Policy Research Working Paper 10275

# **Abstract**

COVID-19 vaccination rates in Sub-Saharan Africa lag behind other world regions, with just over 20 percent of the population in Sub-Saharan Africa fully vaccinated. To reach widespread coverage, high willingness to get vaccinated for COVID-19 among the population is considered an important prerequisite. Drawing on two years of panel survey data, this paper studies the dynamics of vaccine acceptance, its correlates, and reasons for hesitancy over time. The data come from multiple rounds of national High-Frequency Phone Surveys in five countries in East and West Africa (Burkina Faso, Ethiopia, Malawi, Nigeria, and Uganda), covering the period between 2020 and 2022. The surveys are cross-country comparable and draw their samples from nationally representative sampling frames. The paper finds that COVID-19 vaccine acceptance has been high throughout the study period (68 to 98 percent). However, acceptance levels were lower in 2022 than in 2020 in three countries (Burkina Faso, Malawi, and Nigeria) and higher in one country (Uganda). Moreover, individuals are observed to change their stated vaccine attitudes between survey rounds, to a limited extent in some countries (Ethiopia) and more frequently in others (Burkina Faso, Malawi, Nigeria, and Uganda). Vaccine hesitancy is higher in richer households and among those residing in urban areas, women, and the better educated. Conversely, hesitancy is lower in larger households and among heads of the household. The main reasons for hesitancy are concerns about side effects of the vaccine, its safety and efficacy, as well as assessments of COVID-19 risk, although these reasons fluctuate over time. The findings suggest that vaccine hesitancy is not the primary obstacle to reaching greater vaccine coverage in Sub-Saharan Africa. Instead, low coverage rates may be related to access and delivery barriers as well as supply shortages. Nevertheless, vaccine attitudes appear malleable so that continued efforts are needed to retain high levels of vaccine acceptance.

This paper is a product of the Development Data Group, Development Economics. It is part of a larger effort by the World Bank to provide open access to its research and make a contribution to development policy discussions around the world. Policy Research Working Papers are also posted on the Web at http://www.worldbank.org/prwp. The authors may be contacted at pwollburg@worldbank.org.

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