//Background//---
As
of 25/June, 2021, 23 vaccines had advanced to Phase 3 clinical trials(3) and
more than 12 kinds of SARS-CoV-2 vaccine had been approved in multiple
countries(4). However, global vaccine distribution is highly skewed between
high income countries and low-middle income countries, so COVAX facility makes
tremendous efforts for equal vaccine delivery to low-middle income countries.
Vaccine production capacity will be significantly improved in 2022, but the
SAR-CoV-2 pandemic becomes severe due to mutation lineages with higher infectivity
even in the countries which have already conducted broad vaccination like The
United Kingdom. Therefore, vaccine demand is urgent, we need to delivery
vaccine as early as possible for all countries.
On
the other hand, vaccination rate does not increase as we expected even in the
countries preparing sufficient SARS-CoV-2 vaccine like The United States of
America. Current U.S. vaccination rate is only 56.7%. Therefore, we need to
consider about background of unwillingness for vaccination.
In low-middle income countries, acceptance of childhood vaccination
for measles (MCV), Bacille Calmette–Guérin (BCG) and diphtheria, tetanus and
pertussis (DTP) is generally high. Therefore, high acceptance for COVID-19
vaccine is expected. On the other hand, there are several negative factors as
following(#).
(#)Negative perceptions of healthcare
quality(5) / Negative historical experiences involving foreign actors(6,7) /
Weak support from traditional leaders(8) / Mistrust in government(9)
In
this counterbalance, the large-scale survey for acceptance in low-middle income
countries is crucial. Julio S. Solís Arce, Shana S. Warren et al. investigate
acceptance of SARS-CoV-2 vaccine and reason of hesitation in a comparative way
with Russia and The United States which can produce vaccine by themselves(1). I
hope to share a part of contents in this report and my discussion.
//Condition(1)//---
*The 15 survey for COVID-19 vaccine
acceptance
*Nation: 10 low-middle income countries(#),
Russia(upper-middle income country), The United States of America(high income
country)
(#)Burkina Faso, Colombia, India, Mozambique,
Nepal, Nigeria, Pakistan, Rwanda, Sierra Leone, Uganda
*Participants: 44,260 individuals
//Result(1)//---
Willingness to take a COVID-19 vaccine (mean
rate %)
10 low-middle income countries: 80.3%
Russia: 30.4% (*Vaccination rate 22.3%: As
of 19/July, 2021)
The United States: 64.6% (*Vaccination rate
56.7%: As of 18/July, 2021)
-
The most common hesitant reason against
vaccination
*Concerned about side effects:
10 low-middle income countries: 40.8%
Russia: 36.8%
The United States: 79.3%
//Discussion//---
From
statistical data on willingness to take vaccine and vaccination rate in Russia
and The United States, acceptance rate is almost corresponding to the
vaccination rate. As acceptance rate is high by 80.3% in low-middle income
countries, high vaccination rate is expected when vaccine delivery and
vaccination environment become sufficient. Therefore, elevating approved
vaccine production capacity and setting proper vaccination environment (the
trained medical staff and the preservation environment) is needed as early as
possible for alleviating the global pandemic. The most common reason of vaccine
hesitation is concern against side effect. We need to convey precise
information as easy to understand as possible. The most common concerned side
effect is fever (>38℃). However, we can use antipyretic
and the most event was resolved within 1-2 days. Conveying this medical fact
for all persons through media is crucial in order to elevate vaccination rate.
Furthermore, the counterbalance between risk and benefit in vaccination needs
to be considered in all persons, so we need to convey approved information on
reducing infection risk and significant reduction for admission to a hospital
for all persons. Indeed, vaccine efficacy varies by concerned variants, and is
reduced in the lineage having escape mutation. However, we need to
differentiate infection protection and a degree of symptom. Even if we become
PCR-positive after vaccination, symptom tends to be mild. This medical fact is
quite important. The safety and effectiveness is key important factors for
willingness of vaccination(2). Therefore, polite explanation about these
matters is a prerequisite. In addition, the social benefit emerged by
vaccination needs to be confirmed.
//Contributions(1)//---
J.S.S.A., S.S.W., N.F.M., A.S., N.M., G.S.,
M.V. and A.A.M. are co-first authors. D.K., M.C., M.T., M.H., A.M.M. and S.B.O.
are co-last authors. A.M.M. and S.B.O. are the corresponding authors. D.K.,
A.M.M., M.T., N.F.M., M.C. and M.V. conceived the study and provided overall
guidance. S. Aboutajdine and N.F.M. led the literature search, with input from
A.S., N.M., S.S.W., A.M.M., A.A.M. and J.S.S.A. S.S.W., N.F.M., A.S., N.M.,
M.V., G.S., A.A., S. Asad, B.A., A.B., E.B., C.M.B., A.C., E.C., M.F., A.G., A.
Kamwesgiye, S. Kreps, R.L., M.B.N., M.R.P., J.A.Q., J.N.S., J.S., P.C.V., M.C.,
S. Asad, A.C., A.Z.F., A.H., M.C., M.T., M.H., C.V., L.B.W., B. Zhang and B.
Zafar oversaw data collection as part of other research efforts. O.A., D.A., M.
Atyera, M. Awasthi, M.R.C.G., A.C., F.C., G.E.A., M.L.G.S., S.J., S. Kallon, A.
Kamwesigye, A. Kharel, M.M., G.M., J.L.H.M., F.M., A.M., I.M., J.A.N., I.O.,
M.J.O., B.W.O., T.B.P., L.P., M.R., I.R., T.S., S.E.S., A.T., A.M.T., H.A.T.
and B.T. implemented the surveys, including training and oversight of
enumerators and management of sampling for the surveys. S.S.W., N.F.M. and M.T.
coordinated the project across study samples. The following verified the
underlying data for individual study samples: E.C. (Burkina Faso, Colombia,
Rwanda, Sierra Leone survey 1), B.A. and A.B. (India), A.S. and R.L. (Nigeria),
A.G., J.S. and M.B.N. (Uganda survey 1), C.M.B. and M.H. (Uganda survey 2),
N.F.M. and M.V. (Sierra Leone survey 2), G.S. (Russia), M.F. (Mozambique),
A.Z.F. and J.N.S. (Pakistan survey 1), S. Asad (Pakistan survey 2), C.V.
(Nepal) and N.M. (USA). J.S.S.A., G.S., M.H. and S. Aboutajdine collated and
processed all datasets used for the analysis. N.F.M., M.H., A.M.M., J.S.S.A.,
G.S., S.S.W., A.S., E.C., E.B., M.T., M.V. and N.M. carried out data
interpretation with guidance from S.B.O. and A.M. J.S.S.A., G.S., E.C. and M.H.
verified final datasets and analysis. J.S.S.A. and G.S. performed the data
analysis and produced output figures with input from M.H., A.M.M., D.K.,
S.S.W., E.C., M.V., N.F.M. and M.T. M.H. supervised the data analysis.
J.S.S.A., S.S.W., N.F.M., A.M.M., A.S., N.M. and M.V. wrote the first draft of
the manuscript, with guidance from A.A.M. and S.B.O. J.S.S.A., S.S.W., N.F.M.,
A.S., N.M., M.V., S. Aboutajdine, E.B., M.R.P., J.N.S., P.C.V., B. Zhang, M.C.,
M.T., M.H., A.M.M., A.A.M. and S.B.O. revised the manuscript. All authors
approved the final version of the manuscript. All authors had full access to
all the data used in this study and had final responsibility for the decision
to submit for publication.
//Ethics declarations(1)//---
Competing interests
The authors declare no competing interests.
//Peer review information(1)//---
Nature Medicine thanks Jeffrey Lazarus,
Clarissa Simas and the other, anonymous, reviewer(s) for their contribution to
the peer review of this work. Jennifer Sargent was the primary editor on this
article and managed its editorial process and peer review in collaboration with
the rest of the editorial team.
//Publisher’s note(1)//---
Springer Nature remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.
(Reference)
(1)
Julio S. Solís Arce, Shana S. Warren,
Niccolò F. Meriggi, Alexandra Scacco, Nina McMurry, Maarten Voors, Georgiy
Syunyaev, Amyn Abdul Malik, Samya Aboutajdine, Opeyemi Adeojo, Deborah Anigo,
Alex Armand, Saher Asad, Martin Atyera, Britta Augsburg, Manisha Awasthi,
Gloria Eden Ayesiga, Antonella Bancalari, Martina Björkman Nyqvist, Ekaterina
Borisova, Constantin Manuel Bosancianu, Magarita Rosa Cabra García, Ali Cheema,
Elliott Collins, Filippo Cuccaro, Ahsan Zia Farooqi, Tatheer Fatima, Mattia
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Ali Tiwana, Bhartendu Trivedi, Corey Vernot, Pedro C. Vicente, Laurin B.
Weissinger, Basit Zafar, Baobao Zhang, Dean Karlan, Michael Callen, Matthieu
Teachout, Macartan Humphreys, Ahmed Mushfiq Mobarak & Saad B. Omer
COVID-19 vaccine acceptance and hesitancy
in low- and middle-income countries
Nature Medicine (2021)
---
Author information
Affiliations
WZB Berlin Social Science Center, Berlin,
Germany
Julio S. Solís Arce, Alexandra Scacco, Nina
McMurry, Georgiy Syunyaev, Constantin Manuel Bosancianu & Macartan
Humphreys
Innovations for Poverty Action (IPA), New
York, NY, USA
Shana S. Warren, Elliott Collins & Dean
Karlan
International Growth Centre (IGC), Freetown,
Sierra Leone
Niccolò F. Meriggi, Samya Aboutajdine &
Matthieu Teachout
Wageningen University & Research,
Wageningen, the Netherlands
Maarten Voors, Sellu Kallon & Madison
Levine
International Center for the Study of
Institutions and Development (ICSID), HSE University, Moscow, Russia
Georgiy Syunyaev & Ekaterina Borisova
Columbia University, New York, NY, USA
Georgiy Syunyaev & Macartan Humphreys
Yale Institute for Global Health, New
Haven, CT, USA
Amyn Abdul Malik & Saad B. Omer
Busara Center for Behavioral Economics,
Lagos, Nigeria
Opeyemi Adeojo & Isaac Obara
Department of Sociology, University of
Lagos, Lagos, Nigeria
Opeyemi Adeojo
Busara Nigeria, Lagos, Nigeria
Deborah Anigo
Agricultural and Rural Development
Secretariat, Federal Capital Territory Administration, Abuja, Nigeria
Deborah Anigo
Nova School of Business and Economics,
Lisbon, Portugal
Alex Armand, Mattia Fracchia & Pedro C.
Vicente
The Institute for Fiscal Studies, London,
UK
Alex Armand, Britta Augsburg &
Antonella Bancalari
Lahore University of Management Sciences,
Lahore, Pakistan
Saher Asad, Ali Cheema & Ali Hasanain
Innovations for Poverty Action (IPA)
Uganda, Kampala, Uganda
Martin Atyera, Gloria Eden Ayesiga, Anthony
Kamwesigye & Sarene Eyla Shaked
Morsel Research & Development, Lucknow,
India
Manisha Awasthi, Tatheer Fatima &
Bhartendu Trivedi
University of St Andrews, St Andrews, UK
Antonella Bancalari
Redes Peru, Lima, Peru
Antonella Bancalari
Stockholm School of Economics and Misum,
Stockholm, Sweden
Martina Björkman Nyqvist
Ghent University, Department of Economics,
Ghent, Belgium
Ekaterina Borisova
Innovations for Poverty Action (IPA)
Colombia, Bogotá, Colombia
Magarita Rosa Cabra García, Mery Len
Galindo Soria, Sofía Jaramillo, María Juliana Otálora & Laura Polanco
Institute of Development and Economic
Alternatives, Lahore, Pakistan
Ali Cheema, Ahsan Zia Farooqi, Mohammad
Malik, Ahsan Tariq & Hamid Ali Tiwana
Innovations for Poverty Action (IPA) Sierra
Leone, Freetown, Sierra Leone
Filippo Cuccaro & Fatoma Momoh
NOVAFRICA, Lisbon, Portugal
Mattia Fracchia & Pedro C. Vicente
Trinity College Dublin, Dublin, Ireland
Andrea Guariso
Institute of Public Administration and
Management, University of Sierra Leone, Freetown, Sierra Leone
Sellu Kallon
Centre for the Study of Labour and Mobility
(CESLAM), Kathmandu, Nepal
Arjun Kharel
Cornell University, Ithaca, NY, USA
Sarah Kreps & Baobao Zhang
University of Illinois Chicago, Chicago,
IL, USA
Rebecca Littman & Javaeria Ashraf
Qureshi
Innovations for Poverty Action (IPA)
Rwanda, Kigali, Rwanda
Gisele Manirabaruta, Jean Léodomir
Habarimana Mfura & Jean Aime Nsabimana
Associação NOVAFRICA para o Desenvolvimento
Empresarial e Económico de Moçambique, Maputo, Mozambique
Alberto Mucauque, Imamo Mussa & Ismail
Rendrá
Innovations for Poverty Action (IPA)
Burkina Faso, Ouagadougou, Burkina Faso
Béchir Wendemi Ouédraogo, Touba Bakary Pare
& Achille Mignondo Tchibozo
NYU Abu Dhabi, Abu Dhabi, United Arab
Emirates
Melina R. Platas
Centre for Economic Research in Pakistan (CERP),
Lahore, Pakistan
Mariam Raheem, Taimur Shah & Basit
Zafar
Yale Research Initiative on Innovation and
Scale (Y-RISE), New Haven, CT, USA
Vasudha Ramakrishna & Corey Vernot
Princeton University, Princeton, NJ, USA
Jacob N. Shapiro
Institute for International Economic
Studies (IIES), Stockholm University, Stockholm, Sweden
Jakob Svensson
Tufts University, Medford, MA, USA
Laurin B. Weissinger
University of Michigan, Ann Arbor, MI, USA
Basit Zafar
Kellogg School of Management at
Northwestern University, Evanston, IL, USA
Dean Karlan
London School of Economics and Political
Science, London, UK
Michael Callen
Yale University, New Haven, CT, USA
Ahmed Mushfiq Mobarak
(2)
Shingai Machingaidze & Charles Shey
Wiysonge
Understanding COVID-19 vaccine hesitancy
Nature Medicine (2021)
---
Author information
Author notes
These authors contributed equally: Shingai
Machingaidze, Charles Shey Wiysonge.
Affiliations
European and Developing Countries Clinical
Trials Partnership, Africa Office, Cape Town, South Africa
Shingai Machingaidze
School of Public Health and Family
Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South
Africa
Shingai Machingaidze & Charles Shey
Wiysonge
Cochrane South Africa, South African
Medical Research Council, Cape Town, South Africa
Charles Shey Wiysonge
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