Originally published on the Washington Post Monkey Cage blog, where our biweekly Afrobarometer Friday series explores Africans’ views on democracy, governance, quality of life, and other critical topics.
While Africa has trailed other continents in obtaining vaccines against covid-19, rollouts are picking up speed. Shipments are helping launch vaccinations in a growing number of countries, including Ghana, Kenya, Côte d’Ivoire, Nigeria, South Africa, Angola and Zimbabwe.
Even if Africa has so far been spared the massive covid-19 death tolls experienced in some other regions, health officials say vaccinations are urgent to protect Africans — and by extension the rest of the world — from the health and economic ravages of the coronavirus, including surges in new, faster-spreading variants.
But urgent action by African governments may run into a problem of trust. Afrobarometer surveys in five West African countries between October 2020 and January 2021 show that only a minority of citizens want to be vaccinated, and that most don’t trust their government to make sure the vaccines are safe. In some countries, most people prefer to rely on prayer.
Where there’s little trust in vaccines — and the government
Benin, Liberia, Niger, Senegal and Togo have all recorded thousands of covid-19 cases, with death counts ranging from 81 in Benin to 925 in Senegal, and have undergone painful restrictions on economic activities and schools. As of Thursday, all except Niger had reported receiving vaccines through the COVAX initiative.
But skepticism about covid-19 vaccines runs high among citizens in these countries (see Figure 1). On average, only three in 10 citizens (31 percent) say they trust their government “somewhat” or “a lot” to ensure that any vaccine is safe. Mistrust is particularly high in Senegal (83 percent) and Liberia (78 percent), but it’s the majority view in the other three countries as well.
Why does this matter? Simply put, people are less likely to comply with public health messages if they don’t trust the messenger. During Ebola outbreaks in West Africa and the Democratic Republic of Congo, for example, preventive behaviors, including acceptance of Ebola vaccines, were less common among people who mistrusted the government.
In Afrobarometer’s surveys, 60 percent of respondents say they are unlikely to try to get vaccinated against COVID-19 even when a vaccine that the government says is safe becomes available. Resistance (44 percent who say “very unlikely”) is considerably stronger than hesitancy (16 percent who say “somewhat unlikely”).
Vaccine hesitancy/resistance is highest in Senegal (79 percent) and Liberia (66 percent) — the two countries with the least faith in the government’s ability to ensure that vaccines are safe. In Benin and Togo, about half the population (51 percent each) is at least “somewhat likely” to try to get vaccinated — still well below the 60 percent that the Africa Centres for Disease Control and Prevention says is needed to create community immunity.
Figure 1: Don’t trust government, unlikely to get covid-19 vaccine | 5 West African countries | 2020/2021
Respondents were asked:
How much do you trust the government to ensure that any vaccine for covid-19 that is developed or offered citizens is safe before it is used in this country? (percent who say “not at all” or “just a little”)
If a vaccine for covid-19 becomes available and the government says it is safe, how likely are you to try to get vaccinated? (percent who say “not very likely” or “not at all likely”)
Looking at individuals rather than countries, the link between trust in the government’s ability to ensure vaccine safety and willingness to be vaccinated becomes even clearer (see Figure 2). In every surveyed country, people who trust the government “a lot” are about five to 10 times as likely to say they will probably get vaccinated as those who don’t trust the government “at all.” On average, the gap in willingness to get vaccinated is an astounding 71 percentage points.
Figure 2: Likelihood of getting vaccinated, by level of trust in government to ensure vaccine safety | 5 West African countries | 2020/2021
The figure shows the percentage of respondents who say they are “somewhat likely” or “very likely” to try to get vaccinated against covid-19, disaggregated by how much they trust their government to ensure that the vaccine is safe.
Poor and urban communities show greater vaccine reluctance
The differences by demographics, though far smaller than by trust levels, could be useful for targeting vaccine information. While men and women differ little in their likelihood of wanting to get the covid-19 vaccine, hesitancy/resistance is higher among poorer communities. On average across these five countries, a gap of 6 percentage points separates the poorest group (62 percent unlikely) from those who are economically best off (56 percent). In Liberia, the gap is 15 points.
Liberia is the only surveyed country where more educated people are significantly more likely to want the vaccine. In fact, Benin and especially Niger show the opposite pattern, perhaps reflecting the fact that trust in the government’s ability to ensure vaccine safety declines as education level rises.
A similar dynamic may help explain why vaccine hesitancy/resistance is higher (by 13-15 percentage points) in urban than in rural areas in Benin, Togo, and Niger — the three countries where trust in the government is significantly lower in the cities.
The reluctance to be vaccinated against covid-19 shows different age-cohort patterns by country, decreasing with age in Senegal, Niger and Benin but increasing with age in Liberia and Togo.
Will prayer be more effective than the vaccine?
In three of these West African countries, people are far more likely to believe in prayer than in vaccines as effective protection against the coronavirus. This view is nearly universal in Niger (89 percent) and Liberia (86 percent), and very strong in Senegal (71 percent), as shown in Figure 3.
In Togo and Benin, the two countries with the lowest levels of vaccine hesitancy/resistance, four in 10 citizens consider prayer more effective than vaccines.
Figure 3: Prayer vs. vaccine: Which is more effective against covid-19? | 5 West African countries | 2020/2021
Respondents were asked: Do you think that prayer is more effective or less effective than a vaccine would be in preventing covid-19 infection?
How serious is covid-19?
Looking ahead, only a small minority (20 percent) of citizens in these five countries think that covid-19 will be a “somewhat serious” or “very serious” problem for their country over the next six months. Concern is highest in Senegal (40 percent), where people are most doubtful of the government’s ability to ensure a safe vaccine and least likely to want to get vaccinated.
But our analyses show no clear relationship between the expectation that the pandemic will be severe and a willingness to be vaccinated.
Instead, trust in the government’s ability to guarantee a safe vaccine appears to be a decisive factor. In line with the perceived protective power of prayer, Afrobarometer surveys in more than 30 countries have shown that the most trusted public figures are religious leaders. African governments and others focused on promoting vaccination might find powerful allies in religious leaders for whom prayer and vaccines aren’t an either-or choice.
Aminatou Seydou is a senior majoring in international relations and comparative cultures and politics at James Madison College, Michigan State University.
Find her on Twitter @AminatouSeydou.