COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries

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 Fracchia; Mery Len Galindo Soria; Andrea Guariso; Ali Hasanain; Sofía Jaramillo; Sellu Kallon; Anthony Kamwesigye; Arjun Kharel; Sarah Kreps; Madison Levine; Rebecca Littman; Mohammad Malik; Gisele Manirabaruta; Jean Léodomir Habarimana Mfura; Fatoma Momoh; Alberto Mucauque; Imamo Mussa; Jean Aime Nsabimana; Isaac Obara; María Juliana Otálora; Béchir Wendemi Ouédraogo; Touba Bakary Pare; Melina R. Platas; Laura Polanco; Javaeria Ashraf Qureshi; Mariam Raheem; Vasudha Ramakrishna; Ismail Rendrá; Taimur Shah; Sarene Eyla Shaked; Jacob N. Shapiro; Jakob Svensson; Ahsan Tariq; Achille Mignondo Tchibozo; Hamid 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

doi:https://doi.org/10.1038/s41591-021-01454-y

COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries

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 BorisovaConstantin Manuel Bosancianu, Magarita Rosa Cabra García, Ali Cheema, Elliott Collins, Filippo Cuccaro, Ahsan Zia Farooqi, Tatheer Fatima, Mattia Fracchia, Mery Len Galindo Soria, Andrea Guariso, Ali Hasanain, Sofía Jaramillo, Sellu Kallon, Anthony Kamwesigye, Arjun Kharel, Sarah Kreps, Madison Levine, Rebecca Littman, Mohammad Malik, Gisele Manirabaruta, Jean Léodomir Habarimana Mfura, Fatoma Momoh, Alberto Mucauque, Imamo Mussa, Jean Aime Nsabimana, Isaac Obara, María Juliana Otálora, Béchir Wendemi Ouédraogo, Touba Bakary Pare, Melina R. Platas, Laura Polanco, Javaeria Ashraf Qureshi, Mariam Raheem, Vasudha Ramakrishna, Ismail Rendrá, Taimur Shah, Sarene Eyla Shaked, Jacob N. Shapiro, Jakob Svensson, Ahsan Tariq, Achille Mignondo Tchibozo, Hamid 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

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Abstract

Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.

Original language	English
Pages (from-to)	1385 - 1394
Journal	Nature Medicine
Volume	27
Issue number	8
DOIs	https://doi.org/10.1038/s41591-021-01454-y
Publication status	Published - Aug 2021

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COVID-19 vaccine acceptance and hesitancy in low- and middle-income countriesAccepted author manuscript, 383 KBLicence: CC BY-NC-ND
s41591-021-01454-yFinal published version, 7.29 MBLicence: CC BY

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Solís Arce, J. S., Warren, S. S., Meriggi, N. F., Scacco, A., McMurry, N., Voors, M., Syunyaev, G., Malik, A. A., Aboutajdine, S., Adeojo, O., Anigo, D., Armand, A., Asad, S., Atyera, M., Augsburg, B., Awasthi, M., Ayesiga, G. E., Bancalari, A., Björkman-Nyqvist, M., ... Omer, S. B. (2021). COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries. Nature Medicine, 27(8), 1385 - 1394. https://doi.org/10.1038/s41591-021-01454-y

@article{21d48de73f87465dbdad1032228dde46,

title = "COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries",

abstract = "Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.",

author = "{Sol{\'i}s Arce}, {Julio S.} and Warren, {Shana S.} and Meriggi, {Niccol{\`o} F.} and Alexandra Scacco and Nina McMurry and Maarten Voors and Georgiy Syunyaev and Malik, {Amyn Abdul} and Samya Aboutajdine and Opeyemi Adeojo and Deborah Anigo and Alex Armand and Saher Asad and Martin Atyera and Britta Augsburg and Manisha Awasthi and Ayesiga, {Gloria Eden} and Antonella Bancalari and Martina Bj{\"o}rkman-Nyqvist and Ekaterina Borisova and Bosancianu, {Constantin Manuel} and {Cabra Garc{\'i}a}, {Magarita Rosa} and Ali Cheema and Elliott Collins and Filippo Cuccaro and Farooqi, {Ahsan Zia} and Tatheer Fatima and Mattia Fracchia and {Galindo Soria}, {Mery Len} and Andrea Guariso and Ali Hasanain and Sof{\'i}a Jaramillo and Sellu Kallon and Anthony Kamwesigye and Arjun Kharel and Sarah Kreps and Madison Levine and Rebecca Littman and Mohammad Malik and Gisele Manirabaruta and Mfura, {Jean L{\'e}odomir Habarimana} and Fatoma Momoh and Alberto Mucauque and Imamo Mussa and Nsabimana, {Jean Aime} and Isaac Obara and Ot{\'a}lora, {Mar{\'i}a Juliana} and Ou{\'e}draogo, {B{\'e}chir Wendemi} and Pare, {Touba Bakary} and Platas, {Melina R.} and Laura Polanco and Qureshi, {Javaeria Ashraf} and Mariam Raheem and Vasudha Ramakrishna and Ismail Rendr{\'a} and Taimur Shah and Shaked, {Sarene Eyla} and Shapiro, {Jacob N.} and Jakob Svensson and Ahsan Tariq and Tchibozo, {Achille Mignondo} and Tiwana, {Hamid Ali} and Bhartendu Trivedi and Corey Vernot and Vicente, {Pedro C.} and Weissinger, {Laurin B.} and Basit Zafar and Baobao Zhang and Dean Karlan and Michael Callen and Matthieu Teachout and Macartan Humphreys and Mobarak, {Ahmed Mushfiq} and Omer, {Saad B.}",

note = "Funding information# Beyond Conflict# Bill and Melinda Gates Foundation# Columbia University# Givewell.org# Ghent University# HSE University{"}# International Growth Centre# Jameel Poverty Action Lab Crime and Violence Initiative# London School of Economics and Political Science# Mulago Foundation# NOVAFRICA at the Nova School of Business and Economics# NYU Abu Dhabi# Energy for Economic Growth (EEG)# Oxford Policy Management# UK Aid# Princeton University# Social Science Research Council# Trinity College Dublin# COVID19 Response Funding# UKRI GCRF/Newton Fund# United Nations# Office for Project Services# Weiss Family Fund# WZB Berlin Social Science Center# Yale Institute for Global Health# Yale Macmillan Center# and anonymous donors to IPA and Y-RISE# Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2021",

month = aug,

doi = "https://doi.org/10.1038/s41591-021-01454-y",

language = "English",

volume = "27",

pages = "1385 -- 1394",

journal = "Nature Medicine",

issn = "1078-8956",

publisher = "Nature Research",

number = "8",

}

Solís Arce, JS, Warren, SS, Meriggi, NF, Scacco, A, McMurry, N, Voors, M, Syunyaev, G, Malik, AA, Aboutajdine, S, Adeojo, O, Anigo, D, Armand, A, Asad, S, Atyera, M, Augsburg, B, Awasthi, M, Ayesiga, GE, Bancalari, A, Björkman-Nyqvist, M, Borisova, E, Bosancianu, CM, Cabra García, MR, Cheema, A, Collins, E, Cuccaro, F, Farooqi, AZ, Fatima, T, Fracchia, M, Galindo Soria, ML, Guariso, A, Hasanain, A, Jaramillo, S, Kallon, S, Kamwesigye, A, Kharel, A, Kreps, S, Levine, M, Littman, R, Malik, M, Manirabaruta, G, Mfura, JLH, Momoh, F, Mucauque, A, Mussa, I, Nsabimana, JA, Obara, I, Otálora, MJ, Ouédraogo, BW, Pare, TB, Platas, MR, Polanco, L, Qureshi, JA, Raheem, M, Ramakrishna, V, Rendrá, I, Shah, T, Shaked, SE, Shapiro, JN, Svensson, J, Tariq, A, Tchibozo, AM, Tiwana, HA, Trivedi, B, Vernot, C, Vicente, PC, Weissinger, LB, Zafar, B, Zhang, B, Karlan, D, Callen, M, Teachout, M, Humphreys, M, Mobarak, AM & Omer, SB 2021, 'COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries', Nature Medicine, vol. 27, no. 8, pp. 1385 - 1394. https://doi.org/10.1038/s41591-021-01454-y

TY - JOUR

T1 - COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries

AU - Solís Arce, Julio S.

AU - Warren, Shana S.

AU - Meriggi, Niccolò F.

AU - Scacco, Alexandra

AU - McMurry, Nina

AU - Voors, Maarten

AU - Syunyaev, Georgiy

AU - Malik, Amyn Abdul

AU - Aboutajdine, Samya

AU - Adeojo, Opeyemi

AU - Anigo, Deborah

AU - Armand, Alex

AU - Asad, Saher

AU - Atyera, Martin

AU - Augsburg, Britta

AU - Awasthi, Manisha

AU - Ayesiga, Gloria Eden

AU - Bancalari, Antonella

AU - Björkman-Nyqvist, Martina

AU - Borisova, Ekaterina

AU - Bosancianu, Constantin Manuel

AU - Cabra García, Magarita Rosa

AU - Cheema, Ali

AU - Collins, Elliott

AU - Cuccaro, Filippo

AU - Farooqi, Ahsan Zia

AU - Fatima, Tatheer

AU - Fracchia, Mattia

AU - Galindo Soria, Mery Len

AU - Guariso, Andrea

AU - Hasanain, Ali

AU - Jaramillo, Sofía

AU - Kallon, Sellu

AU - Kamwesigye, Anthony

AU - Kharel, Arjun

AU - Kreps, Sarah

AU - Levine, Madison

AU - Littman, Rebecca

AU - Malik, Mohammad

AU - Manirabaruta, Gisele

AU - Mfura, Jean Léodomir Habarimana

AU - Momoh, Fatoma

AU - Mucauque, Alberto

AU - Mussa, Imamo

AU - Nsabimana, Jean Aime

AU - Obara, Isaac

AU - Otálora, María Juliana

AU - Ouédraogo, Béchir Wendemi

AU - Pare, Touba Bakary

AU - Platas, Melina R.

AU - Polanco, Laura

AU - Qureshi, Javaeria Ashraf

AU - Raheem, Mariam

AU - Ramakrishna, Vasudha

AU - Rendrá, Ismail

AU - Shah, Taimur

AU - Shaked, Sarene Eyla

AU - Shapiro, Jacob N.

AU - Svensson, Jakob

AU - Tariq, Ahsan

AU - Tchibozo, Achille Mignondo

AU - Tiwana, Hamid Ali

AU - Trivedi, Bhartendu

AU - Vernot, Corey

AU - Vicente, Pedro C.

AU - Weissinger, Laurin B.

AU - Zafar, Basit

AU - Zhang, Baobao

AU - Karlan, Dean

AU - Callen, Michael

AU - Teachout, Matthieu

AU - Humphreys, Macartan

AU - Mobarak, Ahmed Mushfiq

AU - Omer, Saad B.

N1 - Funding information# Beyond Conflict# Bill and Melinda Gates Foundation# Columbia University# Givewell.org# Ghent University# HSE University"# International Growth Centre# Jameel Poverty Action Lab Crime and Violence Initiative# London School of Economics and Political Science# Mulago Foundation# NOVAFRICA at the Nova School of Business and Economics# NYU Abu Dhabi# Energy for Economic Growth (EEG)# Oxford Policy Management# UK Aid# Princeton University# Social Science Research Council# Trinity College Dublin# COVID19 Response Funding# UKRI GCRF/Newton Fund# United Nations# Office for Project Services# Weiss Family Fund# WZB Berlin Social Science Center# Yale Institute for Global Health# Yale Macmillan Center# and anonymous donors to IPA and Y-RISE# Publisher Copyright: © 2021, The Author(s).

PY - 2021/8

Y1 - 2021/8

N2 - Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.

AB - Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.

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U2 - https://doi.org/10.1038/s41591-021-01454-y

DO - https://doi.org/10.1038/s41591-021-01454-y

M3 - Article

AN - SCOPUS:85110615244

SN - 1078-8956

VL - 27

SP - 1385

EP - 1394

JO - Nature Medicine

JF - Nature Medicine

IS - 8

ER -

COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries

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