Shifts in COVID-19 vaccine acceptance rates among African countries: A systematic review and meta-analysis

Objective: The few existing country-specific studies on vaccine hesitancy in Africa are limited by their focus on specific population groups such as health care workers or medical students. Thus, we aimed to provide a comparative systematic review and meta-analysis of COVID-19 vaccine acceptance rates in African countries and their predictors. Methods: Fifteen studies on COVID-19 vaccine acceptance rates in African countries were reviewed in the PubMed/MEDLINE, Embase, and Google Scholar. Meta-analysis investigated the summary effect and inter-study heterogeneity of vaccine acceptance rates and influential factors. Results: Overall, the COVID-19 vaccine acceptance rate was 71.0% (95% CI 64.0 to 77.0). However, as time passed, the vaccine acceptance rate showed a decrease (second half of 2020: 81%, first half of 2021: 67%). Also, the vaccine acceptance rates in urban areas were higher than in rural areas (urban: 82%, rural: 72%). When considering region, vaccine acceptance rates in Eastern and Southern African countries were higher than in Western and North African countries (East: 72%, South: 72%, West: 60%, and North: 52%). Finally, factors such as older age, male sex, and wealth were identified as factors associated with a more acceptive attitude toward vaccination. Conclusion: COVID-19 vaccine acceptance rates demonstrated shifts and was affected by several factors. The rates decreased over time, were lower in rural (vs. urban) settings, and were relatively low in Northern and West African countries (vs. Southern and East African countries). We also found differences in vaccine acceptance rates by some socio-demographic characteristics. Targeting these characteristics, devising strategies to improve vaccine uptake in Africa could help improve vaccination rates.