A study in Human Vaccines and Immunotherapies in June 2023 found that confidence in vaccines declined across much of sub-Saharan Africa during the pandemic. The authors conducted a study across data from 16 national surveys including more than 17,000 people in 8 countries. The researchers acknowledge that “globally, few countries have managed to avoid losses in uptake rates of routine childhood immunisation”. This has been emphasised in the recent UNICEF ‘State of the World’s Children’ report. However, this trend has “particularly affected” low- and middle-income countries. Identifying a gap in the global understanding of vaccine confidence in sub-Saharan Africa, the authors aim to examine attitudes to routine immunisation during the COVID-19 pandemic.  

Waning confidence and COVID-19’s consequences 

As we know from the UNICEF report, the world is currently “not meeting” the goal of vaccinating every child. The study recognises that lowered rates of routine immunisation during the pandemic have been caused by a range of contributory factors, such as supply chain disruptions, reallocation of limited resources, and travel restrictions.  

Another key element in uptake of vaccinations is the attitude of decision makers towards vaccines and the systems and people behind their delivery. Although the study focuses specifically on perceptions towards vaccines, the authors acknowledge that the role played by confidence in systems and people is also significant. In this study, the idea of vaccine confidence relates to three elements of vaccines: their importance, their safety, and their effectiveness.  

The study 

The study spans 8 countries in Africa: Democratic Republic of the Congo (DRC), Ivory Coast, Kenya, Nigeria, Senegal, South Africa, and Uganda. The surveys were conducted between October and December 2020 and again between January and March 2022. To read the specific methods used by the researchers, click here to access the study.  

To identify shifts in the public perception of vaccines respondents were asked to engage with several general statements such as “vaccines are important for children” or “vaccines are safe”. Although many people expressed positive views of COVID-19 vaccines and other vaccines, the findings reveal “perceptions toward the importance of vaccines for children falling across all eight countries studied”. Notable falls in confidence were observed in DRC and Nigeria, with specific regard to vaccine safety and effectiveness.  

The study in context 

Consistent with the existing literature, the study identifies the largest falls in vaccine confidence in South Africa within “predominantly rural providences”. By contrast, the “reverse seems to be true in Senegal”, where the results indicate that “vaccine refusal is higher in large cities”. However, only two sub-national regions were considered, which means a better-informed conclusion cannot be drawn.  

A review in Science reflects that the reason for varying trends across the countries studied is “not clear”. However, Dr Alex de Figueirido of the London School of Hygiene and Tropical Medicine suggests that the overall trends fit other survey patterns. Furthermore, the research “allows identification of specific regions that may be facing confidence concerns”.  

A worrying decline 

The authors state that their results paint a “worrying picture of declining vaccine confidence trends across many sub-national regions in sub-Saharan Africa”. Although there are national estimates and models of local vaccination rates across Africa, there is “limited evidence of routinely collected vaccine confidence data”.  

“As there is precedent for vaccine confidence losses in one vaccine to trigger confidence losses in others, the losses in confidence in COVID-19 vaccines found in this study may be a cause for concern with respect to childhood immunisations.” 

Do you think this is a useful contribution to the landscape of understanding vaccine attitudes? Was your country involved in the survey? How do you respond to these results?  

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