The prevalence of COVID-19 vaccine hesitancy among the sub-Saharan adolescent population

By Tarun Sai LomteReviewed by Danielle Ellis, B.Sc.Oct 12 2022

In a recent study published in PLOS Global Public Health, researchers examined the prevalence of coronavirus disease 2019 (COVID-19) vaccine hesitancy in the sub-Saharan adolescent population.

Background

COVID-19 morbidity and mortality have been lower in adolescents than in adults. Still, infected adolescents can spread severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to others and may present with severe symptoms. Therefore, the vaccination of adolescents is necessary to limit SARS-CoV-2 transmission and COVID-19 morbidity/mortality. Adolescents (10 – 19 years) constitute 23% of the population of sub-Saharan Africa.

SARS-CoV-2 vaccines are effective and safe; nonetheless, studies from high-income countries report on the growing hesitancy among adolescents to vaccinate. A United States (US) study found that only 52% of the non-vaccinated adolescent population would probably or definitely be vaccinated. Vaccine hesitancy remains a critical challenge to global efforts to control the pandemic.

About the study

In the present study, researchers surveyed the prevalence of vaccine hesitancy among adolescents from five countries in sub-Saharan Africa. Computer-assisted telephonic interviews were conducted using a novel mobile platform. In a previous survey round, one urban and a rural area from Burkina Faso, Ethiopia, and Nigeria were included. In the current survey round, two rural areas from Tanzania and Ghana and one urban area from Tanzania were included.

Households were selected from sampling frames of national surveys or existing health and demographic surveillance systems. Approximately 300 families with adolescents were selected for the interview. The survey was conducted from July to December 2021. Participants from the first round of the survey (July – December 2020) were re-contacted for participation.

The survey comprised questions on willingness to vaccinate, awareness, perceptions, knowledge of vaccines, trusted information sources and expectations on COVID-19 vaccine programs, and potential determinants of vaccine hesitancy. The study outcome was vaccine hesitancy, a response of “definitely unwilling to accept the vaccine” and “maybe unsure or undecided to vaccinate.”

Potential determinants were age, country, sex, rural residence, perceived safety and effectiveness of vaccines, the impact of the pandemic on daily activities, psychological distress levels, and perceived risk of SARS-CoV-2 exposure, among others. Prevalence ratios (PRs) were computed using log-binomial models. In unadjusted models, crude associations were estimated between vaccine hesitancy and potential determinants. Adjusted PRs controlling for age, country, sex, and rural residence, were computed.

Findings

The research team interviewed 2,662 adolescents; sex distribution was balanced across all areas except for Ethiopian regions. More than 80% of adolescents heard about SARS-CoV-2 vaccines. Kersa, a rural area in Ethiopia, had the highest proportion of adolescents (86%) who would have accepted vaccines if available.

In contrast, a rural area in Tanzania, Dodoma, had the highest proportion of adolescents (79%) unwilling to be vaccinated. Dodoma also had the least proportion of participants (12%) willing to vaccinate. Similarly, Kersa had the lowest proportion of adolescents (10%) who would not have accepted vaccines. Nouna, the rural area of Burkina Faso, had the highest proportion of individuals (17%) undecided or unsure of vaccination.

Overall, there were 88% vaccine hesitant adolescents in Dodoma, 76% in Dar es Salaam (Tanzania urban), 65% in Lagos (Nigeria urban), 48% in Kintampo (Ghana rural), 37% in Addis Ababa (Ethiopia urban), 32% in Ouagadougou (Burkina Faso urban), and 14% in Kersa. Low necessity and concerns about the safety and efficacy of vaccines were reasons cited for vaccine hesitancy.

Around 27% of adolescents believed there were no side effects of COVID-19 vaccines, and 46% could not identify any possible side effects. Overall, 30% of participants were more willing to vaccinate had the vaccine been developed/tested in Africa; 36% of participants were willing to accept vaccines developed in the US, 22% for Chinese vaccines, 11% for Indian vaccines, 15% for European vaccines, and 14% for Russian vaccines.

Television, newspaper, or radio were the most highly trusted information sources (85%), followed by medical professionals (83%) and government communications (73%). Overall, 41% of participants did not know when the vaccine would be available. Male adolescents had an 8% lower prevalence of vaccine hesitancy than females. There was a similar prevalence of vaccine hesitancy among adolescents in Ethiopia and Burkina Faso.

Conclusions

In summary, the study found a high prevalence of vaccine hesitancy across nine areas in Sub-Saharan Africa, particularly in Tanzania. Female sex and perceived lack of vaccine safety and efficacy were individual factors that increased vaccine hesitancy. COVID-19 vaccination programs must address the concerns of adolescents to minimize hesitancy and improve coverage.