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

TLDR

Widespread acceptance of COVID‑19 vaccines is crucial for ending the pandemic, yet few studies have examined vaccination attitudes in lower‑income countries where large‑scale vaccination is just beginning. This study investigates COVID‑19 vaccine acceptance across 15 survey samples in 10 low‑ and middle‑income countries. The authors analyze data from 44,260 individuals across 15 surveys covering LMICs in Asia, Africa, South America, Russia, and the United States. The study finds high willingness to vaccinate in LMICs (mean 80.3 %) versus the US (64.6 %) and Russia (30.4 %), driven by personal protection motives, with side‑effect concerns as the main hesitancy factor; health workers are the most trusted source, suggesting that messages emphasizing efficacy and safety delivered by healthcare workers could convert acceptance into uptake and support prioritizing vaccine distribution to the Global South.

Abstract

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.