assessing the prevalence, predictors, and effectiveness of a community pharmacy based counseling intervention

BACKGROUND

Coronavirus disease (COVID-19) vaccine hesitancy is a global challenge. In low- and middle-income countries (LMICs), the problem has persisted despite vaccine availability and decreasing infections. In Uganda, there is still limited information on the extent and predictors of vaccine hesitancy. This study sought to assess the prevalence and predictors of COVID-19 vaccine hesitancy, and the effectiveness of an intervention that involved community pharmacy counseling in combating COVID-19 vaccine hesitancy.

METHODS

A total of 394 participants were enrolled in a 4-week prospective cohort interventional study. The study was conducted across eight community pharmacies in Mbarara City, between 9:00 AM and 5:00 PM daily. The study personnel ascertained the vaccination status of all clients seeking community pharmacy services. All unvaccinated clients were consecutively assessed for eligibility, and eligible clients were systematically enrolled after receiving the community pharmacy services for which they requested. The study intervention involved structured participant counseling (within the pharmacy premise), follow-up short message service (weekly), and telephone calls (bi-weekly). Only participants who did not accept to receive the COVID-19 vaccine despite counseling were followed up for four weeks, or until they accepted to receive a COVID-19 vaccine. The effectiveness of the community pharmacy counseling intervention was determined as an increase in COVID-19 vaccine acceptance, and desirable attitudinal change towards COVID-19 disease, vaccination exercise, and vaccines. Descriptive analysis was used to summarize data, and multivariate analysis was used to determine the predictors of COVID-19 vaccine hesitancy. A p-value < 0.05 was considered statistically significant.

RESULTS

Out of 394 participants, 221 (56%) were hesitant to receive a COVID-19 vaccine. Participants expressed several reasons (mean 2±1) for COVID-19 vaccine hesitancy, mostly concerning vaccine safety (N=160, 47.3%). The overall COVID-19 vaccine acceptance rate increased by 25.4 percent points (43.9 - 69.3 percent points) after the study intervention. Age, religion, level of education, distance from the nearest public health facility, having a friend/family diagnosed with COVID-19, and personal suspicion of contracting COVID-19 were significant predictors of COVID-19 vaccine hesitancy.

CONCLUSION

COVID-19 vaccine hesitancy is a big challenge in Uganda. A mix of sociodemographic and COVID-19 vaccine perceptions are the key predictors of COVID-19 vaccine hesitancy. Although COVID-19 vaccines were not available at the time of the study, this study found that structured counseling interventions can improve COVID-19 vaccine acceptance rates. Larger prospective studies should evaluate the effectiveness of similar interventions in community pharmacies and other healthcare settings.

Vaccine Safety: Assessing the Prevalence and Severity of Adverse Events Following COVID-19 Vaccination amongst Healthcare Workers in Tertiary Health Facilities in Nigeria

BACKGROUND

Vaccines, including COVID-19 vaccines, are known to be cost-effective interventions for disease prevention and control. However, adverse events following immunisation (AEFI) may challenge the acceptance of these vaccines. This study assessed the prevalence and severity of COVID-19-related AEFI amongst healthcare workers at tertiary health facilities in Nigeria.

MATERIALS AND METHODS

This descriptive, cross-sectional study was conducted among healthcare workers who had received the COVID-19 vaccine. A multi-stage sampling technique was used to select participants from six Tertiary Health Facilities in Nigeria. Ethical approval (NHREC/01/01/2007-19/07/2021) was obtained from NHREC. Data were analysed using IBM® SPSS version 25 and categorical variables were presented in tables/charts using frequencies and proportions.

RESULTS

A total of 2130 respondents participated in the study, with a mean age of 37.4 ± 9.1 years. Most of the respondents, 1674 (78.6%), had two doses of the vaccine, and the overall prevalence of AEFI was 813 (38.2%). Common among the AEFI reported following the administration of the first dose of the vaccine were fever 649 (30.5%) and pain at the injection site 644 (30.2%), while it was pain at the injection site 216 (10.1%) and fever 173 (8.1%) for second dose. The higher proportions of AEFI were mostly mild to moderate.

CONCLUSION

The study observed a relatively low prevalence of AEFI, with the commonly reported ones being fever and injection site pain. It is crucial that countries continuously collect the data on AEFI and establish causality as a way to improve quality and guarantee vaccine safety.

Causes and costs of global COVID-19 vaccine inequity

Despite the rapid development of safe and effective COVID-19 vaccines and the widely recognized health and economic benefits of vaccination, there exist stark differences in vaccination rates across country income groups. While more than 70% of the population is fully vaccinated in high-income countries, vaccination rates in low-income countries are only around 30%. The paper reviews the factors behind global COVID-19 vaccine inequity and the health, social, and economic costs triggered by this inequity. The main contributors to vaccine inequity include vaccine nationalism, intellectual property rights, constraints in manufacturing capacity, poor resilience of healthcare systems, and vaccine hesitancy. Vaccine inequity has high costs, including preventable deaths and cases of illnesses in low-income countries, slow economic recovery, and large learning losses among children. Increasing vaccination rates in low-income countries is in the self-interest of higher-income countries as it may prevent the emergence of new variants and continuous disruptions to global supply chains.

Perceptions of the COVID-19 Vaccination Within a Convenience Sample of Sudanese Americans

INTRODUCTION

Sudanese American and other immigrant and refugee communities are at greater risk for exposure to COVID-19. This survey sought to better characterize COVID-19 vaccination practices, motivators, and drivers for hesitancy among Sudanese Americans.

METHODS

We developed an online, cross-sectional survey in English and Arabic distributed by Sudanese American community leaders in April 2022 with data stored anonymously in REDCap. Inclusion criteria were self-reporting being born within Sudan and living in the US within the last 2 years. Descriptive analysis tested survey responses for possible associations between the primary outcome, self-reported vaccination status, and questions regarding vaccination history, perspectives on vaccination, and demographic characteristics using Fishers Exact and Chi Squared Tests.

RESULTS

Of 111 survey responses received, 107 met inclusion criteria. 93% of respondents reported COVID-19 vaccine uptake with the primary motivation to protect oneself from disease. The most cited reason for vaccine hesitancy was belief it had not been studied enough. The group that reported vaccination had higher levels of education (.032) and were more likely to perceive that COVID-19 vaccinations were able to reduce spread (.001), decrease severe outcomes (.004), and benefits outweighing their risks (.004).

DISCUSSION AND CONCLUSIONS

This survey population of Sudanese Americans demonstrated high levels of vaccine uptake (93%), far greater than either the corresponding US (78%) or Sudanese population (15%). It is likely that high levels of educational attainment moderated vaccine uptake, though our survey may not have had the power to fully evaluate vaccine hesitancy.

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.

COVID-19 vaccination coverage among travellers at Lomé international airport (Togo), in 2022

COVID-19 pandemic management leads to new health policies including the requirement of a vaccination pass or a negative Polymerase Chain Reaction (PCR) test for cross-border flights. The objective of this study was to estimate COVID-19 vaccination coverage among travellers, as well as factors associated with a full vaccination. A cross sectional study was conducted in July 2022 at the Gnassingbé Eyadema International Airport (LFW) in Lomé. Travellers met at LFW, aged 12 years or above, and who agreed to participate in the study have been submitted a questionnaire. Logistic regression analysis was performed to identify factors associated with full vaccination defined as having received at least two doses of COVID-19 vaccine according to a validated vaccine schedule. A total of 847 travellers were included. 67% were men The median age was 40 years, Interquartile Range [31-48]. The main health document presented by travellers was the vaccination pass (69.1%). The majority (84.4%) of travellers had received at least one dose of COVID-19 vaccine and 63.9% had received at least two doses. Being 40 years of age or above (aOR=1.42; P=0.046), and travelling from a country outside Africa (aOR=2.18, P=0.003), were positively associated with full vaccination. Vaccination coverage among travellers at the LFW was relatively high. Travellers from a region outside Africa and aged 40 years or above were more likely to be full vaccinated. Better communication and strengthening of the vaccination strategies in Africa could help reduce these gaps.

Development and Assessment of a Six-Item Index to Gauge Motivation to Receive COVID-19 Vaccination

This study examined the factors influencing vaccine uptake using the Fogg Behavioral Model (FBM) and validated a multi-dimensional index for measuring a key construct in the FBM, motivation, using Confirmatory Factor Analysis (CFA) and Cronbach's alpha. The research was conducted in Yopougon Est, Côte d'Ivoire, and Kinshasa, Democratic Republic of Congo. We aimed to develop a motivation index for COVID-19 vaccination uptake informed by the FBM. The motivation index was developed and refined using interviews and cognitive testing, and then used in baseline and endline surveys to measure the motivation to uptake COVID-19 vaccination among 2173 respondents. The index was simplified to six items validated using Confirmatory Factor Analysis (CFA) and demonstrated strong internal reliability with Cronbach's alphas of 0.89 for the baseline and 0.77 for the endline. The study's findings indicate that this motivation index is a valid tool for measuring motivation to receive COVID-19 vaccination, with potential applications in other vaccination campaigns. However, further testing in diverse settings is needed to enhance generalizability, including in rural areas. This research provides valuable insights for designing effective behavior change interventions to increase COVID-19 vaccination rates.

Vaccine inequity: a threat to Africa's recovery from COVID-19

BACKGROUND

Vaccine inequity is a reality facing the Sub-Saharan Africa region as vaccine nationalism from high-income countries (HICs) leads to limited access to the lifesaving vaccines needed to end the pandemic. In Africa, a significant portion of the population has yet to be vaccinated against Covid-19; however, the barriers to accessing such vaccines, including capacity challenges, still persist despite the implementation of the COVAX facility meant to support the lower- and middle-income countries (LMICs) to boost vaccination.

METHODS

This study involved a systemic narrative review where literature search was conducted using the NCBI's PMC and BMC databases based on defined keywords. Three authors were involved in the literature search and consensus was applied to settle disagreements and validate the findings.

RESULTS

In this systematic narrative review, we report that vaccine nationalism remains a challenge for LMICs as HICs still hoard vaccines and even bypass COVAX to procure doses directly from the manufacturers. Factors that promote vaccine hesitancy in Africa include misinformation regarding the Covid-19 vaccine, a lack of trust in politicians and the pharmaceutical industry, and concerns about vaccine safety and efficacy. The policies implemented to enhance vaccine coverage in Africa, such as mandates, community engagement, and partnerships, all seek to promote equity of vaccination and ending Covid-19.

CONCLUSION

Covid-19 vaccine inequity persists and contributes to prolonged pandemic in LMICs. In response, African governments have taken certain measures to enhance vaccine uptake but more needs to be done to address resistance to vaccines.

Dynamically adjustable SVEIR(MH) model of multiwave epidemics: Estimating the effects of public health measures against COVID-19

The COVID-19 pandemic was characterized by multiple subsequent, overlapping outbreaks, as well as extremely rapid changes in viral genomes. The information about local epidemics spread and the epidemic control measures was shared on a daily basis (number of cases and deaths) via centralized repositories. The vaccines were developed within the first year of the pandemic. New modes of monitoring and sharing of epidemic data were implemented using Internet resources. We modified the basic SEIR compartmental model to include public health measures, multiwave scenarios, and the variation of viral infectivity and transmissibility reflected by the basic reproduction number R0 of emerging viral variants. SVEIR(MH) model considers the capacity of the medical system, lockdowns, vaccination, and changes in viral reproduction rate on the epidemic spread. The developed model uses daily infection reports for assessing the epidemic dynamics, and daily changes of mobility data from mobile phone networks to assess the lockdown effectiveness. This model was deployed to six European regions Baden-Württemberg (Germany), Belgium, Czechia, Lombardy (Italy), Sweden, and Switzerland for the first 2 years of the pandemic. The correlation coefficients between observed and reported infection data showed good concordance for both years of the pandemic (ρ = 0.84-0.94 for the raw data and ρ = 0.91-0.98 for smoothed 7-day averages). The results show stability across the regions and the different epidemic waves. Optimal control of epidemic waves can be achieved by dynamically adjusting epidemic control measures in real-time. SVEIR(MH) model can simulate different scenarios and inform adjustments to the public health policies to achieve the target outcomes. Because this model is highly representative of actual epidemic situations, it can be used to assess both the public health and socioeconomic effects of the public health measures within the first 7 days of the outbreak.

Global Vaccine Access Demands Combating Both Inequity And Hesitancy

The world's population suffered from lack of access to COVID-19 vaccines. Although inequities in vaccine availability for low- and middle-income countries are widely cited as a component of this lack of access, there is a related but less discussed component: vaccine refusal or hesitancy. Regarding the first component (global vaccine inequities), there are multiple dimensions to this topic and its causes, but for low- and middle-income countries, the most glaring one resulted from upstream science policies that prioritized speed and innovation at the expense of technologies that could be produced by low- and middle-income country vaccine producers. Regarding the second component (vaccine refusal or hesitancy), as COVID-19 waves swept across the United States in 2021, thousands of unvaccinated Americans perished from refusing COVID-19 immunizations. These deaths occurred because of an expanding antiscience ecosystem that now extends into low- and middle-income countries and could block the uptake of new vaccines or routine childhood immunizations. Future vaccine policies must address both elements of global access and their political identities. This recommendation reflects the author's experiences as a vaccine scientist who both develops affordable COVID-19 and neglected disease vaccines and lives on the front lines combating vaccine refusal.

Trends in Vaccine Completeness in Children Aged 0-23 Months in Cape Town, South Africa

BACKGROUND

We have previously determined that the occurrence of missed vaccination opportunities in children in Cape Town, South Africa, is shaped by both individual and contextual factors. These factors present valuable openings for enhancing quality and implementing broader strategies to enhance the delivery of routine Immunisation services.

METHODS

Here, we are further reporting regional-level data on the coverage and factors influencing vaccination completion within a similar study population, based on extensive data analysis from the 2016 South African Demographic and Health Survey.

RESULTS AND DISCUSSION

The study reveals commendable vaccination coverage for most vaccines within recommended schedules, with high rates of initial vaccinations at birth and during the primary vaccination schedule. However, there are notable areas for improvement, particularly in ensuring complete coverage for the second measles vaccine and the 18-month vaccine. Socio-demographic factors also play a role, with maternal education and caregiver awareness campaigns showing the potential to positively influence vaccination completeness. This study emphasises the importance of timely vaccinations during the early months of life and underscores the need for interventions to maintain coverage as children age. Specific sub-districts, such as Tygerberg, may require targeted efforts to enhance vaccination completeness. Additionally, assessing caregiver knowledge about child vaccination is deemed vital, as it can impact vaccination decisions and adherence.

CONCLUSIONS

The findings provide valuable insights for public health interventions in Cape Town, aimed at reducing the burden of vaccine-preventable diseases and ensuring the health of the region's youngest population.

Factors associated with COVID-19 vaccine hesitancy among healthcare workers in Cameroon and Nigeria: a web-based cross-sectional study

BACKGROUND

This study investigated the determinants of coronavirus disease 2019 (COVID-19) vaccine hesitancy among healthcare workers (HCWs) in Cameroon and Nigeria.

METHODS

This analytic cross-sectional study was conducted from May to June 2021, including consenting HCWs aged ≥18 y identified using snowball sampling. Vaccine hesitancy was defined as indecisiveness or unwillingness to receive the COVID-19 vaccine. Multilevel logistic regression yielded adjusted ORs (aORs) for vaccine hesitancy.

RESULTS

We included a total of 598 (about 60% women) participants. Little or no trust in the approved COVID-19 vaccines (aOR=2.28, 95% CI 1.24 to 4.20), lower perception of the importance of the vaccine on their personal health (5.26, 2.38 to 11.6), greater concerns about vaccine-related adverse effects (3.45, 1.83 to 6.47) and uncertainty about colleagues' acceptability of the vaccine (2.98, 1.62 to 5.48) were associated with higher odds of vaccine hesitancy. In addition, participants with chronic disease (aOR=0.34, 95% CI 0.12 to 0.97) and higher levels of concerns about getting COVID-19 (0.40, 0.18 to 0.87) were less likely to be hesitant to receive the COVID-19 vaccine.

CONCLUSIONS

COVID-19 vaccine hesitancy among HCWs in this study was high and broadly determined by the perceived risk of COVID-19 and COVID-19 vaccines on personal health, mistrust in COVID-19 vaccines and uncertainty about colleagues' vaccine acceptability.

The role of trust in the implementation and uptake of COVID-19 response measures: a qualitative study of health professionals' experiences in Tanzania

BACKGROUND

Even though trust is placed at the central point in ensuring proper functioning of the health systems, studies remain scant on how it affects both the implementation and uptake of COVID-19 response measures in low- and middle-income countries such as Tanzania. This study, therefore, explored the role of trust in the implementation and uptake of recommended COVID-19 response measures including vaccines from the perspective of health professionals in Tanzania.

METHODS

This cross-sectional qualitative study was implemented in four of Tanzania's thirty-one regions. Qualitative data was collected through 26 in-depth interviews held with regional and district disease outbreak response teams, district cold chain co-ordinators and health facility in-charges. In addition, five focus group discussions and seven group interviews were conducted with healthcare workers from the lower-level health facilities. Thematic analysis was conducted and applied the trust constructs.

RESULTS

Interpersonal trust and health system trust emerged as two major themes in the study. Interpersonal trust was reported to stem from lack of transparency that instigated fear, worries, and confusion regarding the implementation and uptake of the recommended response measures. The distrust was mainly between health professionals in health facilities and those assigned to isolation centres as well as between patients and community members. On the other hand, the health system trust was shaped by mixed feelings regarding COVID-19 vaccine national decisions, and conflicting messages from national officials, politicians and religious leaders on COVID-19 responses, safety, and effectiveness of the vaccines. Questions surrounding the short duration of clinical trials, indeterminate post-vaccination protection duration, impotence-linked beliefs, freemasonry notion and unclear vaccinated cards information are other reported contributory factors to mistrust in the health system. However, after a comprehensive health education and experience in COVID-19 vaccination administration most professionals affirmed the effectiveness of the vaccines in limiting infections and its severe consequences.

CONCLUSION

Participants indicated limited trust at both interpersonal and health system levels aggravated by lack of transparency, unclear and conflicting messages on COVID-19 infections and response measures. Enforced transparency on pandemics alongside standardised messages from the reliable sources is crucial in enhancing trust in implementation and uptake of the recommended response measures.

Nigerian parents and caregivers knowledge, attitude and willingness to vaccinate their children against COVID-19

Objectives

In order to achieve herd immunity against COVID-19, a significant proportion of the population will need to be vaccinated. Experts have recommended that African children be allowed to get vaccinated to protect them from emerging variants of COVID-19 infection. This study investigated Nigerian parents and caregivers' knowledge, attitude, and willingness to vaccinate their children against COVID-19 once the vaccines are made available to them.

Methods

A cross-sectional online survey of 500 parents/caregivers was conducted in Nigeria. Participants were asked to complete a questionnaire about their sociodemographic characteristics, knowledge of and attitude toward COVID-19 infection and vaccination, willingness to vaccinate their child and factors that could influence their decision to vaccinate their child. A scoring system was used to classify the level of knowledge and attitude of participants into 2 categories, namely poor, and good. We analyzed data obtained using SPSS Version 22.

Results

Majority of the participants were females (63.6%). Analysis of responses revealed good knowledge and attitude in 265 (53.0%) and 266 (53.2%) respondents, respectively. Overall, less than half of the parents/caregivers (48.4%) expressed intention to vaccinate their children against COVID-19. Factors associated with willingness to vaccinate children against COVID-19 included age greater than 40 years, male gender, residing in Southern Nigeria, having good knowledge, knowing an infected person or a vaccinated person, feeling they or their child is at risk of contracting COVID-19 infection, willingness to vaccinate self against COVID-19 and good attitude. Significant predictors of willingness to vaccinate their child include age greater than 40 years [AOR: 2.56; 95% CI = (1.14-5.76)], willingness to vaccinate self [AOR: 1016.81; 95% CI = (128.51-8045.60)] and good attitude [AOR: 6.21; 95% CI = (2.83-13.64)].

Conclusion

This study revealed that parental willingness to vaccinate their children against COVID-19 is low and identified factors influencing it. It is important to develop and implement health education programs iterating the risk of children getting infected with SARS-CoV-2 and its emerging variants to ensure optimal uptake of the COVID-19 vaccine in Nigerian children.

Validation of the vaccination attitudes examination scale in a South African context in relation to the COVID-19 vaccine: quantifying dimensionality with bifactor indices

BACKGROUND

The COVID-19 pandemic represented a global public health emergency. Existing studies support the view that vaccination and mass immunization are among the most effective means of containing the outbreak and promoting health. However, negative attitudes toward vaccination and the related vaccine hesitancy among many groups have created a significant barrier to effectively managing the health crisis. Having a valid and reliable tool to assess attitudes toward vaccination remains imperative so that factors underlying vaccine refusal can be identified and public health interventions can be facilitated. The current study examined the psychometric properties of the Vaccination Attitudes Examination Scale (VAX) in South Africa.

METHODS

Participants (n = 322) completed the VAX. Confirmatory factor analysis and ancillary bifactor indices were used to examine the hypothesized factor structure (a total scale and four subscales) of the scale. Inter-item correlations, factor loadings, and average variance extracted were used to examine the validity of the scale. Predictive validity was examined by comparing those who had received the COVID-19 vaccine and those who had not. The reliability of the scale was examined in terms of both Cronbach's alpha and composite reliability.

RESULTS

Confirmatory factor analysis provided support for the conceptualization of the scale as consisting of a total scale and four subscales, and ancillary bifactor indices indicated that the subscales accounted for a sufficient amount of variance (44%) after the variance explained by the total scale was considered. Overall, the analysis indicated that the scale had satisfactory reliability (alpha and composite reliability = 0.70) and provided evidence for the construct, convergent, and predictive validity of the VAX.

CONCLUSIONS

The sound psychometric qualities of the scale, when used in a low- to middle-income country, have the potential to advance research and immunization policy within these settings and facilitate more targeted interventions to promote vaccine uptake.

Correlates of COVID-19 Vaccine Acceptance and Hesitancy in Rural Communities in Western Kenya

Vaccine hesitancy is a significant global public health concern. This study sought to determine the correlates of acceptance and hesitancy regarding COVID-19 vaccines in rural populations of selected counties in Western Kenya and assess the strategies that can be used to improve COVID-19 vaccine acceptance in Kenya. The study used a quantitative research strategy with a sample of 806 individuals in the Kisumu, Vihiga, and Kakamega counties. Descriptive statistics, correlations and regression analyses were used. Of the 806 study participants, 55% were males and 45% females. Vaccine acceptance was significantly associated with being a male (AOR: 1.46, 95% CI: 1.24-1.59, p < 0.031), having no formal education (AOR: 2.25, 95% CI: 1.16-4.40, p < 0.02), working in the private sector (AOR: 5.78, 95% CI: 3.28-10.88 p < 0.02), and have low income (KES 0-999 (USD 0-9.16)), (AOR: 2.35, 95% CI: 1.13-3.47, p < 0.02). Conclusions: The current study suggests that male gender, no formal education, working in the private sector, and low income KES 0-999 (USD 0-9.6) are significant factors influencing awareness of and possible acceptance of COVID-19 vaccination.

Exploring Community Perceptions of COVID-19 and Vaccine Hesitancy in Selected Cities of Ethiopia: A Qualitative Study

Even though the COVID-19 vaccine has been available and free of charge to the targeted population in Ethiopia, the vaccination rate was lower than needed to achieve herd immunity at community level. This study aimed to explore community perceptions of COVID-19 and vaccine hesitancy in selected cities of Ethiopia involving 70 in-depth interviews and 28 focused group discussions. The audio-taped data were transcribed verbatim, translated into English, and analyzed using a qualitative content analysis approach using the ATLAS.ti software version 8. The findings revealed that COVID-19 was perceived as evil and caused fear and frustration upon its emergence. The community initially used traditional remedies for its prevention but later transitioned to employing non-pharmaceutical interventions. The primary reasons for vaccine hesitancy were misinformation and misconceptions, such as connecting the vaccine with the mark of the beast, a lack of trust due to the multiple vaccine types, a shorter production timeline resulting in distrust of its effectiveness, and a fear of pain and side effects. Based on our findings, we recommend monitoring the use of social media and countering misinformation with the correct information and continuous public health campaigns. Further studies should be conducted to assess the types and magnitude of impacts from the myths and misconceptions on vaccination uptake.

COVID-19 vaccine uptake and associated factors among adolescents and youths: Findings and implications for future vaccination programmes

Adolescents and youths are a key part of the population that needs to be protected against the coronavirus disease 2019 (COVID-19). This is because they are more likely to spread the virus to vulnerable individuals. In view of these concerns, this study investigated the uptake of COVID-19 vaccines and associated factors among adolescents and youths attending secondary schools in Zambia. This cross-sectional study was conducted among 1500 school-going adolescents in Lusaka from September 2022 to November 2022. Overall, 1409 participants took part giving a response rate of 94%. Only 29.2% (n = 411) of the participants were vaccinated against COVID-19 at the time of the study. Compared to their unvaccinated counterparts, vaccinated adolescents and youths scored higher for knowledge (66.2% vs 57.8%) and attitudes (76.7% vs 39.4%) regarding COVID-19 vaccines. Healthcare workers, family/friends and social media were key sources of information regarding the vaccine. Factors associated with increased vaccine uptake were positive attitudes (AOR = 33.62, 95% CI: 19.92-56.73), indicating it was stressful to follow COVID-19 preventive measures (AOR = 1.47, 95% CI: 1.09-1.99), participants in Grade 12 (AOR = 3.39, 95% CI: 1.94-5.91), Grade 11 (AOR = 2.59, 95% CI: 1.94-5.91), Grade 10 (AOR = 3.48, 95% CI: 1.98-6.11) and Grade 9 (AOR = 3.04, 95% CI: 1.74-5.32) compared to Grade 8. This study found a relatively low uptake of COVID-19 vaccines among adolescents and youths in Zambia. There is a need to provide adequate strategies to address knowledge and attitude gaps regarding COVID-19 vaccines to improve uptake and reduce future morbidity and mortality.

Exploring COVID-19 vaccine hesitancy and uptake in Nairobi's urban informal settlements: an unsupervised machine learning analysis of a longitudinal prospective cohort study from 2021 to 2022

OBJECTIVES

To illustrate the utility of unsupervised machine learning compared with traditional methods of analysis by identifying archetypes within the population that may be more or less likely to get the COVID-19 vaccine.

DESIGN

A longitudinal prospective cohort study (n=2009 households) with recurring phone surveys from 2020 to 2022 to assess COVID-19 knowledge, attitudes and practices. Vaccine questions were added in 2021 (n=1117) and 2022 (n=1121) rounds.

SETTING

Five informal settlements in Nairobi, Kenya.

PARTICIPANTS

Individuals from 2009 households included.

OUTCOME MEASURES AND ANALYSIS

Respondents were asked about COVID-19 vaccine acceptance (February 2021) and vaccine uptake (March 2022). Three distinct clusters were estimated using K-Means clustering and analysed against vaccine acceptance and vaccine uptake outcomes using regression forest analysis.

RESULTS

Despite higher educational attainment and fewer concerns regarding the pandemic, young adults (cluster 3) were less likely to intend to get the vaccine compared with cluster 1 (41.5% vs 55.3%, respectively; p<0.01). Despite believing certain COVID-19 myths, older adults with larger households and more fears regarding economic impacts of the pandemic (cluster 1) were more likely to ultimately to get vaccinated than cluster 3 (78% vs 66.4%; p<0.01), potentially due to employment requirements. Middle-aged women who are married or divorced and reported higher risk of gender-based violence in the home (cluster 2) were more likely than young adults (cluster 3) to report wanting to get the vaccine (50.5% vs 41.5%; p=0.014) but not more likely to have gotten it (69.3% vs 66.4%; p=0.41), indicating potential gaps in access and broader need for social support for this group.

CONCLUSIONS

Findings suggest this methodology can be a useful tool to characterise populations, with utility for improving targeted policy, programmes and behavioural messaging to promote uptake of healthy behaviours and ensure equitable distribution of prevention measures.

Africa (COVID-19) Vaccine Technology Transfer: Where Are We?

The rampant spread of the COVID-19 infection poses a grave and formidable challenge to global healthcare, with particular concern to the inhabitants of the African continent. In response to these pressing concerns, different strategies have been employed to combat the emergence of this insidious disease, encompassing crucial measures such as physical distancing, the utilization of face masks, meticulous hand hygiene, and widespread vaccination campaigns. Nevertheless, the economic realities faced by numerous African nations, characterized by their classification as "low-income countries (LICs)", present a formidable barrier to accessing and distributing approved vaccines to their populations. Moreover, it is essential to discuss the hesitancy of the European Union (EU) in releasing intellectual property rights associated with the transfer of vaccine technology to Africa. While the EU has been a key player in global efforts to combat the pandemic, there has been reluctance in sharing valuable knowledge and resources with African countries. This hesitancy raises concerns about equitable vaccine access and the potential for a prolonged health crisis in Africa. This review underscores the urgent imperative and need of establishing localized vaccine development and production facilities within Africa, necessitating the active involvement of governments and collaborative partnerships to achieve this crucial objective. Furthermore, this review advocates for the exploration of viable avenues for the transfer of vaccine technology as a means to facilitate equitable vaccine access across the African continent and also the cruciality and the need for the EU to reconsider its stance and actively engage in transferring vaccine technology to Africa through sharing intellectual property. The EU can contribute to the establishment of localized vaccine production facilities on the continent, which will not only increase vaccine availability but also promote self-sufficiency and resilience in the face of future health emergencies.

COVID-19 vaccine equity: a retrospective population-based cohort study examining primary series and first booster coverage among persons with a history of immigration and other residents of Ontario, Canada

Introduction

Immigrants were disproportionately impacted by COVID-19 and experience unique vaccination barriers. In Canada (37 million people), 23% of the population is foreign-born. Immigrants constitute 60% of the country's racialized (non-white) population and over half of immigrants reside in Ontario, the country's most populous province. Ontario had several strategies aimed at improving vaccine equity including geographic targeting of vaccine supply and clinics, as well as numerous community-led efforts. Our objectives were to (1) compare primary series vaccine coverage after it was widely available, and first booster coverage 6 months after its availability, between immigrants and other Ontario residents and (2) identify subgroups experiencing low coverage.

Materials and methods

Using linked immigration and health administrative data, we conducted a retrospective population-based cohort study including all community-dwelling adults in Ontario, Canada as of January 1, 2021. We compared primary series (two-dose) vaccine coverage by September 2021, and first booster (three-dose) coverage by March 2022 among immigrants and other Ontarians, and across sociodemographic and immigration characteristics. We used multivariable log-binomial regression to estimate adjusted risk ratios (aRR).

Results

Of 11,844,221 adults, 22% were immigrants. By September 2021, 72.6% of immigrants received two doses (vs. 76.4%, other Ontarians) and by March 2022 46.1% received three doses (vs. 58.2%). Across characteristics, two-dose coverage was similar or slightly lower, while three-dose coverage was much lower, among immigrants compared to other Ontarians. Across neighborhood SARS-CoV-2 risk deciles, differences in two-dose coverage were smaller in higher risk deciles and larger in the lower risk deciles; with larger differences across all deciles for three-dose coverage. Compared to other Ontarians, immigrants from Central Africa had the lowest two-dose (aRR = 0.60 [95% CI 0.58-0.61]) and three-dose coverage (aRR = 0.36 [95% CI 0.34-0.37]) followed by Eastern Europeans and Caribbeans, while Southeast Asians were more likely to receive both doses. Compared to economic immigrants, resettled refugees and successful asylum-claimants had the lowest three-dose coverage (aRR = 0.68 [95% CI 0.68-0.68] and aRR = 0.78 [95% CI 0.77-0.78], respectively).

Conclusion

Two dose coverage was more equitable than 3. Differences by immigrant region of birth were substantial. Community-engaged approaches should be re-invigorated to close gaps and promote the bivalent booster.

Vaccine hesitancy for COVID19: what is the role of statistical literacy?

Introduction

Vaccination is an important measure used to control the spread of COVID19. The estimation of risk versus benefit of vaccination is based on the understanding of information about the vaccine. Statistics are frequently part of communications about COVID19. Individuals that do not have an adequate foundation of statistical knowledge may not be able to properly assess associated risks and benefits. This study aims to assess the association between statistical literacy and hesitation to receive the COVID19 vaccine.

Methods

A nationally representative sample of 2,138 adults, recruited through CINT United States, Inc., (Lawrenceville, NJ; http://www.cint.com), completed an internet survey in the summer of 2021. This survey collected demographic measures and information about COVID19 vaccination status. The competency of respondents on various basic statistical concepts was assessed along with the corresponding confidence of respondents in their answers. A multivariable logistic regression model was constructed to assess the relationship between vaccine hesitancy and statistical literacy while controlling for covariates of interest.

Results

Statistical literacy was found to have a negligible association with COVID19 vaccine hesitancy (OR 1.01; 95% CI 1.00-1.02). In addition, differences in the proportion receiving the COVID19 vaccine between political affiliations, income levels, race groups, and ethnicities were observed.

Discussion

The statistical knowledge of the general American public is not commensurate with the need to be literate in basic statistical concepts in the data-driven world in which we live. An effective way to stem vaccine hesitancy may rely on increased statistical knowledge to not be biased by preconceived beliefs shaped by misinformation.

COVID-19 Vaccine Hesitancy in Cameroon: The Role of Medical Mistrust and Social Media Use

Most African countries report low COVID-19 vaccination rates (Msellati et al., 2022; WHO Africa; 2020). This study focuses on factors associated with vaccine hesitancy specifically in the country of Cameroon. Social media use and medical mistrust have been suggested as key variables that may increase vaccine hesitancy. Adopting the information-related perspective guided by the risk information seeking and processing model, the current research explored how social media use and medical mistrust are related to vaccine hesitancy among Cameroonians. Survey results from a sample of 1,000 Cameroonians fielded in early 2022 showed that social media use and medical mistrust were positively associated with belief in misinformation related to the COVID-19 vaccine. Belief in misinformation about the COVID-19 vaccine was negatively associated with perceived information insufficiency. A positive relationship between perceived information insufficiency and information seeking, as well as a negative relationship between information seeking and vaccine hesitancy were also found. Theoretical and practical implications are discussed.

Addressing vaccine concerns through the spectrum of vaccine acceptance

RATIONALE/OBJECTIVE

Several studies have examined attitudes towards COVID-19 vaccines, giving prominence to hesitancy and conceptual models that seek to explain its prevalence, mostly in high-income contexts. An alternative conceptual approach that prioritises an understanding of vaccine concerns, the rationality of the questions people have, the political and media ecologies that raise them, will help recommend ways in which such concerns can be addressed. This current study employs the Spectrum of Vaccine Acceptance as a conceptual framework to explain vaccine concerns, in a low-income context.

METHODS

A cross-sectional survey was designed by drawing on the extant literature on indirect impacts of COVID-19 pandemic. The survey was administered face to face to a stratified random sample of 459 healthcare professionals in Uganda, from 1st to July 31, 2021. Key findings from the survey were explored using focus group interviews. Descriptive analysis was performed to quantify key responses on socio-demographic characteristics, feelings and views about COVID-19 and vaccines. Qualitative themes from the survey and focus groups were explained through the framework of the Spectrum of Vaccine Acceptance.

RESULTS

Vaccine acceptance was the most dominant attitude among healthcare professionals, with 74.9% of all respondents (N = 224) having been vaccinated. The findings highlight a relationship between vaccine acceptance, vaccine questioning and vaccine hesitancy, in that nearly 60% (N = 127) of those that were already vaccinated had several concerns about the vaccines they had received, suggesting that questions do not necessarily equate to refusal. This led to a partial reframing of the Spectrum of Vaccine Acceptance.

CONCLUSION

Factors which determine and differentiate vaccine concerns among healthcare professionals in a low-income context show that rational concerns far outweigh non-sensical and conspiratorial views. The findings will act as a useful input into the importance of understanding and addressing vaccine concerns, and the role of managing information voids in pandemic management.

Building Global Health Systems Capacity During COVID-19 to Improve Vaccination Access and Reduce Hesitancy: Case Studies in Zambia and Tanzania

During the COVID-19 pandemic, the CDC Foundation collaborated with implementing partners in Zambia and Tanzania to address challenges related to vaccination access and hesitancy through strategic partnership, technical assistance, and community engagement. These efforts were successful in fostering collaborations among community partners and health authorities and actively engaging the ministries of health. This article describes 2 case studies from Zambia and Tanzania involving different strategies to build health system capacity through projects that improved vaccination access and reduced hesitancy. Such projects illustrate how efforts that strengthen public health and healthcare systems have further positive implications for building localized response systems through context-tailored approaches and building capacity of local healthcare workers. The case studies are examples of public health emergency response projects that successfully increased vaccination access and reduced hesitancy in local communities by rapidly implementing projects to strengthen health system capacity and resilience.

COVID-19 vaccine hesitancy among pregnant women in an antenatal clinic in Durban, South Africa

Background

Mass administration of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most efficient intervention against the coronavirus disease 2019 (COVID-19) pandemic. Recently, vaccinations were shown to be safe and effective during pregnancy. However, vaccination rates are low in low- and middle-income countries, and vaccine hesitancy is a major limiting factor.

Objectives

To investigate the rate of COVID-19 vaccine hesitancy among pregnant women.

Method

A cross-sectional questionnaire-based investigation of 313 unvaccinated pregnant women attending an antenatal clinic in Durban, South Africa (SA). The questionnaire included clinical and socio-demographic data, and reasons for vaccine hesitancy were recorded and evaluated.

Results

Of 313 women participating, 126 (40.3%) were vaccinated against COVID-19, 21/313 = 6.7%; for those unvaccinated, 21/187 (13.9%) were planning to be vaccinated. However, most unvaccinated women, 174 of 187 (93%), showed COVID-19 vaccine hesitancy.

Conclusion

The COVID-19 vaccination hesitancy among pregnant women in Durban, SA, is exceptionally high. This requires urgent attention by the relevant health authorities (both professional health organisations and the SA Department of Health) as many countries experience different waves of the variants of SARS-CoV-2 and herd immunity may not have been achieved.

Contribution

This study showed a high vaccine acceptance hesitancy rate among pregnant women in SA.

A Qualitative Study on Barriers to COVID-19 Vaccine Uptake among Community Members in Tanzania

The use of vaccines is one of the key tools in reversing the COVID-19 pandemic; however, various reports reported the low uptake of the vaccines. This study explored the barriers to the COVID-19 vaccine uptake among community members in Tanzania. A qualitative explorative study was conducted in December 2021 and April 2022 in eight regions of Tanzania. Focus group discussions (FGDs) and in-depth interviews (IDIs) were the methods of data collection. A total of 48 FGDs and 32 IDIs were conducted. Participants were aware of the COVID-19 disease and vaccines. The barriers to the COVID-19 vaccine non-uptake included receiving contradicting statements from top government leaders, vaccine preceded the education, myths towards vaccines, the presence of different types of vaccines, the process of getting the vaccine, the influence of social media and random people from the community, and vaccine conflicting religious beliefs. Despite being aware of the vaccine, the uptake of the COVID-19 vaccine is still low. Interventions that focus on increasing community knowledge about COVID-19 vaccines and addressing myths about the vaccines are needed.

Predictors of COVID-19 vaccine uptake among adults in South Africa: multimethod evidence from a population-based longitudinal study

BACKGROUND

COVID-19 vaccine coverage remains low in many low and middle-income countries despite widespread access. To understand the dynamic decision-making process around vaccination and provide evidence for future vaccine promotion campaigns, we identified predictors of COVID-19 vaccine uptake among South African adults, including those who did not believe in the vaccine's safety or efficacy.

METHODS

Data from two longitudinal telephone surveys in late 2021 and early 2022 of unvaccinated South African adults were used to model COVID-19 uptake. Predictors of interest informed by the theory of planned behaviour included vaccine attitudes and beliefs, social norms, perceived behavioural control and vaccine intentions. Responses to open-ended questions provided insights into key reasons for getting vaccinated.

RESULTS

Among panel participants (n=1772), 19% reported being vaccinated between Survey 1 and Survey 2. Vaccine uptake was greater among participants who reported wanting to get vaccinated 'as soon as possible' (+27 percentage points, p<0.01). Vaccine uptake was greater among participants who believed that the vaccine is effective in preventing COVID-19 infection and/or death (+12 percentage points, p<0.01) and lower among those who believed that the vaccine is unsafe (-9 percentage points, p<0.01). Among participants who did not believe the vaccine is safe, living with someone already vaccinated against COVID-19 increased vaccine uptake (+6 percentage points, p<0.05). At Survey 1, the intention to get vaccinated as soon as possible was positively associated with perceived risk of illness from COVID-19 (+9.2 percentage points, p<0.05), the belief that most people in their area had been vaccinated (+7.0 percentage points, p<0.05) and living with someone already vaccinated against COVID-19 (+6.6 percentage points, p<0.05).

CONCLUSION

Study findings underscore the predictive power of intentions and of beliefs about disease risk, vaccine safety and vaccine efficacy. Social proof interventions hold promise for increasing vaccination intentions and overcoming concerns about vaccine safety.

Measuring behavioral and social drivers of COVID-19 vaccination in health workers in Eastern and Southern Africa

BACKGROUND

In 2021, twenty out of twenty-one countries in the Eastern and Southern Africa (ESA) region introduced COVID-19 vaccines. With variable willingness to uptake vaccines across countries, the aim of the present study was to better understand factors that impact behavioral and social drivers of vaccination (BeSD). Using the theory-based "increasing vaccination model", the drivers Thinking & Feeling, Social Processes, Motivation, and Practical Issues were adapted to the COVID-19 context and utilized in a cross-country assessment.

METHODS

Data was collected on 27.240 health workers in Kenya, Malawi, Mozambique, South Africa and South Sudan. This was done by administering a survey of seven target questions via the UNICEF Internet of Good Things (IoGT) online platform between February and August 2021.

RESULTS

Findings showed a gap between perceived importance and trust in vaccines: Most health workers thought Covid-19 vaccination was very important for their health, while less than 30% trusted it very much. The pro-vaccination social and work norm was not well established since almost 66% of all respondents would take the vaccine if recommended to them, but only 49% thought most adults would, and only 48% thought their co-workers would. Access was highlighted as a crucial barrier, with less than a quarter reporting that accessing vaccination services for themselves would be very easy. Women exhibited slightly lower scores than men across the board. When testing the associations between drivers in Kenya and South Africa, it appears that when target interventions are developed for specific age groups, social norms become the main drivers of intention to get vaccinated.

CONCLUSIONS

The present study revealed various key relations with demographic variables that would help immunization programmes and implementing partners to develop targeted interventions. First, there is a serious gap between perceived importance of COVID-19 vaccines and how much trust people in them. Second, problems with access are still rather serious and solving this would strongly benefit those who demand a vaccine, Third, the role of social norms is the most important predictor of willingness when considering age differences.

COVID-19 transmission dynamics and the impact of vaccination: modelling, analysis and simulations

Despite the lifting of COVID-19 restrictions, the COVID-19 pandemic and its effects remain a global challenge including the sub-Saharan Africa (SSA) region. Knowledge of the COVID-19 dynamics and its potential trends amidst variations in COVID-19 vaccine coverage is therefore crucial for policy makers in the SSA region where vaccine uptake is generally lower than in high-income countries. Using a compartmental epidemiological model, this study aims to forecast the potential COVID-19 trends and determine how long a wave could be, taking into consideration the current vaccination rates. The model is calibrated using South African reported data for the first four waves of COVID-19, and the data for the fifth wave are used to test the validity of the model forecast. The model is qualitatively analysed by determining equilibria and their stability, calculating the basic reproduction number R0 and investigating the local and global sensitivity analysis with respect to R0. The impact of vaccination and control interventions are investigated via a series of numerical simulations. Based on the fitted data and simulations, we observed that massive vaccination would only be beneficial (deaths averting) if a highly effective vaccine is used, particularly in combination with non-pharmaceutical interventions. Furthermore, our forecasts demonstrate that increased vaccination coverage in SSA increases population immunity leading to low daily infection numbers in potential future waves. Our findings could be helpful in guiding policy makers and governments in designing vaccination strategies and the implementation of other COVID-19 mitigation strategies.

Addressing sociodemographic disparities in COVID-19 vaccine uptake among youth in Zimbabwe

INTRODUCTION

COVID-19 vaccine acceptance research has mostly originated from high-income countries and reasons why youth may not get vaccinated may differ in low-income settings. Understanding vaccination coverage across different population groups and the sociocultural influences in healthcare delivery is important to inform targeted vaccination campaigns.

METHODS

A population-based survey was conducted in 24 communities across three provinces (Harare, Bulawayo and Mashonaland East) in Zimbabwe between October 2021 and June 2022. Youth aged 18-24 years were randomly selected using multistage sampling. Sociodemographic characteristics, COVID-19 vaccination uptake and reasons for non-uptake were collected, and odds of vaccination was investigated using logistic regression.

RESULTS

17 682 youth were recruited in the survey (n=10 742, 60.8% female). The median age of participants was 20 (IQR: 19-22) years. Almost two thirds (n=10 652, 60.2%) reported receiving at least one dose of COVID-19 vaccine. A higher proportion of men than women had been vaccinated (68.9% vs 54.7%), and vaccination prevalence increased with age (<19 years: 57.5%, 20-22: 61.5%, >23: 62.2%). Lack of time to get vaccinated, belief that the vaccine was unsafe and anxiety about side effects (particularly infertility) were the main reasons for not getting vaccinated. Factors associated with vaccination were male sex (OR=1.69, 95% CI 1.58 to 1.80), increasing age (>22 years: OR=1.12, 95% CI 1.04 to 1.21), education level (postsecondary: OR=4.34, 95% CI 3.27 to 5.76) and socioeconomic status (least poor: OR=1.32, 95% CI 1.20 to 1.47).

CONCLUSION

This study found vaccine inequity across age, sex, educational attainment and socioeconomic status among youth. Strategies should address these inequities by understanding concerns and tailoring vaccine campaigns to specific groups.

COVID-19 vaccine uptake, confidence and hesitancy in rural KwaZulu-Natal, South Africa between April 2021 and April 2022: A continuous cross-sectional surveillance study

High COVID-19 vaccine hesitancy in South Africa limits protection against future epidemic waves. We evaluated how vaccine hesitancy and its correlates evolved April 2021-April 2022 in a well-characterized rural KwaZulu-Natal setting. All residents aged >15 in the Africa Health Research Institute's surveillance area were invited to complete a home-based, in-person interview. We described vaccine uptake and hesitancy trends, then evaluated associations with pre-existing personal factors, dynamic environmental context, and cues to action using ordinal logistic regression. Among 10,011 respondents, vaccine uptake rose as age-cohorts became vaccine-eligible before levelling off three months post-eligibility; younger age-groups had slower uptake and plateaued faster. Lifetime receipt of any COVID-19 vaccine rose from 3.0% in April-July 2021 to 32.9% in January-April 2022. Among 7,445 unvaccinated respondents, 47.7% said they would definitely take a free vaccine today in the first quarter of the study time period, falling to 32.0% in the last. By March/April 2022 only 48.0% of respondents were vaccinated or said they would definitely would take a vaccine. Predictors of lower vaccine hesitancy included being male (adjusted odds ratio [aOR]: 0.70, 95% confidence interval [CI]: 0.65-0.76), living with vaccinated household members (aOR:0.65, 95%CI: 0.59-0.71) and knowing someone who had had COVID-19 (aOR: 0.69, 95%CI: 0.59-0.80). Mistrust in government predicted greater hesitancy (aOR: 1.47, 95%CI: 1.42-1.53). Despite several COVID-19 waves, vaccine hesitancy was common in rural South Africa, rising over time and closely tied to mistrust in government. However, interpersonal experiences countered hesitancy and may be entry-points for interventions.

Utilisation of services along the continuum of maternal healthcare during the COVID-19 pandemic in Lubumbashi, DRC: findings from a cross-sectional household survey of women

OBJECTIVES

The continuum of maternal care along antenatal (ANC), intrapartum and postnatal care (PNC) is fundamental for protecting women's and newborns' health. The COVID-19 pandemic interrupted the provision and use of these essential services globally. This study examines maternal healthcare utilisation along the continuum during the COVID-19 pandemic in the Democratic Republic of the Congo (DRC).

DESIGN

This is a cross-sectional study using data collected on a survey of 599 households in Lubumbashi, DRC, using stratified random sampling.

PARTICIPANTS

We included 604 women (15-49 years) who were pregnant between March 2020 and May 2021.

OUTCOME MEASURES

A structured interview involved questions on sociodemographic characteristics, attitudes regarding COVID-19 and maternal service use and cost. Complete continuum of care was defined as receiving ANC 4+ consultations, skilled birth attendance and at least one PNC check for both mother and newborn. Data were analysed in SPSS using descriptive statistics and multivariable logistic regression.

RESULTS

One-third (36%) of women who gave birth during the COVID-19 pandemic completed the continuum of maternal healthcare. Factors significantly associated with completing the continuum included higher education (aOR=2.6; p<0.001) and positive attitude towards the COVID-19 vaccination (aOR=1.9; p=0.04). Reasons for not seeking maternal care included lack of money and avoiding COVID-19 vaccination.

CONCLUSION

During the COVID-19 pandemic, maternal healthcare seeking behaviours were shaped by vaccine hesitancy and care unaffordability in Lubumbashi. Addressing the high cost of maternal healthcare and vaccine hesitancy appear essential to improve access to maternal healthcare.

Assessment of COVID-19 Vaccine Acceptance and Its Associated Factors during the Crisis: A Community-Based Cross-Sectional Study in Benin

BACKGROUND

Having a maximum number of people vaccinated was the objective to control the COVID-19 pandemic. We report in this manuscript the factors associated with the willingness to be vaccinated against COVID-19 during the pandemic period.

METHODS

From April to May 2022, a community-based cross-sectional survey was performed. Participants were randomly selected from four districts in Benin (taking into account the COVID-19 prevalence). Mixed-effect logistic regression models were used to identify the variables associated with COVID-19 vaccine acceptance.

RESULTS

A total of 2069 participants were included. The proportion of vaccine acceptance was 43.3%. A total of 24.2% were vaccinated and showed proof of vaccination. The population's request for vaccination was higher after the third epidemic wave. The district of residence, the education level, a fear of being infected, the channel of information, poor medical conditions, a good knowledge of the transmission mode and symptoms, and good behaviors were significantly associated with vaccine acceptance.

CONCLUSION

The overall acceptance of the COVID-19 vaccine in the Beninese population was relatively high. However, vaccine campaigns in areas with a low acceptance as well as the disclosure of information, particularly on our knowledge of the disease and the safety, side effects, and effectiveness of the COVID-19 vaccines, should be strengthened with adapted and consistent messages.

Declining trends in vaccine confidence across sub-Saharan Africa: A large-scale cross-sectional modeling study

Current WHO/UNICEF estimates of routine childhood immunization coverage reveal the largest sustained decline in uptake in three decades with pronounced setbacks across Africa. Although the COVID-19 pandemic has induced significant supply and delivery disruptions, the impact of the pandemic on vaccine is less understood. We here examine trends in vaccine confidence across eight sub-Saharan countries between 2020 and 2022 via a total of 17,187 individual interviews, conducted via a multi-stage probability sampling approach and cross-sectional design and evaluated using Bayesian methods. Multilevel regression combined with poststratification weighting using local demographic information yields national and sub-national estimates of vaccine confidence in 2020 and 2022 as well as its socio-demographic associations. We identify declines in perceptions toward the importance of vaccines for children across all eight countries, with mixed trends in perceptions toward vaccine safety and effectiveness. We find that COVID-19 vaccines are perceived to be less important and safe in 2022 than in 2020 in six of the eight countries, with the only increases in COVID-19 vaccine confidence detected in Ivory Coast. There are substantial declines in vaccine confidence in the Democratic Republic of Congo and South Africa, notably in Eastern Cape, KwaZulu-Natal, Limpopo, and Northern Cape (South Africa) and Bandundu, Maniema, Kasaï-Oriental, Kongo-Central, and Sud-Kivu (DRC). While over 60-year-olds in 2022 have higher vaccine confidence in vaccines generally than younger age groups, we do not detect other individual-level socio-demographic associations with vaccine confidence at the sample sizes studied, including sex, age, education, employment status, and religious affiliation. Understanding the role of the COVID-19 pandemic and associated policies on wider vaccine confidence can inform post-COVID vaccination strategies and help rebuild immunization system resilience.

Barriers and facilitators of HPV vaccination in sub-saharan Africa: a systematic review

BACKGROUND

Human Papilloma Virus (HPV) is the most common sexually transmitted infection worldwide. Globally, both men and women have a 50% risk of being infected at least once in their life. HPV prevalence is among the highest in sub-Saharan Africa (SSA), at an average of 24%. HPV causes different types of cancers, including cervical cancer (CC), which is the leading cause of cancer deaths among women in SSA. HPV-vaccination has been proven to be effective in reducing HPV induced cancers. SSA countries are delayed in reaching the WHO's target of fully vaccinating 90% of girls within the age of 15 by 2030. Our systematic review aims to identify barriers and facilitators of HPV-vaccination in SSA to inform national implementation strategies in the region.

METHODS

This is a mixed method systematic review based on the PRISMA statement and The Joanna Briggs Institute Reviewers' Manual. Search strategies were adapted to each selected database: PubMed/MEDLINE, Livivo, Google Scholar, Science Direct, and African Journals Online for papers published in English, Italian, German, French and Spanish between 1 December 2011 and 31 December 2021. Zotero and Rayyan were the software used for data management. The appraisal was conducted by three independent reviewers.

RESULTS

A total of 20 articles were selected for appraisal from an initial 536 articles. Barriers included: limited health system capacities, socio-economic status, stigma, fear and costs of vaccines, negative experience with vaccinations, COVID-19 pandemic, lack of correct information, health education (HE) and consent. Additionally, we found that boys are scarcely considered for HPV-vaccination by parents and stakeholders. Facilitators included: information and knowledge, policy implementation, positive experience with vaccinations, HE, stakeholders' engagement, women's empowerment, community engagement, seasonality, and target-oriented vaccination campaigns.

CONCLUSIONS

This review synthesizes barriers and facilitators of HPV-vaccinations in SSA. Addressing these can contribute to the implementation of more effective HPV immunization programs targeted at eliminating CC in line with the WHO 90/70/90 strategy.

REGISTRATION AND FUNDING

Protocol ID: CRD42022338609 registered in the International Prospective Register of Systematic Reviews (PROSPERO). Partial funds: German Centre for Infection research (DZIF) project NAMASTE: 8,008,803,819.

COVID-19 Prevention Behaviours and Vaccine Acceptability, and Their Association with a Behaviour Change Campaign in Somalia: Analysis of a Longitudinal Cohort

Somalia experienced its first wave of COVID-19 infections in March 2020 and has experienced fluctuating infection levels since. Longitudinal data on suspected cases of COVID-19, attitudes, and behaviours were collected by telephone interviews of cash-transfer programme beneficiaries from June 2020-April 2021. A multi-media Social and Behaviour Change Communication (SBCC) campaign was designed and implemented from February 2021 to May 2021. Between the end of the first wave and the onset of the second the perceived threat from COVID-19 increased, with the proportion of respondents viewing it as a major threat increasing from 46% to 70% (p = 0.021). Use of face coverings increased by 24% (p < 0.001) and hand shaking and hugging for social greeting decreased, with 17% and 23% more people abstaining from these practices (p = 0.001). A combined preventative behaviour score (PB-Score) increased by 1.3 points (p < 0.0001) with a higher score in female respondents (p < 0.0001). During wave 2, vaccine acceptance was reported by 69.9% (95% CI 64.9, 74.5), overall. Acceptance decreased with increasing age (p = 0.009) and was higher in males (75.5%) than females (67.0%) (p = 0.015). Awareness of the SBCC campaign was widespread with each of the 3 key campaign slogans having been heard by at least 67% of respondents. Awareness of 2 specific campaign slogans was independently associated with an increased use of face coverings (aOR 2.31; p < 0.0001) and vaccine acceptance (aOR 2.36; p < 0.0001). Respondents reported receiving information on the pandemic from a wide range of sources with mobile phones and radio the most common. Trust in different sources ranged widely.

COVID-19 Vaccine Perceptions among Ebola-Affected Communities in North Kivu, Democratic Republic of the Congo, 2021

Populations affected by humanitarian crises and emerging infectious disease outbreaks may have unique concerns and experiences that influence their perceptions toward vaccines. In March 2021, we conducted a survey to examine the perceptions toward COVID-19 vaccines and identify the factors associated with vaccine intention among 631 community members (CMs) and 438 healthcare workers (HCWs) affected by the 2018-2020 Ebola Virus Disease outbreak in North Kivu, Democratic Republic of the Congo. A multivariable logistic regression was used to identify correlates of vaccine intention. Most HCWs (81.7%) and 53.6% of CMs felt at risk of contracting COVID-19; however, vaccine intention was low (27.6% CMs; 39.7% HCWs). In both groups, the perceived risk of contracting COVID-19, general vaccine confidence, and male sex were associated with the intention to get vaccinated, with security concerns preventing vaccine access being negatively associated. Among CMs, getting the Ebola vaccine was associated with the intention to get vaccinated (RR 1.43, 95% CI 1.05-1.94). Among HCWs, concerns about new vaccines' safety and side effects (OR 0.72, 95% CI 0.57-0.91), religion's influence on health decisions (OR 0.45, 95% CI 0.34-0.61), security concerns (OR 0.52, 95% CI 0.37-0.74), and governmental distrust (OR 0.50, 95% CI 0.35-0.70) were negatively associated with vaccine perceptions. Enhanced community engagement and communication that address this population's concerns could help improve vaccine perceptions and vaccination decisions. These findings could facilitate the success of vaccine campaigns in North Kivu and similar settings.

Application of Traditional Vaccine Development Strategies to SARS-CoV-2

Over the past 150 years, vaccines have revolutionized the relationship between people and disease. During the COVID-19 pandemic, technologies such as mRNA vaccines have received attention due to their novelty and successes. However, more traditional vaccine development platforms have also yielded important tools in the worldwide fight against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A variety of approaches have been used to develop COVID-19 vaccines that are now authorized for use in countries around the world. In this review, we highlight strategies that focus on the viral capsid and outwards, rather than on the nucleic acids inside. These approaches fall into two broad categories: whole-virus vaccines and subunit vaccines. Whole-virus vaccines use the virus itself, in either an inactivated or an attenuated state. Subunit vaccines contain instead an isolated, immunogenic component of the virus. Here, we highlight vaccine candidates that apply these approaches against SARS-CoV-2 in different ways. In a companion article (H. M. Rando, R. Lordan, L. Kolla, E. Sell, et al., mSystems 8:e00928-22, 2023, https://doi.org/10.1128/mSystems.00928-22), we review the more recent and novel development of nucleic acid-based vaccine technologies. We further consider the role that these COVID-19 vaccine development programs have played in prophylaxis at the global scale. Well-established vaccine technologies have proved especially important to making vaccines accessible in low- and middle-income countries. Vaccine development programs that use established platforms have been undertaken in a much wider range of countries than those using nucleic acid-based technologies, which have been led by wealthy Western countries. Therefore, these vaccine platforms, though less novel from a biotechnological standpoint, have proven to be extremely important to the management of SARS-CoV-2. IMPORTANCE The development, production, and distribution of vaccines is imperative to saving lives, preventing illness, and reducing the economic and social burdens caused by the COVID-19 pandemic. Vaccines that use cutting-edge biotechnology have played an important role in mitigating the effects of SARS-CoV-2. However, more traditional methods of vaccine development that were refined throughout the 20th century have been especially critical to increasing vaccine access worldwide. Effective deployment is necessary to reducing the susceptibility of the world's population, which is especially important in light of emerging variants. In this review, we discuss the safety, immunogenicity, and distribution of vaccines developed using established technologies. In a separate review, we describe the vaccines developed using nucleic acid-based vaccine platforms. From the current literature, it is clear that the well-established vaccine technologies are also highly effective against SARS-CoV-2 and are being used to address the challenges of COVID-19 globally, including in low- and middle-income countries. This worldwide approach is critical for reducing the devastating impact of SARS-CoV-2.