In Africa, doubts about vaccines grew during pandemic, survey finds | Science

Public confidence in vaccines has declined across sub-Saharan Africa since the COVID-19 pandemic, new research shows.

A survey of 17,000 people in eight African nations found that the share of respondents agreeing with the statement that “vaccines are important for children” dropped by up to 20 percentage points from 2020 to 2022. The survey also revealed growing doubts about the safety and effectiveness of COVID-19 vaccines and other immunizations in some nations and subnational regions.

The trends represent “an early warning signal” for efforts to widely vaccinate children and adults, says Charles Shey Wiysonge, who leads a vaccination program at the World Health Organization’s (WHO’s) Regional Office for Africa. But the data could also help health officials identify specific regions where they will need to undertake focused efforts to restore trust in vaccines, he and other specialists say.

To detect shifts in public perceptions of vaccines, an international research team surveyed people in the eight nations—the Democratic Republic of the Congo (DRC), Ivory Coast, Kenya, Niger, Nigeria, Senegal, South Africa, and Uganda—in late 2020 and again in early 2022. Respondents were asked whether they agreed or disagreed with a number of general statements about vaccines, including “vaccines are important for children,” “vaccines are important for all ages,” and “vaccines are safe.” The survey also probed perceptions of COVID-19 vaccines.

Overall, a majority of respondents expressed positive views of COVID-19 vaccines and vaccines generally.

In all eight nations, however, respondents expressed growing doubts about childhood vaccination, the researchers reported on 9 June in Human Vaccines & Immunotherapeutics. The biggest change was seen in the DRC, with a 20-percentage-point drop—from 83% to 63%—in the share of respondents who agreed that vaccines are important for children. Smaller declines were seen in Uganda (14 percentage points, to roughly 70% agreement) and Nigeria (10.5-percentage-point drop, to roughly 80% agreement).

Agreement with the statement “vaccines are important for all ages” dropped in Ivory Coast, Kenya, Nigeria, South Africa, and Uganda. And confidence in vaccine safety declined in Nigeria and the DRC, whereas it improved in Ivory Coast, Kenya, and Senegal.

In seven nations, the share of people agreeing that COVID-19 vaccines were “important” declined; the exception was Ivory Coast.

It’s not clear why trends varied from nation to nation, the researchers say. But the overall trends are similar to those seen in other national and international surveys on vaccine confidence, says Alex de Figueirido, an author of the study and statistician at the London School of Hygiene & Tropical Medicine.

The new data, however, provide a more fine-grained look at how perceptions shifted in 17 specific subnational regions, he notes. They show, for example, that confidence in vaccines can be lower in rural areas than in cities. Such information “allows identification of specific regions that may be facing confidence concerns, which policymakers … can address,” he says.

The survey results arrive as WHO and other international organizations are reporting a worrying dip in the uptake of routine childhood immunizations. Six million fewer children in Africa received routine shots for diseases including tetanus, polio, diphtheria, and measles over the past 2 years, threatening to reverse decades of progress against preventable diseases. Supply chain problems, travel limitations, and other disruptions caused by the COVID-19 pandemic have likely contributed to the decline, officials say. But the new study suggests “reduced confidence in vaccines brought about by the pandemic may be another significant factor,” says Sara Cooper, a public health specialist at the South African Medical Research Council. And Wiysonge worries that “declines of confidence in COVID-19 vaccines may spill over to confidence in childhood vaccination.”

It’s not clear, however, whether people who express hesitancy about vaccines ultimately reject all immunizations. “Some people who are vaccine-hesitant may accept all vaccines or some vaccines,” Cooper says. Understanding the factors that influence that choice, she adds, “is essential and urgent if we hope to increase vaccination uptake and prevent further outbreaks of vaccine-preventable diseases.”

Public confidence in vaccines has declined across sub-Saharan Africa since the COVID-19 pandemic, new research shows.

A survey of 17,000 people in eight African nations found that the share of respondents agreeing with the statement that “vaccines are important for children” dropped by up to 20 percentage points from 2020 to 2022. The survey also revealed growing doubts about the safety and effectiveness of COVID-19 vaccines and other immunizations in some nations and subnational regions.

The trends represent “an early warning signal” for efforts to widely vaccinate children and adults, says Charles Shey Wiysonge, who leads a vaccination program at the World Health Organization’s (WHO’s) Regional Office for Africa. But the data could also help health officials identify specific regions where they will need to undertake focused efforts to restore trust in vaccines, he and other specialists say.

To detect shifts in public perceptions of vaccines, an international research team surveyed people in the eight nations—the Democratic Republic of the Congo (DRC), Ivory Coast, Kenya, Niger, Nigeria, Senegal, South Africa, and Uganda—in late 2020 and again in early 2022. Respondents were asked whether they agreed or disagreed with a number of general statements about vaccines, including “vaccines are important for children,” “vaccines are important for all ages,” and “vaccines are safe.” The survey also probed perceptions of COVID-19 vaccines.

Overall, a majority of respondents expressed positive views of COVID-19 vaccines and vaccines generally.

In all eight nations, however, respondents expressed growing doubts about childhood vaccination, the researchers reported on 9 June in Human Vaccines & Immunotherapeutics. The biggest change was seen in the DRC, with a 20-percentage-point drop—from 83% to 63%—in the share of respondents who agreed that vaccines are important for children. Smaller declines were seen in Uganda (14 percentage points, to roughly 70% agreement) and Nigeria (10.5-percentage-point drop, to roughly 80% agreement).

Agreement with the statement “vaccines are important for all ages” dropped in Ivory Coast, Kenya, Nigeria, South Africa, and Uganda. And confidence in vaccine safety declined in Nigeria and the DRC, whereas it improved in Ivory Coast, Kenya, and Senegal.

In seven nations, the share of people agreeing that COVID-19 vaccines were “important” declined; the exception was Ivory Coast.

It’s not clear why trends varied from nation to nation, the researchers say. But the overall trends are similar to those seen in other national and international surveys on vaccine confidence, says Alex de Figueirido, an author of the study and statistician at the London School of Hygiene & Tropical Medicine.

The new data, however, provide a more fine-grained look at how perceptions shifted in 17 specific subnational regions, he notes. They show, for example, that confidence in vaccines can be lower in rural areas than in cities. Such information “allows identification of specific regions that may be facing confidence concerns, which policymakers … can address,” he says.

The survey results arrive as WHO and other international organizations are reporting a worrying dip in the uptake of routine childhood immunizations. Six million fewer children in Africa received routine shots for diseases including tetanus, polio, diphtheria, and measles over the past 2 years, threatening to reverse decades of progress against preventable diseases. Supply chain problems, travel limitations, and other disruptions caused by the COVID-19 pandemic have likely contributed to the decline, officials say. But the new study suggests “reduced confidence in vaccines brought about by the pandemic may be another significant factor,” says Sara Cooper, a public health specialist at the South African Medical Research Council. And Wiysonge worries that “declines of confidence in COVID-19 vaccines may spill over to confidence in childhood vaccination.”

It’s not clear, however, whether people who express hesitancy about vaccines ultimately reject all immunizations. “Some people who are vaccine-hesitant may accept all vaccines or some vaccines,” Cooper says. Understanding the factors that influence that choice, she adds, “is essential and urgent if we hope to increase vaccination uptake and prevent further outbreaks of vaccine-preventable diseases.”