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As COVID-19 vaccines have become more widely available in Sub-Saharan Africa, vaccination campaigns in the region have struggled to pick up pace and trail the rest of the world. This paper presents new evidence on vaccine hesitancy, uptake, last-mile delivery barriers, and potential strategies to reach those who remain unvaccinated. The data come from high-frequency phone surveys in five countries in East and West Africa (Burkina Faso, Kenya, Malawi, Nigeria, and Tanzania). The surveys were conducted by countries' national statistical agencies, have national scope, are cross-country comparable, and draw their samples from nationally representative sampling frames. The findings show that across the study countries, a majority is willing to get vaccinated. Still, vaccine hesitancy is non-negligible among those pending vaccination. Concerns about side effects of the vaccine are the primary reason for hesitancy. At the same time, many who are willing to get vaccinated are deterred by a lack of easy access to vaccines at the local level. Radio broadcasts have widespread reach and medical professionals have good rapport among the unvaccinated population. Furthermore, social ties and perceptions as well as intrahousehold power relations matter for vaccine take-up. Based on the findings, the paper elaborates policy options to boost vaccination campaigns in Sub-Saharan Africa.

Vaccine hesitancy.

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The information set from which individuals make their decision on vaccination includes signals from trusted agents, such as governments, community leaders, and the media. By implementing restrictions, or by relaxing them, governments can provide a signal about the underlying risk of the pandemic and indirectly affect vaccination take-up. Rather than focusing on measures specifically designed to increase vaccine acceptance, this paper studies how governments' nonpharmaceutical policy responses to the pandemic can modify the degree of preventive health behavior, including vaccination. To do so, the paper uses repeated waves of a global survey on COVID-19 beliefs, behaviors, and norms covering 67 countries from August 2020 to February 2021. Controlling for the usual determinants, the analysis explores how individuals' willingness to get vaccinated is affected by changes in government restriction measures (as measured by the Oxford Stringency Index). This relationship is mediated by individual characteristics, social norms (social pressure to conform with what most people do), and trust in government institutions. The results point to a complex picture as the implementation of restrictions is associated with increased acceptance in some contexts and decreased acceptance in others. The stringency of government restrictions has significant positive correlations with vaccine acceptance in contexts of weak social norms of vaccine acceptance and lower trust in government. In countries or communities where social norms are tighter and trust in government health authorities is high, vaccine acceptance is high but less sensitive to changes in policies. These results suggest that the indirect effect of government policy stringency is stronger among individuals who report lower trust and weaker social norms of vaccine acceptance.

Vaccine hesitancy.

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Communication in public health --- Medicine in mass media. --- Vaccine hesitancy --- Vaccine hesitancy.

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Dans une forme d’éthique réflexive et collective, les auteurs se sont attachés à dresser un panorama des problèmes qui ont trait à la vaccination, mis en exergue dans le contexte de la pandémie due au coronavirus.A partir du constat des hésitations, des défiances et des résistances face à la vaccination, alors que subsistent les incertitudes sur l’avenir, les auteurs proposent des cadrages interprétatifs et interrogent particulièrement l’opposition individualisme vs solidarité. Ils abordent les questions d’éthique essentielles qui se posent à l’échelle collective : y a-t-il une façon de bien informer et communiquer sur les vaccins ? Quelle stratégie vaccinale est-elle juste et efficace ? Quelles conséquences ont eu les mesures de lutte contre le virus sur les enfants et les adolescents ? En termes d’obligation vaccinale, est-ce que la fin justifie les moyens ? Les libertés individuelles peuvent-elles être écartées au profit du bien collectif ? Quels sont les enjeux de justice internationale et globale en matière de distribution des doses de vaccin dans le monde.

Medical ethics. --- Medical policy. --- Vaccination --- Vaccine hesitancy. --- COVID-19 Pandemic, 2020 --- -Moral and ethical aspects.

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COVID-19 (Disease) --- Vaccine hesitancy --- COVID-19 (Disease) --- Vaccination --- Prevention. --- United States.