COVID-19 vaccine hesitancy and its determinants among sub-Saharan African adolescents

Dongqing Wang; Angela Chukwu; Mary Mwanyika-Sando; Sulemana Watara Abubakari; Nega Assefa; Isabel Madzorera; Elena C Hemler; Abbas Ismail; Bruno Lankoande; Frank Mapendo; Ourohiré Millogo; Firehiwot Workneh; Temesgen Azemraw; Lawrence Gyabaa Febir; Christabel James; Amani Tinkasimile; Kwaku Poku Asante; Till Baernighausen; Yemane Berhane; Japhet Killewo; Ayoade M J Oduola; Ali Sie; Emily R Smith; Abdramane Bassiahi Soura; Tajudeen Raji; Said Vuai; Wafaie W Fawzi

doi:10.1371/journal.pgph.0000611

COVID-19 vaccine hesitancy and its determinants among sub-Saharan African adolescents

PLOS Glob Public Health. 2022 Oct 5;2(10):e0000611. doi: 10.1371/journal.pgph.0000611. eCollection 2022.

Authors

Dongqing Wang¹, Angela Chukwu², Mary Mwanyika-Sando³, Sulemana Watara Abubakari⁴, Nega Assefa⁵, Isabel Madzorera⁶, Elena C Hemler⁶, Abbas Ismail⁷, Bruno Lankoande⁸, Frank Mapendo³, Ourohiré Millogo⁹, Firehiwot Workneh¹⁰, Temesgen Azemraw¹⁰, Lawrence Gyabaa Febir⁴, Christabel James¹¹, Amani Tinkasimile³, Kwaku Poku Asante⁴, Till Baernighausen^{6

12

13}, Yemane Berhane¹⁰, Japhet Killewo¹⁴, Ayoade M J Oduola¹¹, Ali Sie⁹, Emily R Smith^{15

16}, Abdramane Bassiahi Soura⁸, Tajudeen Raji¹⁷, Said Vuai⁷, Wafaie W Fawzi^{6

18

19}

Affiliations

¹ Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia, United States of America.
² Department of Statistics, University of Ibadan, Ibadan, Nigeria.
³ Africa Academy for Public Health, Dar es Salaam, Tanzania.
⁴ Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana.
⁵ College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
⁶ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.
⁷ College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania.
⁸ Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso.
⁹ Nouna Health Research Center, Nouna, Burkina Faso.
¹⁰ Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
¹¹ University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria.
¹² Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
¹³ Africa Health Research Institute, KwaZulu-Natal, South Africa.
¹⁴ Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
¹⁵ Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America.
¹⁶ Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America.
¹⁷ Division of Public Health Institutes and Research, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia.
¹⁸ Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.
¹⁹ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.

Abstract

COVID-19 vaccine hesitancy among adolescents poses a challenge to the global effort to control the pandemic. This multi-country survey aimed to assess the prevalence and determinants of COVID-19 vaccine hesitancy among adolescents in sub-Saharan Africa between July and December 2021. The survey was conducted using computer-assisted telephone interviewing among adolescents in five sub-Saharan African countries, Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. A rural area and an urban area were included in each country (except Ghana, which only had a rural area), with approximately 300 adolescents in each area and 2662 in total. Sociodemographic characteristics and perceptions and attitudes on COVID-19 vaccines were measured. Vaccine hesitancy was defined as definitely not getting vaccinated or being undecided on whether to get vaccinated if a COVID-19 vaccine were available. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations between potential determinants and COVID-19 vaccine hesitancy. The percentage of COVID-19 vaccine hesitancy was 14% in rural Kersa, 23% in rural Ibadan, 31% in rural Nouna, 32% in urban Ouagadougou, 37% in urban Addis Ababa, 48% in rural Kintampo, 65% in urban Lagos, 76% in urban Dar es Salaam, and 88% in rural Dodoma. Perceived low necessity, concerns about vaccine safety, and concerns about vaccine effectiveness were the leading reasons for hesitancy. Healthcare workers, parents or family members, and schoolteachers had the greatest impacts on vaccine willingness. Perceived lack of safety (aPR: 3.52; 95% CI: 3.00, 4.13) and lack of effectiveness (aPR: 3.46; 95% CI: 2.97, 4.03) were associated with greater vaccine hesitancy. The prevalence of COVID-19 vaccine hesitancy among adolescents is alarmingly high across the five sub-Saharan African countries, especially in Tanzania. COVID-19 vaccination campaigns among sub-Saharan African adolescents should address their concerns and misconceptions about vaccine safety and effectiveness.

Copyright: © 2022 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This work was supported by institutional support from Harvard T.H. Chan School of Public Health, Boston, MA (WWF), Harvard University Center for African Studies, Boston, MA (WWF), Heidelberg Institute of Global Health, Germany (TB), and the George Washington University Milken Institute School of Public Health, Washington, DC (ERS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.