Perceptions and predictors of COVID-19 vaccine hesitancy among healthcare providers across five countries in sub-Saharan Africa.

The African continent has some of the world's lowest COVID-19 vaccination rates. While the limited availability of vaccines is a contributing factor, COVID-19 vaccine hesitancy among healthcare providers (HCP) is another factor that could adversely affect efforts to control infections on the continent. We sought to understand the extent of COVID-19 vaccine hesitancy among HCP, and its contributing factors in Africa. We evaluated COVID-19 vaccine hesitancy among 1,499 HCP enrolled in a cross-sectional study conducted as a telephone survey in Burkina Faso, Ethiopia, Nigeria, Tanzania, and Ghana between July to December of 2021. We defined COVID-19 vaccine hesitancy among HCP as self-reported responses of definitely not, maybe, unsure, or undecided on whether to get the COVID-19 vaccine, compared to definitely getting the vaccine. We used log-binomial or modified Poisson regression models to evaluate factors influencing vaccine hesitancy among HCP. Approximately 65.6% of the HCP interviewed were nurses and the mean age (±SD) of participants was 35.8 (±9.7) years. At least 67% of the HCP reported being vaccinated. COVID-19 vaccine hesitancy affected 45.7% of the HCP in Burkina Faso, 25.7% in Tanzania, 9.8% in Ethiopia, 9% in Ghana and 8.1% in Nigeria. Among unvaccinated HCP reasons for low vaccine uptake included concern about vaccine effectiveness, side effects, and fear of receiving experimental and unsafe vaccines. HCP reporting that COVID-19 vaccines are very effective (RR: 0.21, 95% CI: 0.08, 0.55), and older HCP (45 or older vs.20-29 years, RR: 0.65, 95% CI: 0.44, 0.95) were less likely to be vaccine-hesitant. Nurses were more likely to be vaccine-hesitant (RR 1.38, 95% CI: 1.01, 1.89) than doctors. Information asymmetry among HCP, beliefs about vaccine effectiveness, and the endorsement of vaccines by public health institutions may be important. Efforts to address hesitancy should consider information and knowledge gaps among different cadres of HCP alongside efforts to increase vaccine supply.