- Open Access
COVID-19 vaccine hesitancy in Africa: a scoping review
Global Health Research and Policy volume 7, Article number: 21 (2022)
Vaccination against the novel coronavirus is one of the most effective strategies for combating the global Coronavirus disease (COVID-19) pandemic. However, vaccine hesitancy has emerged as a major obstacle in several regions of the world, including Africa. The objective of this rapid review was to summarize the literature on COVID-19 vaccine hesitancy in Africa.
We searched Scopus, Web of Science, African Index Medicus, and OVID Medline for studies published from January 1, 2020, to March 8, 2022, examining acceptance or hesitancy towards the COVID-19 vaccine in Africa. Study characteristics and reasons for COVID-19 vaccine acceptance were extracted from the included articles.
A total of 71 articles met the eligibility criteria and were included in the review. Majority (n = 25, 35%) of the studies were conducted in Ethiopia. Studies conducted in Botswana, Cameroun, Cote D’Ivoire, DR Congo, Ghana, Kenya, Morocco, Mozambique, Nigeria, Somalia, South Africa, Sudan, Togo, Uganda, Zambia, Zimbabwe were also included in the review. The vaccine acceptance rate ranged from 6.9 to 97.9%. The major reasons for vaccine hesitancy were concerns with vaccine safety and side effects, lack of trust for pharmaceutical industries and misinformation or conflicting information from the media. Factors associated with positive attitudes towards the vaccine included being male, having a higher level of education, and fear of contracting the virus.
Our review demonstrated the contextualized and multifaceted reasons inhibiting or encouraging vaccine uptake in African countries. This evidence is key to operationalizing interventions based on facts as opposed to assumptions. Our paper provided important considerations for addressing the challenge of COVID-19 vaccine hesitancy and blunting the impact of the pandemic in Africa.
Reports from several countries in Africa suggest a lower burden of the novel coronavirus disease 2019 (COVID-19) pandemic, relative to countries such as the United States, Italy, and Peru [1,2,3]. However, factors influencing the pandemic’s trajectory across Africa are not generalizable. These drivers are diverse, including a nation’s experience dealing with communicable diseases, connectivity among communities, infection fatality ratios, low physical access to health facilities, as well as low testing rates [4, 5]. Considering the debilitating health, social, and economic consequences of COVID-19, a marked increase in infection and mortality rates may be particularly devastating for African countries with under-resourced healthcare systems. Governments have instituted measures to contain the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including various forms of social distancing measures. The economic ramifications of these health restrictions disproportionately affect the populations in this region who are primarily informal workers. With their livelihoods predicated on in-person interactions, such workers do not readily adhere to lockdowns and similar measures [6,7,8].
Mass immunization has been demonstrated to be the most effective intervention for curtailing communicable disease pandemics and is therefore adopted and implemented by several countries [9, 10]. Despite the innumerable deaths that have been prevented by vaccines, the emergence of vaccine hesitancy and its penetration into mainstream views threaten to undermine the future success of immunization campaigns. Specifically, the demonstrated efficacy of vaccines in curbing the spread of COVID-19 has not necessarily translated to a decrease in global vaccine-hesitancy [11, 12].
According to the World Health Organization (WHO), vaccine hesitancy is the “delay in acceptance or refusal of vaccines despite availability of vaccination services” . This phenomenon has been highlighted by the WHO as one of the ten threats to global health. False rumours about vaccine side-effects often spread via social media. Additionally, negative experiences with the healthcare system, and general distrust towards the government have established the perfect milieu for vaccine-hesitant attitudes across Africa. The accelerated development, approval, and roll-out of COVID-19 vaccines further fuel pre-existing distrust and suspicion. Thus, regions that historically struggle with adequate supplies and equitable access to healthcare also face a new hurdle—insufficient vaccine uptake.
The goal of this scoping review was to synthesize the current literature on vaccine-hesitant attitudes in Africa. This is necessary to establish an understanding of the multiplicity of perceptions and attitudes towards the COVID-19 vaccine, and to help frame strategies for addressing them.
This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) extension for Scoping Reviews . Literature that was examined included those indexed in Scopus, Web of Science, African Index Medicus, and OVID Medline on the topic of attitudes, acceptance, or hesitancy towards the COVID-19 vaccine in Africa. Covidence  was used for managing deduplication of studies, as well as for screening, full text review, and data extraction.
Eligible studies met the following inclusion criteria of being (1) peer-reviewed, published, and indexed in Scopus, Web of Science, African Index Medicus, or OVID Medline; (2) primarily discussing or evaluating COVID-19 vaccine acceptance/hesitancy; (3) focused on Africa or included African countries; (4) published in English; (5) published between January 1, 2020, to March 8, 2022. Letters to the editor, non-empirical studies, reviews, or protocols were also excluded from the review.
The searches on all four databases were done on March 8, 2022. Detailed search strategies and search results are presented in the Additional file 1. Bibliographies of articles that were included for review were also scanned to capture any literature that was missed from the formal search.
Title, abstract screening, and full text reviews were conducted independently by two authors following the inclusion and exclusion criteria. The following information was extracted from articles that were included for data extraction: last name of the first author, year of publication, study design, country of focus, sample description, sample size, reported acceptance or hesitancy rate, reported factors and reasons associated with acceptance or hesitancy.
A combined total of 536 records from our initial search in the aforementioned databases were eligible for title and abstract screening. Duplicates (n = 245) were removed, and 291 studies were eligible for title and abstract screening. One hundred and eighty-six (186) articles were deemed irrelevant and were removed, leaving 105 studies for full text screening. During the full text screening, 34 studies were excluded because they were either non-peer reviewed, letters to the editor or protocols, not focused on vaccine hesitancy, not focused on Africa, or the full text was not available. The remaining 71 articles were included in the final analysis. The selection process is shown in the PRISMA flow diagram (Fig. 1).
Characteristics of the included studies
There was heterogeneity in the included articles in terms of country of focus and participant characteristics (Table 1).
Country of focus
Majority (n = 68, 95.8%) of the included studies were conducted in a single country while 3 studies [16,17,18] were conducted in multiple countries. Majority of the studies were conducted in Ethiopia (n = 25, 35.2%), followed by Nigeria (n = 13, 18.3%) and then Ghana (n = 8, 11.3%). The remaining were conducted in South Africa (n = 5), Kenya (n = 3), DR Congo (n = 2), Uganda (n = 2), Botswana (n = 1), Cameroon (n = 1), Cote D’Ivoire (n = 1), Morocco (n = 1), Mozambique (n = 1), Somalia (n = 1), Sudan (n = 1), Togo (n = 1), Zambia (n = 1) and Zimbabwe (n = 1).
Study design and data collection
All but 5 of the included studies were cross-sectional in design. Participant data were collected in-person in 40 studies, online in 23 studies; via telephone in 5 studies, both online and in-person in 2 studies and via telephone and in-person in one study.
The study samples were mostly drawn from the general public, university or college students or from healthcare settings, with adults aged ≥ 18 years, and sample sizes ranging from 14  to 11,895 .
Themes from included studies
Two major themes were captured in the included studies: COVID-19 vaccine acceptance rate and factors associated with or reasons for vaccine acceptability or hesitancy.
COVID-19 vaccine acceptance rate
The rate of acceptance of COVID-19 vaccine ranged from 6.9 to 97.9% (Table 2). Twenty-one representing 29.6% of the included studies reported lower than 50% acceptance. The lowest acceptance rate of 6.9% was reported by Chinawa and colleagues  and the highest acceptance rate of 97.9% was reported by Kanyanda and colleagues .
Factors associated with/reasons for COVID-19 vaccine acceptability/hesitancy
Being male was the most commonly reported factor associated with increased acceptability of the COVID-19 vaccine [21,22,23,24,25,26,27,28]. Other factors that were associated with COVID-19 vaccine acceptance included higher level of education [21, 25, 28,29,30,31,32,33,34], working in a health-related occupation especially as a medical doctor [26, 35], greater knowledge of COVID-19 or fear of contracting the virus (including having flu-like symptoms, being tested for COVID-19, or relatives who had contracted the virus) [36,37,38,39]. Also, possessing positive perceptions towards vaccine sources and the pharmaceutical industry  and higher income  were reported as facilitators of vaccine acceptance.
The reasons for vaccine hesitancy varied across studies (Table 2). Concern for safety was the most-mentioned factor [17,18,19, 25, 34, 36, 36, 37, 37, 38, 40, 41, 41,42,43, 43,44,45,46,47,48,49,50,51,52,53]. Some of these concerns appeared to stem from mistrust towards the pharmaceutical industry, results from clinical trials, poor vaccine promotion with conflicting information, misinformation from social media, and the fear of getting ill or side effects from the vaccine [26, 36, 40, 44].
Although COVID-19 vaccines have mostly been delivered free-of-expense, vaccine affordability was mentioned in some sources [17, 50, 54].
Since the start of the COVID-19 pandemic, mitigation strategies including rapid vaccine development and roll-out have been implemented to curb the spread of the virus. Governments are faced with an unprecedented need to acquire vaccines, distribute them, and immunize large populations at a pace and scale that has not been done before . However, vaccine hesitancy remains a major obstacle, even amongst cohorts that are not known to be particularly reluctant to accept vaccines or other health interventions.
This review presents a mapping of the relevant literature and findings on attitudes to COVID-19 vaccines in Africa. The included studies were mostly cross-sectional studies that investigated diverse populations. The low levels of vaccine acceptance recorded in many of the included studies contrasts studies that were carried out in other regions like Europe and the Americas , China , Kuwait , and the United Kingdom .
Ditekemena and colleague’s study showed that people in middle-income or high-income groups were more willing to get immunized . Participants in some studies [39, 54, 60] also mentioned financial considerations as hindrances. Thus, even though many countries in Africa are vaccinating the populace for free, the reticence from resource-constrained communities could point to a miscommunication about who bears the cost. Similarly, the financial burden on such communities likely goes beyond the vaccine themselves to include transportation to vaccination centres which might not be proximal to them, childcare costs and other barriers.
Interestingly, vaccine hesitancy was persistent among students and healthcare workers [26, 37, 51, 54, 61]. Healthcare workers are often role models for vaccine uptake, especially for populations expressing low levels of trust towards vaccines. In many cases, they are gatekeepers for public health messaging, and their interactions could encourage health-seeking behaviours such as receiving vaccines [26, 62]. As such, vaccine hesitancy among them is especially concerning given their involvement at the forefront of immunization campaigns and other clinical interventions. In contrast, research on health providers conducted in Italy, Saudi Arabia, France, and China [63,64,65,66,67] have shown greater acceptance of vaccines. In Nzaji and colleagues’ study , there was a differentiation between the various types of health workers that were surveyed. Doctors were more likely to accept the vaccines compared to nurses and laboratory technicians.
Kanyike and colleagues  underscored the fact that participants reported such high levels of hesitancy because of the relatively slower infection rates compared to other countries. Caserotti and colleagues  established a link between risk perception and acceptance of COVID-19 vaccines. Thus, the reduced perception of risk and mortality in many African countries can be related to widespread vaccine hesitancy . For instance, the recovery rate from COVID-19 in Cameroon at the time of Dinga et al.’s study  was 80%. In Ahmed and colleagues’ study , participants reported their decreasing adherence to COVID-19 prevention protocols like physical distancing and wearing facemasks. This correlates with an increase in flu-like symptoms, spurring a consequent rise in vaccine acceptance. This instance of the perception of increased risk encouraging vaccine uptake is quite interesting. This exemplifies the import of contextual factors of cultural norms as well as misinformation on acceptance and hesitancy rates even in instances of similar awareness of heightened risk. National sensitization campaigns must therefore heed these contextual nuances to ensure that public health messaging is catered to specific socioeconomic and sociocultural groups.
In general, more men than women were open to COVID-19 vaccinations. Ngoyi and colleagues  attributed this to a widespread impression that men were more at risk of poor outcomes from COVID-19 infections. These gendered patterns of vaccine acceptance match findings from other COVID-19 literature including a study mapping global trends with participants from eight countries [56, 70]. Contrastingly, Faezi and colleagues’ study  which also included participants from countries outside Africa had women showing a higher propensity for vaccines.
The studies listed a diversity of explanations for why participants refused to be vaccinated. A common reason was the concern for vaccine side effects. Zewude and Zikarge  found that participants were particularly averse to the AstraZeneca vaccine. This sentiment was likely fueled by reports of serious side effects such as blood clots and other complications, as well as the decision by several European countries to halt AstraZeneca vaccinations for a period to investigate the adverse reactions.
With regards to the fear of side effects, an explanation that was cited in almost all research contexts was the role of misinformation especially on social media platforms. Social media holds substantial power at mediating the perpetuation of misinformation on anti-vaccine campaigns [72,73,74]. The major sources disseminating false information that were cited by some studies [39, 40, 63, 69] were social media-based, and to a lesser extent traditional media. Interestingly, even though they are medical students, 91% of the respondents of Kanyike and colleagues’ study  reported they sourced information on COVID-19 from social media, rather than from health experts. Misinformation from social media fueled their vaccine hesitancy although they expressed a self-perception of an increased risk due to their participation in COVID-19 health interventions. As these results prove, social media wields immense power in effective dissemination of information and in influencing health-seeking behaviors. These influences must be fundamental considerations in national campaigns to address vaccine hesitancy. It would involve tailoring the content of campaigns to appeal to people more strongly than the misinformation that they so easily accept.
Other key commonalities from the included studies include mistrust of vaccine manufacturers [36, 40] and the notion that COVID-19 vaccines would be used as targets to harm Africans [26, 37,38,39,40, 63]. Respondents were mistrustful because the pharmaceutical companies are foreign, and scientists from their respective countries were not involved in developing the vaccines. Further longitudinal studies will be necessary to complement the findings of these studies considering the advanced stages of vaccination campaigns in many countries. This would also be relevant for studies [75,76,77,78] which were based on hypothetical situations prior to vaccine availability.
Additionally, the global need to attain high levels of vaccination rates will require more than one effective vaccine approach due to geographic diversity . Educational interventions that highlight vaccine safety and efficacy have been recognized in the literature as an urgent need to combat misinformation to increase compliance rates . As Zewude and Zikarge  demonstrated, vaccine hesitation could be fueled by public response to particular vaccines, in this case AstraZeneca. The messages in these interventions should therefore be tailored to reflect the differing concerns for specific vaccines. These educational programs could be more impactful if targeted towards the individuals whom we have highlighted as especially concerned about getting vaccinated.
Although education may not address the underlying causes for mistrust and prevent conspiracies from evolving within communities, we believe that education especially in the context of a novel infection is important in creating awareness and dispelling fears that might contribute to conspiracies or distrust towards prevention and control measures. However, it is important to acknowledge that education as an intervention must be accompanied by other efforts such as understanding historical and cultural contexts of disease, ensuring transparency within public media, and involving community leaders in efforts to respectfully engage in dialogue around prevention and control measures.
The global health community needs to act as a united front while promoting the adaptation of local strategies to address the root causes of mistrust and skepticism for COVID-19 vaccines. This must be done in a respectful manner that acknowledges rather than dismisses the concerns of individuals who are genuinely wary about the safety and efficacy of the available vaccines. Lessons can be learned that will promote vaccine acceptance even for existing vaccines among historically non-compliant groups.
The robust and comprehensive nature of the search strategy is a strength of this paper. With regards to limitations, a critical appraisal of studies included in this review was not carried out as the objective of this review is to present available and relevant evidence in a time-sensitive manner to aid decision-making on strategies to urgently curb vaccine hesitancy during the COVID-19 pandemic in Africa. Moreover, studies were only included from the English language; this may have excluded studies that were written in a different language but still relevant to our research question.
This scoping review illustrated the current state of evidence regarding COVID-19 vaccine hesitancy in Africa. Our synthesis revealed that factors that drove vaccine hesitant sentiments across Africa varied from fear of adverse events following vaccination, distrust towards the pharmaceutical industry, as well as myths surrounding immunization. This evidence would be instrumental in addressing the sources and manifestations of skepticism towards vaccines to stop COVID-19 and its manifold impacts. This is integral as global efforts for equitable COVID-19 vaccine distribution are underway. The persistence of outbreaks and emergence of variants of concern make this endeavor even more pertinent for helping to frame educational and other approaches for reducing vaccine hesitancy in Africa. Further, identifying the determinants and facilitators of vaccine hesitancy is critical to improving both the current and future success of vaccine rollout. This evidence would be particularly useful for policy makers and health promotion stakeholders.
Availability of data and materials
- DR Congo:
Democratic Republic of Congo
Severe acute respiratory syndrome coronavirus 2
World Health Organization
Africa CDC. Africa CDC—COVID-19 daily updates. Africa CDC. [Cited 2021 July 13]. Available from https://africacdc.org/covid-19/.
Hulland E. COVID-19 and health care inaccessibility in sub-Saharan Africa. Lancet Healthy Longev. 2020;1(1):e4-5.
Johns Hopkins University. Mortality analyses. Johns Hopkins Coronavirus Resource Center. [Cited 2021 July 23]. Available from https://coronavirus.jhu.edu/data/mortality.
Geldsetzer P, Reinmuth M, Ouma PO, Lautenbach S, Okiro EA, Bärnighausen T, et al. Mapping physical access to healthcare for older adults in sub-Saharan Africa: a cross-sectional analysis with implications for the COVID-19 response. medRxiv. 2020;2020.07.17.20152389.
Rice BL, Annapragada A, Baker RE, Bruijning M, Dotse-Gborgbortsi W, Mensah K, et al. Variation in SARS-CoV-2 outbreaks across sub-Saharan Africa. Nat Med. 2021;27(3):447–53.
Ataguba JE. COVID-19 pandemic, a war to be won: understanding its economic implications for Africa. Appl Health Econ Health Policy. 2020;18(3):325–8.
Bonnet F, Vanek J, Chen M. Women and men in the informal economy—a statistical brief. Manchester: WIEGO; 2019.
United Nations Development Programme. Informality and social protection in African countries: a forward-looking assessment of contributory schemes | UNDP in Africa. UNDP Africa. [Cited 2021 July 23]. Available from https://www.africa.undp.org/content/rba/en/home/library/reports/informality-and-social-protection-in-african-countries--a-forwar.html.
Hajj Hussein I, Chams N, Chams S, El Sayegh S, Badran R, Raad M, et al. Vaccines through centuries: major cornerstones of global health. Front Public Health. 2015 [Cited 2021 July 13];3. Available from https://www.frontiersin.org/articles/10.3389/fpubh.2015.00269/full.
Fisher KA, Bloomstone SJ, Walder J, Crawford S, Fouayzi H, Mazor KM. Attitudes toward a potential SARS-CoV-2 vaccine: a survey of U.S. adults. Ann Intern Med. 2020;173(12):964–73.
Gerussi V, Peghin M, Palese A, Bressan V, Visintini E, Bontempo G, et al. Vaccine hesitancy among italian patients recovered from COVID-19 infection towards influenza and Sars-Cov-2 vaccination. Vaccines. 2021;9(2):172.
Paul E, Steptoe A, Fancourt D. Attitudes towards vaccines and intention to vaccinate against COVID-19: implications for public health communications. Lancet Reg Health Eur. 2021 Feb 1 [Cited 2021 July 23];1. Available from https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(20)30012-0/abstract.
World Health Organization. Ten health issues WHO will tackle this year. 2019 [Cited 2021 July 13]. Available from https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019.
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73.
Veritas Health Innovation. Covidence systematic review software. Melbourne; [Cited 2021 July 23]. Available from https://www.covidence.org/.
Anjorin AA, Odetokun IA, Abioye AI, Elnadi H, Umoren MV, Damaris BF, et al. Will Africans take COVID-19 vaccination? PLoS ONE. 2021;16(12):e0260575.
Davis TP, Yimam AK, Kalam MA, Tolossa AD, Kanwagi R, Bauler S, et al. Behavioural determinants of COVID-19-vaccine acceptance in rural areas of six lower- and middle-income countries. Vaccines. 2022;10(2):214.
Kanyanda S, Markhof Y, Wollburg P, Zezza A. Acceptance of COVID-19 vaccines in sub-Saharan Africa: evidence from six national phone surveys. BMJ Open. 2021;11(12):e055159.
Chukwuocha UM, Emerole CO, Iwuoha GN, Dozie UW, Njoku PU, Akanazu CO, et al. Stakeholders’ hopes and concerns about the COVID-19 vaccines in Southeastern Nigeria: a qualitative study. BMC Public Health. 2022;22(1):330.
Chinawa AT, Chinawa JM, Ossai EN, Obinna N, Onukwuli V, Aronu AE, et al. Maternal level of awareness and predictors of willingness to vaccinate children against COVID 19; A multi-center study. Hum Vaccines Immunother. 2021;17(11):3982–8.
Asmare G, Abebe K, Atnafu N, Asnake G, Yeshambel A, Alem E, et al. Behavioral intention and its predictors toward COVID-19 vaccination among people most at risk of exposure in Ethiopia: applying the theory of planned behavior model. Hum Vaccines Immunother. 2021;17(12):4838–45.
Ayele AD, Ayenew NT, Tenaw LA, Kassa BG, Yehuala ED, Aychew EW, et al. Acceptance of COVID-19 vaccine and associated factors among health professionals working in Hospitals of South Gondar Zone, Northwest Ethiopia. Hum Vaccines Immunother. 2021;17(12):4925–33.
Gbeasor-Komlanvi FA, Afanvi KA, Konu YR, Agbobli Y, Sadio AJ, Tchankoni MK, et al. Prevalence and factors associated with COVID-19 vaccine hesitancy in health professionals in Togo, 2021. Public Health Pract Oxf Engl. 2021;2:100220.
Kassaw C, Shumye S. Trust about corona vaccine among health professionals working at Dilla University referral hospital, 2021. Vaccine X. 2021;9:100120.
McAbee L, Tapera O, Kanyangarara M. Factors associated with COVID-19 vaccine intentions in Eastern Zimbabwe: a cross-sectional study. Vaccines. 2021;9(10):1109.
Nzaji MK, Ngombe L, Mwamba GN, Banza Ndala DB, Mbidi Miema J, Luhata Lungoyo C, et al. Acceptability of vaccination against COVID-19 among healthcare workers in the Democratic Republic of the Congo. Pragmatic Obs Res. 2020;11:103–9.
Sahile AT, Mulugeta B, Hadush S, Fikre EM. COVID-19 vaccine acceptance and its predictors among college students in Addis Ababa, Ethiopia, 2021: a cross-sectional survey. Patient Prefer Adher. 2022;16:255–63.
Tlale LB, Gabaitiri L, Totolo LK, Smith G, Puswane-Katse O, Ramonna E, et al. Acceptance rate and risk perception towards the COVID-19 vaccine in Botswana. PLoS ONE. 2022;17(2):e0263375.
Abebe H, Shitu S, Mose A. Understanding of COVID-19 vaccine knowledge, attitude, acceptance, and determinates of COVID-19 vaccine acceptance among adult population in Ethiopia. Infect Drug Resist. 2021;14:2015–25.
Adejumo OA, Ogundele OA, Madubuko CR, Oluwafemi RO, Okoye OC, Okonkwo KC, et al. Perceptions of the COVID-19 vaccine and willingness to receive vaccination among health workers in Nigeria. Osong Public Health Res Perspect. 2021;12(4):236–43.
Adeniyi OV, Stead D, Singata-Madliki M, Batting J, Wright M, Jelliman E, et al. Acceptance of COVID-19 vaccine among the healthcare workers in the Eastern Cape, South Africa: a cross sectional study. Vaccines. 2021;9(6):666.
Hailemariam S, Mekonnen B, Shifera N, Endalkachew B, Asnake M, Assefa A, et al. Predictors of pregnant women’s intention to vaccinate against coronavirus disease 2019: a facility-based cross-sectional study in southwest Ethiopia. SAGE Open Med. 2021;9:20503121211038456.
Handebo S, Wolde M, Shitu K, Kassie A. Determinant of intention to receive COVID-19 vaccine among school teachers in Gondar City, Northwest Ethiopia. PLoS ONE. 2021;16(6):e0253499.
Oyekale AS. Compliance indicators of COVID-19 prevention and vaccines hesitancy in Kenya: a random-effects endogenous probit model. Vaccines. 2021;9(11):1359.
Wiysonge CS, Ndwandwe D, Ryan J, Jaca A, Batouré O, Anya BPM, et al. Vaccine hesitancy in the era of COVID-19: could lessons from the past help in divining the future? Hum Vaccines Immunother. 2021;18:1–3.
Adebisi YA, Alaran AJ, Bolarinwa OA, Akande-Sholabi W, Lucero-Prisno DE. When it is available, will we take it? Social media users’ perception of hypothetical COVID-19 vaccine in Nigeria. Pan Afr Med J. 2021;38:230.
Agyekum MW, Afrifa-Anane GF, Kyei-Arthur F, Addo B. Acceptability of COVID-19 Vaccination among health care workers in Ghana. Adv Public Health. 2021;2021:e9998176.
Ahmed MAM, Colebunders R, Gele AA, Farah AA, Osman S, Guled IA, et al. COVID-19 vaccine acceptability and adherence to preventive measures in Somalia: results of an online survey. Vaccines. 2021;9(6):543.
Ditekemena JD, Nkamba DM, Mutwadi A, Mavoko HM, Siewe Fodjo JN, Luhata C, et al. COVID-19 vaccine acceptance in the Democratic Republic of Congo: a cross-sectional survey. Vaccines. 2021;9(2):153.
Dinga JN, Sinda LK, Titanji VPK. Assessment of vaccine hesitancy to a COVID-19 vaccine in Cameroonian adults and its global implication. Vaccines. 2021;9(2):175.
Bongomin F, Olum R, Andia-Biraro I, Nakwagala FN, Hassan KH, Nassozi DR, et al. COVID-19 vaccine acceptance among high-risk populations in Uganda. Ther Adv Infect Dis. 2021;8:20499361211024376.
Botwe BO, Antwi WK, Adusei JA, Mayeden RN, Akudjedu TN, Sule SD. COVID-19 vaccine hesitancy concerns: findings from a Ghana clinical radiography workforce survey. Radiogr Lond Engl 1995. 2022;28(2):537–44.
Carcelen AC, Prosperi C, Mutembo S, Chongwe G, Mwansa FD, Ndubani P, et al. COVID-19 vaccine hesitancy in Zambia: a glimpse at the possible challenges ahead for COVID-19 vaccination rollout in sub-Saharan Africa. Hum Vaccines Immunother. 2022;18(1):1–6.
Iliyasu Z, Garba MR, Gajida AU, Amole TG, Umar AA, Abdullahi HM, et al. “Why Should I Take the COVID-19 Vaccine after Recovering from the Disease?” A mixed-methods study of correlates of COVID-19 vaccine acceptability among health workers in Northern Nigeria. Pathog Glob Health. 2021;116:1–9.
Iliyasu Z, Umar AA, Abdullahi HM, Kwaku AA, Amole TG, Tsiga-Ahmed FI, et al. “They have produced a vaccine, but we doubt if COVID-19 exists”: correlates of COVID-19 vaccine acceptability among adults in Kano, Nigeria. Hum Vaccines Immunother. 2021;17(11):4057–64.
Khalis M, Boucham M, Luo A, Marfak A, Saad S, Mariama Aboubacar C, et al. COVID-19 vaccination acceptance among health science students in Morocco: a cross-sectional study. Vaccines. 2021;9(12):1451.
Mohammed R, Nguse TM, Habte BM, Fentie AM, Gebretekle GB. COVID-19 vaccine hesitancy among Ethiopian healthcare workers. PLoS ONE. 2021;16(12):e0261125.
Orangi S, Pinchoff J, Mwanga D, Abuya T, Hamaluba M, Warimwe G, et al. Assessing the level and determinants of COVID-19 vaccine confidence in Kenya. Vaccines. 2021;9(8):936.
Shiferie F, Sada O, Fenta T, Kaba M, Fentie AM. Exploring reasons for COVID-19 vaccine hesitancy among healthcare providers in Ethiopia. Pan Afr Med J. 2021;40:213.
Tibbels NJ, Dosso A, Fordham C, Benie W, Brou JA, Kamara D, et al. “On the last day of the last month, I will go”: a qualitative exploration of COVID-19 vaccine confidence among Ivoirian adults. Vaccine. 2022;40(13):2028–35.
Uzochukwu IC, Eleje GU, Nwankwo CH, Chukwuma GO, Uzuke CA, Uzochukwu CE, et al. COVID-19 vaccine hesitancy among staff and students in a Nigerian tertiary educational institution. Ther Adv Infect Dis. 2021;8:20499361211054924.
Yassin EOM, Faroug HAA, Ishaq ZBY, Mustafa MMA, Idris MMA, Widatallah SEK, et al. COVID-19 vaccination acceptance among healthcare staff in Sudan, 2021. J Immunol Res. 2022;2022:e3392667.
Zewude B, Zikarge T. Willingness to take COVID-19 vaccine among people most at risk of exposure in Southern Ethiopia. Pragmatic Obs Res. 2021;12:37–47.
Mustapha M, Lawal BK, Sha’aban A, Jatau AI, Wada AS, Bala AA, et al. Factors associated with acceptance of COVID-19 vaccine among University health sciences students in Northwest Nigeria. PLoS ONE. 2021;16(11):e0260672.
Corey L, Mascola JR, Fauci AS, Collins FS. A strategic approach to COVID-19 vaccine R&D. Science. 2020;368(6494):948–50.
Stojanovic J, Boucher VG, Gagne M, Gupta S, Joyal-Desmarais K, Paduano S, et al. Global trends and correlates of COVID-19 vaccination hesitancy: findings from the iCARE Study. Vaccines. 2021;9(6):661.
Lin HH, Ezzati M, Murray M. Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta-analysis. PLOS Med. 2007;4(1):e20.
Alqudeimat Y, Alenezi D, AlHajri B, Alfouzan H, Almokhaizeem Z, Altamimi S, et al. Acceptance of a COVID-19 vaccine and its related determinants among the general adult population in Kuwait. Med Princ Pract Int J Kuwait Univ Health Sci Cent. 2021;30(3):262–71.
Williams L, Gallant AJ, Rasmussen S, Brown Nicholls LA, Cogan N, Deakin K, et al. Towards intervention development to increase the uptake of COVID-19 vaccination among those at high risk: outlining evidence-based and theoretically informed future intervention content. Br J Health Psychol. 2020;25(4):1039–54.
Belsti Y, Gela YY, Akalu Y, Dagnew B, Getnet M, Seid MA, et al. Willingness of Ethiopian population to receive COVID-19 vaccine. J Multidiscip Healthc. 2021;14:1233–43.
Mose A, Haile K, Timerga A. COVID-19 vaccine hesitancy among medical and health science students attending Wolkite University in Ethiopia. PLoS ONE. 2022;17(1):e0263081.
Leask J, Kinnersley P, Jackson C, Cheater F, Bedford H, Rowles G. Communicating with parents about vaccination: a framework for health professionals. BMC Pediatr. 2012;12(1):154.
Kanyike AM, Olum R, Kajjimu J, Ojilong D, Akech GM, Nassozi DR, et al. Acceptance of the coronavirus disease-2019 vaccine among medical students in Uganda. Trop Med Health. 2021;49(1):37.
Aurilio MT, Mennini FS, Gazzillo S, Massini L, Bolcato M, Feola A, et al. Intention to be vaccinated for COVID-19 among Italian Nurses during the pandemic. Vaccines. 2021;9(5):500.
Baghdadi LR, Alghaihb SG, Abuhaimed AA, Alkelabi DM, Alqahtani RS. Healthcare workers’ perspectives on the upcoming COVID-19 vaccine in terms of their exposure to the influenza vaccine in Riyadh, Saudi Arabia: a cross-sectional study. Vaccines. 2021;9(5):465.
Detoc M, Bruel S, Frappe P, Tardy B, Botelho-Nevers E, Gagneux-Brunon A. Intention to participate in a COVID-19 vaccine clinical trial and to get vaccinated against COVID-19 in France during the pandemic. Vaccine. 2020;38(45):7002–6.
Wang J, Jing R, Lai X, Zhang H, Lyu Y, Knoll MD, et al. Acceptance of COVID-19 vaccination during the COVID-19 pandemic in China. Vaccines. 2020;8(3):E482.
Caserotti M, Girardi P, Rubaltelli E, Tasso A, Lotto L, Gavaruzzi T. Associations of COVID-19 risk perception with vaccine hesitancy over time for Italian residents. Soc Sci Med. 1982;2021(272):113688.
Ngoyi JM, Mbuyu LK, Kibwe DN, Kabamba LN, Umba EK, Tambwe PN, et al. Covid-19 vaccination acceptance among students of the Higher Institute of Medical Techniques of Lubumbashi, Democratic Republic of Congo. Revue de l’Infirmier Congolais. 2020;4(2):48–52.
Green MS, Abdullah R, Vered S, Nitzan D. A study of ethnic, gender and educational differences in attitudes toward COVID-19 vaccines in Israel—implications for vaccination implementation policies. Isr J Health Policy Res. 2021;10(1):26.
Faezi NA, Gholizadeh P, Sanogo M, Oumarou A, Mohamed MN, Cissoko Y, et al. Peoples’ attitude toward COVID-19 vaccine, acceptance, and social trust among African and Middle East countries. Health Promot Perspect. 2021;11(2):171–8.
Betsch C, Brewer NT, Brocard P, Davies P, Gaissmaier W, Haase N, et al. Opportunities and challenges of Web 2.0 for vaccination decisions. Vaccine. 2012;30(25):3727–33.
Cooper LZ, Larson HJ, Katz SL. Protecting public trust in immunization. Pediatrics. 2008;122(1):149–53.
Kata A. Anti-vaccine activists, Web 2.0, and the postmodern paradigm—an overview of tactics and tropes used online by the anti-vaccination movement. Vaccine. 2012;30(25):3778–89.
Oriji PC, Allagoa DO, Obagah L, Tekenah ESE, Ohaeri OS, Atemie G. Perception about COVID-19 vaccine among patients at the federal medical centre, Yenagoa, South-South Nigeria. Int J Res Med Sci. 2021 Apr 28 [cited 2021 July 1]; Available from https://www.scienceopen.com/document?vid=e3889043-fbda-4497-8644-9ebf0490e61b.
Bono SA, Faria de Moura Villela E, Siau CS, Chen WS, Pengpid S, Hasan MT, et al. Factors affecting COVID-19 vaccine acceptance: an international survey among low- and middle-income countries. Vaccines. 2021;9(5):515.
Ekwebene OC, Obidile VC, Azubuike PC, Nnamani CP, Dankano NE, Egbuniwe MC. COVID-19 vaccine knowledge and acceptability among healthcare providers in Nigeria. Int J Trop Dis Health. 2021;8:51–60.
Mohamud AI, Mohamed S, Jimale K. Assessments of a COVID-19 vaccine acceptance rate in population of Benadir region, Somalia. IOSR J Dent Med Sci. 2021;20:1–04.
Dror AA, Eisenbach N, Taiber S, Morozov NG, Mizrachi M, Zigron A, et al. Vaccine hesitancy: the next challenge in the fight against COVID-19. Eur J Epidemiol. 2020;35(8):775–9.
Acheampong T, Akorsikumah EA, Osae-Kwapong J, Khalid M, Appiah A, Amuasi JH. Examining vaccine hesitancy in Sub-Saharan Africa: a survey of the knowledge and attitudes among adults to receive COVID-19 vaccines in Ghana. Vaccines. 2021;9(8):814.
Adane M, Ademas A, Kloos H. Knowledge, attitudes, and perceptions of COVID-19 vaccine and refusal to receive COVID-19 vaccine among healthcare workers in northeastern Ethiopia. BMC Public Health. 2022;22(1):128.
Addo PC, Kulbo NB, Sagoe KA, Ohemeng AA, Amuzu E. Guarding against COVID-19 vaccine hesitance in Ghana: analytic view of personal health engagement and vaccine related attitude. Hum Vaccines Immunother. 2021;17(12):5063–8.
Adedeji-Adenola H, Olugbake OA, Adeosun SA. Factors influencing COVID-19 vaccine uptake among adults in Nigeria. PLoS ONE. 2022;17(2):e0264371.
Admasu FT. Knowledge and proportion of COVID-19 vaccination and associated factors among cancer patients attending public hospitals of Addis Ababa, Ethiopia, 2021: a multicenter study. Infect Drug Resist. 2021;14:4865–76.
Aemro A, Amare NS, Shetie B, Chekol B, Wassie M. Determinants of COVID-19 vaccine hesitancy among health care workers in Amhara region referral hospitals, Northwest Ethiopia: a cross-sectional study. Epidemiol Infect. 2021;149:e225.
Alle YF, Oumer KE. Attitude and associated factors of COVID-19 vaccine acceptance among health professionals in Debre Tabor Comprehensive Specialized Hospital, North Central Ethiopia; 2021: cross-sectional study. Virusdisease. 2021;32(2):272–8.
Amuzie CI, Odini F, Kalu KU, Izuka M, Nwamoh U, Emma-Ukaegbu U, et al. COVID-19 vaccine hesitancy among healthcare workers and its socio-demographic determinants in Abia State, Southeastern Nigeria: a cross-sectional study. Pan Afr Med J. 2021;40:10.
Angelo AT, Alemayehu DS, Dachew AM. Health care workers intention to accept COVID-19 vaccine and associated factors in southwestern Ethiopia, 2021. PLoS ONE. 2021;16(9):e0257109.
Berihun G, Walle Z, Berhanu L, Teshome D. Acceptance of COVID-19 vaccine and determinant factors among patients with chronic disease visiting Dessie Comprehensive Specialized Hospital, Northeastern Ethiopia. Patient Prefer Adher. 2021;15:1795–805.
Burger R, Köhler T, Golos AM, Buttenheim AM, English R, Tameris M, et al. Longitudinal changes in COVID-19 vaccination intent among South African adults: evidence from the NIDS-CRAM panel survey, February to May 2021. BMC Public Health. 2022;22(1):422.
Carpio CE, Sarasty O, Hudson D, Macharia A, Shibia M. The demand for a COVID-19 vaccine in Kenya. Hum Vaccines Immunother. 2021;17(10):3463–71.
Dubik SD. Understanding the facilitators and barriers to COVID-19 vaccine uptake among teachers in the Sagnarigu Municipality of Northern Ghana: a cross-sectional study. Risk Manag Healthc Policy. 2022;15:311–22.
Dula J, Mulhanga A, Nhanombe A, Cumbi L, Júnior A, Gwatsvaira J, et al. COVID-19 vaccine acceptability and its determinants in Mozambique: an online survey. Vaccines. 2021;9(8):828.
Eze UA, Ndoh KI, Ibisola BA, Onwuliri CD, Osiyemi A, Ude N, et al. Determinants for acceptance of COVID-19 vaccine in Nigeria. Cureus. 2021;13(11):e19801.
Josiah BO, Kantaris M. Perception of Covid-19 and acceptance of vaccination in Delta State Nigeria. Niger Health J. 2021;21(2):60–86.
Kassa Mekonnen C, Gizaw Demissie N, Wako Beko Z, Mulu Ferede Y, Kindie AH. Intent to get vaccinated against COVID-19 pandemic and its associated factors among adults with a chronic medical condition. Int J Afr Nurs Sci. 2022;16:100401.
Katoto PDMC, Parker S, Coulson N, Pillay N, Cooper S, Jaca A, et al. Predictors of COVID-19 vaccine hesitancy in South African Local Communities: the VaxScenes Study. Vaccines. 2022;10(3):353.
Kollamparambil U, Oyenubi A, Nwosu C. COVID19 vaccine intentions in South Africa: health communication strategy to address vaccine hesitancy. BMC Public Health. 2021;21(1):2113.
Lamptey E, Serwaa D, Appiah AB. A nationwide survey of the potential acceptance and determinants of COVID-19 vaccines in Ghana. Clin Exp Vaccine Res. 2021;10(2):183–90.
Mesele M. COVID-19 vaccination acceptance and its associated factors in Sodo Town, Wolaita Zone, Southern Ethiopia: cross-sectional study. Infect Drug Resist. 2021;14:2361–7.
Mose A, Yeshaneh A. COVID-19 vaccine acceptance and its associated factors among pregnant women attending Antenatal Care Clinic in Southwest Ethiopia: institutional-based cross-sectional study. Int J Gen Med. 2021;14:2385–95.
Oyekale AS. Willingness to take COVID-19 vaccines in Ethiopia: an instrumental variable probit approach. Int J Environ Res Public Health. 2021;18(17):8892.
Reuben RC, Danladi MMA, Saleh DA, Ejembi PE. Knowledge, attitudes and practices towards COVID-19: an epidemiological survey in North-Central Nigeria. J Community Health. 2020;46:1–14.
Seboka BT, Yehualashet DE, Belay MM, Kabthymer RH, Ali H, Hailegebreal S, et al. Factors influencing COVID-19 vaccination demand and intent in resource-limited settings: based on health belief model. Risk Manag Healthc Policy. 2021;14:2743–56.
Shitu K, Wolde M, Handebo S, Kassie A. Acceptance and willingness to pay for COVID-19 vaccine among school teachers in Gondar City, Northwest Ethiopia. Trop Med Health. 2021;49(1):63.
Taye BT, Amogne FK, Demisse TL, Zerihun MS, Kitaw TM, Tiguh AE, et al. Coronavirus disease 2019 vaccine acceptance and perceived barriers among university students in northeast Ethiopia: a cross-sectional study. Clin Epidemiol Glob Health. 2021;12:100848.
Taye EB, Taye ZW, Muche HA, Tsega NT, Haile TT, Tiguh AE. COVID-19 vaccine acceptance and associated factors among women attending antenatal and postnatal cares in Central Gondar Zone public hospitals, Northwest Ethiopia. Clin Epidemiol Glob Health. 2022;14:100993.
Twum KK, Ofori D, Agyapong GKQ, Yalley AA. Intention to vaccinate against COVID-19: a social marketing perspective using the theory of planned behaviour and health belief model. J Soc Mark. 2021;11(4):549–74.
Yeboah P, Daliri DB, Abdin AY, Appiah-Brempong E, Pitsch W, Panyin AB, et al. Knowledge into the practice against COVID-19: a cross-sectional study from Ghana. Int J Environ Res Public Health. 2021;18(24):12902.
The authors would like to acknowledge the authors of all the included studies in this review as well as all researchers working in this important area of research.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethics approval and consent to participate
Consent for publication
All authors consented to have the paper published.
The authors declare there are no competing interests.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Ackah, B.B.B., Woo, M., Stallwood, L. et al. COVID-19 vaccine hesitancy in Africa: a scoping review. glob health res policy 7, 21 (2022). https://doi.org/10.1186/s41256-022-00255-1
- Scoping review