With the prolongation of the COVID-19 pandemic, the importance of vaccination cannot be understated28,29. In order to increase vaccination rates in any country, it is important to first analyze the vaccination hesitancy rates and identify factors that propagate rejection of the vaccine. A proper understanding of this helps tailor appropriate strategies to avert the budding rate of vaccine hesitancy.
This study examined COVID-19 vaccine acceptance among African countries. We found that approximately 7 out of 10 (71%) Africans wanted to be vaccinated. This is relatively less than around 80% that observed in an American populati on according to a 2021 randomized controlled trial , conducted in the United States30. Another article published in December 2020 however stated that vaccine acceptance rate in the US was as low as 56.9%.31 The difference between the two studies seems to have been caused by the faction of participants who were unsure rather than hesitant to receive the vaccine. The observed lower rates of vaccine hesitancy in Africa have been attributed to a lack of knowledge on vaccine efficacy, socio-cultural and historical aspects4.
We also found that vaccine acceptability was also influenced by several other factors. First, depending on the study period, it was possible to see a trend of decreasing vaccine acceptance over time, from 81% in the second half of 2020 to 67% in the first half of 2021. This is the same trend seen in a meta-analysis of 28 representative samples from 13 countries (UK, North America, France, Australia, China, Denmark, Germany, Italy, Ireland, Netherlands, Poland and Portugal) on COVID-19 vaccine hesitation32. This phenomenon is also seen in vaccines other than the coronavirus vaccine. In 2009, a study of the H1N1 influenza vaccine in France also showed a sharp increase in negative attitudes toward the vaccine over time33. This can be explained by decrease in people's fear of disease with increasing information on the new disease, and more information on side effects of vaccines.
Second, the vaccine acceptance rate in rural areas was 72%, lower than in urban areas (82%). This is in contrast to a study conducted in the United States in 2021, which found that rural people (16.3%) were less likely to reject COVID-19 vaccines as compared to urban people (19.7%)34. The difference between the two studies may be that there are people who are torn between either accepting or rejecting vaccination. Alternatively, as shown in a study conducted in the United States, people living in rural areas may be less likely to participate in health promoting behaviors35, so they may not be interested in the vaccine per se. This may be the reason of low rates for acceptance.
Third, the vaccine acceptance rate in Northern African countries was 52%, relatively lower than in Western African countries (60%), Southern African and Eastern African countries (72%). These findings could be influenced by the number of studies conducted in each of the regions with a possibility of regional underreporting of vaccine hesitancy. Hence, a need for more research on vaccine hesitancy especially in Northern African countries are warranted. We also found differences in vaccine acceptance rate and some socio-demographic characteristics. Older age, male, wealth, health-related workers, and chronic medical conditions were mainly identified as factors contributing to a receptive attitude toward vaccination. Interestingly, low educational attainment was identified as a factor related with hesitancy to receive the vaccine. Among these factors, the low acceptance rate of women's vaccines tended to be consistent with previous studies36–38. Overall, it is thought that people who are interested in health activities and those who will suffer great damage from COVID-19 are favorable to vaccination, and those who are worried about vaccines tend to refuse vaccination.
Advantages and singularities of this study
There are several articles on vaccine acceptance rates in developed countries such as European countries and USA. However, studies in African countries are lacking. As the COVID-19 situation is prolonged, vaccinations in developing countries such as African nations are considered important. This study is meaningful in that it is a meta-analysis of studies conducted in African countries.
To our knowledge, this study is the first attempt to meta-analyze recent vaccine rejection related studies conducted in African countries and to demonstrate trends and associated factors. Therefore, this meta-analysis will provide a more systematic understanding of vaccine acceptance rate, rejection factors, and the appropriate strategy in African countries.
This study was also the first to investigate how much the previously investigated vaccine acceptance rate is related to the actual vaccination rate. It has the advantage of being able to see how much the surveyed vaccine acceptance rate is related to the actual vaccination rate.
Opinions on the results and hypotheses of other studies
Several studies have reported that age, gender, and residential area are related to the vaccine rejection rate32,39. Also, as a result of meta-analysis, sex and residential area were related. Urban areas had higher vaccine acceptance rates than rural areas, and male-dominated areas had higher vaccine acceptance rates than female-dominated areas. In addition, as a result of analysis according to the study period, it was found that the vaccine acceptance rate decreased over time. This can also be considered to be an advantage of the meta-analysis because it is a factor that cannot be known by individual surveys.
Many studies have ended in analyzing the acceptance rate of vaccines, but as a result of our comparison with the actual vaccination rate, there was no significant correlation. It seems that the actual vaccination rate tends to be determined by other external factors rather than one's own opinion on vaccines in the past.
The limitations of research
There are some limitations to this study. First, the included studies have generally mentioned vaccine acceptance rates, but there have been some discrepancies in defining vaccine acceptance rates. Each study showed various expressions such as vaccine acceptance rate, vaccine rejection rate, vaccine hesitancy and vaccine willingness rate.
Second, the heterogeneity between results was significant, and careful interpretation is required depending on different environments. This heterogeneity may be due to differences between study designs, cultural differences, vaccination local policies, or studies of other unidentified variables. In addition, there is a possibility that there will be a double aggregated case among the included studies.