We must increase people’s access to and willingness to take COVID-19 vaccines


Recent research published by the journal Nature shows that people in low- and middle-income countries (LMICs) are more willing to take COVID-19 vaccines than their counterparts in high-income countries.

The researchers analysed 15 COVID-19 vaccine acceptance surveys involving 44,260 respondents across 13 countries – Burkina Faso, Colombia, India, Mozambique, Nepal, Nigeria, Pakistan, Rwanda, Sierra Leone, Uganda, Russia, and the United States.

The willingness to take COVID-19 vaccines was highest in LMICs, with an average of 80.3% (Nepal was highest scoring above 90%). Concern about side effects is the most frequently expressed reason for reluctance in getting vaccinated among LMICs. Across the board, respondents identify health workers as the most trustworthy sources to help them make decisions to take COVID-19 vaccines.

There are important lessons in the result of this research to enable increased uptake of COVID-19 vaccines globally.

Although there is high willingness to take vaccines in LMICs, the current global vaccine inequity prevents this from being fully realised. The people most willing to get the vaccine cannot access it.

Despite this, global leaders continue to advocate for vaccines to LMICs. For instance, former British Prime Minister, Gordon Brown warned that more than 100 million COVID-19 vaccine doses are due to expire and be “thrown away” unless global leaders urgently share surplus supplies with the world’s poorest countries. To put this in perspective, only 51 million Africans out of 1.4 billion people on the continent have been fully vaccinated. Also Strive Masiyiwa, African Union special envoy, has made it clear that Africa is not waiting for crumbs from the table of high-income countries. “We are not asking for donations; you can donate if you so wish but our basis is not a donation. We want to buy vaccines.”, he said.

National vaccination agencies in LMICs must move away from waiting for people to come to health facilities to be vaccinated. For example, people are willing to take vaccines in Africa, but many of them also do not have the luxury to take time off earning a living and go to health facilities. This is because economies of African countries are mainly informal – people go out to trade to earn. According to the United Nations Economic Commission for Africa, the informal sector remains the major source of employment across Africa (70% of employment in Sub-Saharan Africa). It is unrealistic to expect a market woman to leave her wares and go in search of COVID-19 vaccination sites. More so, the social service sector is poorly developed on the continent and the poor are unlikely to be compensated for their time by their governments. Therefore, vaccines must be taken to people in places where they live and work. In Nigeria’s southeast state of Enugu, the government has opened vaccination centers at markets, malls and other public spaces to make it easy for people to be vaccinated. In Johannesburg, South Africa, an open-air parking garage has been turned into a vaccination site. Further, it is time to replicate the house-to-house strategy used in polio eradication. There is no time to be complacent. The people are willing to be vaccinated. Let’s get vaccines to them.

Respondents in the research identified health workers as trustworthy guides to help them make decisions to take COVID-19 vaccines. Indeed, health workers are revered and respected. They are viewed as being knowledgeable about health issues and particularly COVID-19 vaccination. They are better equipped to discuss possible side effects of COVID-19 vaccines, their implications and what to do when someone vaccinated develops side effects. They could be utilised to share messaging through platforms like radio, tv, churches, mosques, and community townhall meetings.

The research showed that most respondents were concerned about side effects of COVID-19 vaccines as a reason for delay in being vaccinated. Health workers can counter this by being abreast of the latest evidence-based information. Coincidentally, the UK  ZOE Covid Symptom Study app identified “pain at the injection site” as the commonest side effects following COVID-19 vaccination. The ZOE study researchers looked at self-reported symptoms in 627,383 people using their app in the eight days after being vaccinated. Health workers equipped with information from the ZOE study can allay concerns about side effects. When people know that the most common side effect is simply pain at the site of injection, they are more likely to accept being vaccinated. Health workers must also show empathy in countering COVID-19-related misinformation and disinformation, especially in the context of high willingness to be vaccinated.

To be sure, vaccine hesitancy due to other reasons plagues LMICs as well. Therefore, governments, civil society organizations, community-based organizations must continue to engage with the public to improve knowledge that leads to behavior change.

Without a doubt, people in the global south are more willing to take COVID-19 vaccines. It is imperative to remove barriers to actualise this willingness. It is an equitable thing to do to end this pandemic.


About the author: Ifeanyi M. Nsofor, is a public health physician, a graduate of the Liverpool School of Tropical Medicine and the CEO of EpiAFRIC. He is a Senior New Voices Fellow at the Aspen Institute, Senior Atlantic Fellow for Health Equity at the George Washington University and an Innovation Fellow at PandemicTech. You can follow Nsofor on Twitter @ekemma

Competing Interests: None

Handling Editor: Neha Faruqui

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