Article Text

Original research
Acceptance of COVID-19 vaccines in sub-Saharan Africa: evidence from six national phone surveys
  1. Shelton Kanyanda,
  2. Yannick Markhof,
  3. Philip Wollburg,
  4. Alberto Zezza
  1. Development Data Group, World Bank Group, Washington, DC, USA
  1. Correspondence to Dr Alberto Zezza; azezza{at}


Objectives To estimate the willingness to accept a COVID-19 vaccine in six sub-Saharan African countries and identify differences in acceptance across countries and population groups.

Design Cross-country comparable, descriptive study based on a longitudinal survey.

Setting Six national surveys from countries representing 38% of the sub-Saharan African population (Burkina Faso, Ethiopia, Malawi, Mali, Nigeria and Uganda).

Participants Respondents of national high-frequency phone surveys, aged 15 years and older, drawn from a nationally representative sample of households.

Main outcome measures Willingness to get vaccinated against COVID-19 if an approved vaccine is provided now and for free, disaggregated by demographic attributes and socioeconomic factors obtained from national household surveys. Correlates of and reasons for vaccine hesitancy.

Results Acceptance rates in the six sub-Saharan African countries studied are generally high, with at least four in five people willing to be vaccinated in all but one country. Vaccine acceptance ranges from nearly universal in Ethiopia (97.9%, 95% CI 97.2% to 98.6%) to below what would likely be required for herd immunity in Mali (64.5%, 95% CI 61.3% to 67.8%). We find little evidence for systematic differences in vaccine hesitancy by sex or age but some clusters of hesitancy in urban areas, among the better educated, and in richer households. Safety concerns about the vaccine in general and its side effects specifically emerge as the primary reservations toward a COVID-19 vaccine across countries.

Conclusions Our findings suggest that inadequate demand is unlikely to represent the key bottleneck to reaching high COVID-19 vaccine coverage in sub-Saharan Africa. To turn intent into effective demand, targeted information, sensitisation and engagement campaigns bolstering confidence in the safety of approved vaccines and reducing concerns about side effects will be crucial to safeguard the swift progression of vaccine rollout in one of the world’s poorest regions.

  • COVID-19
  • public health
  • health policy

Data availability statement

Data are available in a public, open access repository. The data and country-specific questionnaires are available from the World Bank’s Microdata Library, High Frequency Phone Survey Catalog ( as well as Living Standards Measurement Study catalog (

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

Data are available in a public, open access repository. The data and country-specific questionnaires are available from the World Bank’s Microdata Library, High Frequency Phone Survey Catalog ( as well as Living Standards Measurement Study catalog (

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  • Contributors All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors were responsible for its conception and design. YM, PW and SK were responsible for the preparation and analysis of the data and all authors contributed to their interpretation. YM and PW drafted the manuscript, and AZ made critical revision of the manuscript for important intellectual content. SK and AZ conceptualised an early version. AZ is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting criteria have been omitted.

  • Funding Funding for the analysis comes from the World Bank Multi-Donor Trust Fund for Integrated Household and Agricultural Surveys in Low and Middle-Income Countries (TF072496).

  • Disclaimer The funders had no role in study design, data collection, analysis, interpretation of the data, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.