Study finds COVID-19 vaccine acceptance is higher in low- and middle-income countries than in richer countries

Study examines vaccine acceptance and hesitancy in 10 low- and middle-income countries in Asia, Africa, and South America. 

New research published in Nature Medicine reveals willingness to get a COVID-19 vaccine was considerably higher in developing countries (80% of respondents) than in the United States (65%) and Russia (30%). 

The study provides one of the first insights into vaccine acceptance and hesitancy in a broad selection of low- and-middle income countries (LMIC), covering over 20,000 survey respondents and bringing together researchers from over 30 institutions including the International Growth Centre (IGC), Innovations for Poverty Action (IPA), WZB Berlin Social Science Center, the Yale Institute for Global Health, the Yale Research Initiative on Innovation and Scale (Y-RISE), and HSE University (Moscow, Russia). 

Personal protection against COVID-19 was the main reason given for vaccine acceptance among LMIC respondents (91%), and concern about side effects (44%) was the most common reason for vaccine hesitancy. Health workers are considered the most trusted sources of information about COVID-19 vaccines. 

The study comes at a critical juncture when vaccine shipments are still slow to arrive to the majority of the world’s population, and COVID-19 cases are surging in many parts of Africa, Asia, and Latin America. The findings suggest that prioritising vaccine distribution to low and middle income countries should yield high returns in expanding global immunisation coverage. 

“As COVID-19 vaccine supplies trickle into developing countries, the next few months will be key for governments and international organisations to focus on designing and implementing effective vaccine uptake programmes,” said Niccoló Meriggi, Country Economist for IGC Sierra Leone and study co-author. “Governments can use this evidence to develop communications campaigns and systems to ensure that those who intend to get a vaccine actually follow through.”

The researchers, who conducted the surveys between June 2020 and January 2021, point out that vaccine acceptance may vary with time and the information that people have available to them. While the evidence on the safety and efficacy of available COVID-19 vaccines has become more clear in the last six months, severe, but rare, side effects may have undermined public confidence. 

Saad Omer, Director of the Yale Institute of Global Health and study co-author, said: “What we’ve seen in Europe, the US, and other countries suggests that vaccine hesitancy can complicate policy decisions, thereby hindering rapid and widespread vaccine uptake. Governments in developing countries can start engaging trusted people like health workers now to deliver vaccine messaging about side effects that is accurate, balanced, and easily available to the public.” 

“Across countries, we observe that acceptance of COVID-19 vaccines is generally somewhat lower than for other vaccines, perhaps because of their novelty. However, the consistently pro-vaccine attitudes we see in low and middle income countries give us reason to be optimistic about uptake,” said Alexandra Scacco, Senior Research Fellow at the WZB and study co-author. “We hope that evidence from our study can help inform strategies to expand global COVID-19 vaccination.”

A policy brief with recommendations based on this study is available here.

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Funding for this study was provided by: Beyond Conflict, Bill and Melinda Gates Foundation, Columbia University, Givewell.org, Ghent University, HSE University Basic Research Program, International Growth Centre, Jameel Poverty Action Lab Crime and Violence Initiative, London School of Economics and Political Science, Mulago Foundation, NOVAFRICA at the Nova School of Business and Economics, NYU Abu Dhabi, Energy for Economic Growth (EEG) led by Oxford Policy Management, funded by UK Aid, Social Science Research Council, Trinity College Dublin COVID-19 Response Funding, FCDO, UKRI GCRF/Newton Fund, United Nations Office for Project Services, Weiss Family Fund, WZB Berlin Social Science Center, Yale Institute for Global Health, Yale Macmillan Center, and anonymous donors to IPA and Y-RISE. 

Researchers on this study represent the following institutions: WZB Berlin Social Science Center, Innovations for Poverty Action (IPA), International Growth Centre (IGC), Wageningen University & Research, International Center for the Study of Institutions and Development (HSE University, Moscow, Russia), Yale Institute for Global Health, Nova School of Business and Economics, Lahore University of Management Sciences, The Institute for Fiscal Studies, University of St. Andrews & The Institute for Fiscal Studies, Stockholm School of Economics and Misum, Economics Department of Ghent University, Institute of Development and Economic Alternatives, Trinity College Dublin, Cornell University, University of Illinois Chicago, NYU Abu Dhabi, Yale Research Initiative on Innovation and Scale (Y-RISE), Princeton University, Institute for International Economic Studies (IIES) at Stockholm University, Tufts University, Kellogg School of Management at Northwestern University, London School of Economics and Political Science, Columbia University, Yale University, Centre for Economic Research in Pakistan (CERP), Institute of Development and Economic Alternatives (IDEAS) – Pakistan, University of Michigan, Busara Center for Behavioral Economics (Nigeria and Kenya), Centre for the Study of Labour and Mobility (CESLAM) – Nepal, and Morsel Research & Development (India). 

Contact information:

Emilie Yam, Head of Communications, IGC
Email: e.yam@lse.ac.uk Phone: +44 (0)7804 906 778