and opportunities to reach out to those who are hesitant. As such, our data can inform strategies that national vaccination campaigns may pursue to turn vaccines into vaccinations in Africa.

# **Limitations**

While our data stands out in its informational richness, national scope, and robust survey methodology, it is still subject to the challenges and limitations of (phone) survey data collection on vaccination. These include sample selection at the household level due to under-coverage, non-response, and attrition, as well as within the household arising from the purposive selection of respondents.<sup>19,20</sup> The implications of these issues for findings on vaccine hesitancy should be the subject of future research as should be the reliability of survey data on vaccination in the context of COVID-19.<sup>29–31</sup> Survey data, regardless of mode, necessarily relies on respondent self-reporting which is susceptible to respondents’ incentives, misreporting, and misperceptions.

# **Main findings and policy recommendations**

We find that in our study countries a majority remains willing to get vaccinated but that hesitancy among those unvaccinated is a non-negligible issue. As vaccine coverage in much of SSA is still below 20 percent, vaccination campaigns should focus first on getting those who are willing but yet unvaccinated to take up the vaccine. The main barriers keeping this group away from the vaccination sites are country-specific but commonly relate to the ease with which vaccines can be accessed within communities. Therefore, it is indispensable that vaccination sites become more widespread at the local level.<sup>28</sup> Furthermore, a continuation of communication campaigns about the ongoing risk of COVID-19 and safety of vaccines will be pivotal: We find that the protection vaccines afford to one’s own health is the main reason why people take up the vaccine and that hesitancy mostly relates to concerns about the vaccine’s side effects.<sup>24</sup> As this was already the main concern among the hesitant in 2020<sup>14–16</sup> , national vaccination campaigns should double-down on their efforts to assure the population of the safety of COVID-19 vaccines.

Concerning the means through which the population acquires information on COVID-19 vaccination, we find radio broadcasting to have widespread reach. Radio broadcasts are therefore a promising avenue through which mass communication campaigns could reach their target population. Our results also suggest that medical professionals have good rapport with both the willing and hesitant. Vaccination campaigns could employ endorsements by this group in order to sway the opinions of the hesitant.

Lastly, we find that the social context informs vaccine attitudes, as perceptions about the general acceptance of COVID-19 and within-household power dynamics matter. Changing public perceptions about the true support for vaccines in the country and creating a positive social norm around vaccination could be effective measures. Those already vaccinated could be mobilized as ambassadors that can promote vaccine demand at the community level. Furthermore, convincing key members of the household, mostly the household head, of the need for vaccination may positively affect the take-up of vaccines by the remaining household members. These findings are in line with recent experimental evidence from Zambia.<sup>24</sup>

# **Concluding remarks**

With COVID-19 vaccines becoming more widely available but a large majority of African countries far off the WHO’s target to fully vaccinate 70 percent of the population by June 2022, now is the time to push for 11