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Coronavirus Disease 2019 (COVID-19) Pandemic across Africa: Current Status of Vaccinations and Implications for the Future

by 1,2, 3,4,5,*, 6,7, 8,9, 7, 10, 1,2, 11, 12, 13, 14, 15, 16, 8, 5,17,18, 19, 20, 21, 21, 22, 23,24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36,37, 36,38, 39, 40, 41, 42,43, 44, 45, 46, 5,47,48 and 5add Show full author list remove Hide full author list
Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos 100271, Nigeria
Department of Medicine, Lagos State University Teaching Hospital, Lagos 100271, Nigeria
Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 02084, South Africa
Department of Pharmacology and Therapeutics, Ekiti State University, Ado Ekiti 362103, Nigeria
Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti 360211, Nigeria
Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
Nigerian Center for Disease Control, Plot 801, Ebitu Ukiwe Street, Jabi, Abuja 900108, Nigeria
Department of Pharmacy, Lagos State University Teaching Hospital, Lagos 100271, Nigeria
Child, Youth and School Health Directorate, National Department of Health, Pretoria 0083, South Africa
Children’s Cancer Hospital, Egypt-57357 (CCHE-57357), Cairo 11441, Egypt
Biomedical Research Department, Armed Forces College of Medicine, Cairo 11774, Egypt
CIMAS, Cimas House, Borrowdale Office Park, Borrowdale Road, Harare P.O. Box 1243, Zimbabwe
Department of Medicine, University of Zimbabwe College of Health Sciences, Harare P.O. Box MP167, Zimbabwe
Department of Child Health and Paediatrics, Egerton University, Nakuru P.O.Box 536, Kenya
East Africa Centre for Vaccines and Immunization (ECAVI), Namela House, Naguru, Kampala P.O. Box 3040, Uganda
Department of Pharmacology & Therapeutics, Busitema University, Mbale P.O. Box 236, Uganda
Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania
Pharmacy Department, Formerly College of Medicine, Kamuzu University of Health Sciences (KUHeS), Blantyre P.O. Box 278, Malawi
Department of Global Health and Development (GHD), London School of Hygiene and Tropical Medicine (LSHTM), London WC1E 7TH, UK
National Medicines and Poisons Board, Federal Ministry of Health, Khartoum P.O. Box 303, Sudan
Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 51911, Saudi Arabia
Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum 11111, Sudan
Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 19676-00202, Kenya
Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 19676-00202, Kenya
Department of Pharmacy, Korle Bu Teaching Hospital, Accra P.O. Box 77, Ghana
Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Hohoe PMB 31, Ghana
Pharmacy Department, Ghana Police Hospital, Accra P.O. Box CT104, Ghana
Department of Management Science, University of Strathclyde, Glasgow G4 0QU, UK
Pharmacy Department, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H100, Eswatini
Faculty of Health Sciences, Department of Medical Laboratory Sciences, Eswatini Medical Christian University, Swazi Plaza P.O. Box A624, Mbabane H100, Eswatini
Department of Medical Laboratory Sciences, Faculty of Health Sciences, Eswatini Medical Christian University, Swazi Plaza P.O. Box A624, Mbabane H100, Eswatini
School of Pharmaceutical Sciences, College of Health Sciences, University of Kwazulu-natal (UKZN), Durban 4001, South Africa
Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda 5175, Cameroon
Faculty of Health and Medical Sciences, Adelaide University, Adelaide 5005, Australia
Department of Public Health, University of Bamenda, Bambili P.O. Box 39, Cameroon
Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone P.O. Box 70480, Botswana
Department of Medicine, Sir Ketumile Masire Teaching Hospital, Gaborone P.O. Box 70480, Botswana
Department of Pharmacy, University of Botswana, Gaborone P.O. Box 70480, Botswana
Health and Safety Department, Dubai Municipality, Dubai P.O. Box 67, United Arab Emirates
School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
Department of Community Health, Lagos University Teaching Hospital, Idi-Araba, Lagos PMB 21266, Nigeria
Medical Microbiology Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare P.O. Box MP167, Zimbabwe
School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston, MA 02115, USA
Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
Author to whom correspondence should be addressed.
Vaccines 2022, 10(9), 1553;
Received: 14 August 2022 / Revised: 6 September 2022 / Accepted: 10 September 2022 / Published: 17 September 2022
(This article belongs to the Section Vaccines and Public Health)


The introduction of effective vaccines in December 2020 marked a significant step forward in the global response to COVID-19. Given concerns with access, acceptability, and hesitancy across Africa, there is a need to describe the current status of vaccine uptake in the continent. An exploratory study was undertaken to investigate these aspects, current challenges, and lessons learnt across Africa to provide future direction. Senior personnel across 14 African countries completed a self-administered questionnaire, with a descriptive analysis of the data. Vaccine roll-out commenced in March 2021 in most countries. COVID-19 vaccination coverage varied from low in Cameroon and Tanzania and up to 39.85% full coverage in Botswana at the end of 2021; that is, all doses advocated by initial protocols versus the total population, with rates increasing to 58.4% in Botswana by the end of June 2022. The greatest increase in people being fully vaccinated was observed in Uganda (20.4% increase), Botswana (18.5% increase), and Zambia (17.9% increase). Most vaccines were obtained through WHO-COVAX agreements. Initially, vaccination was prioritised for healthcare workers (HCWs), the elderly, adults with co-morbidities, and other at-risk groups, with countries now commencing vaccination among children and administering booster doses. Challenges included irregular supply and considerable hesitancy arising from misinformation fuelled by social media activities. Overall, there was fair to reasonable access to vaccination across countries, enhanced by government initiatives. Vaccine hesitancy must be addressed with context-specific interventions, including proactive programmes among HCWs, medical journalists, and the public.

1. Introduction

In March 2020, SARS-CoV-2, the virus that caused the coronavirus disease of 2019 (COVID-19), was declared a pandemic by the World Health Organisation (WHO) [1], and by late June 2022, there were 540 million confirmed cases of COVID-19 globally, with over 6.3 million deaths recorded [2].
The focus among countries and continents, certainly initially, was the introduction of public health policies to try and slow down the spread of the virus, with its subsequent impact on morbidity and mortality, in the absence of proven treatments and vaccines to treat COVID-19 [3,4]. These policies included lockdown measures incorporating the closure of educational establishments and borders, promoting hand hygiene, social distancing and the wearing of personal protective equipment (PPE) as well as quarantining measures [5,6,7,8,9,10,11,12,13]. However, there was variable implementation and adherence to the recommended preventative measures across countries, which adversely affected the subsequent prevalence and mortality rates [14,15,16,17,18].
Several re-purposed medicines were proposed for the prevention and management of patients with COVID-19 in the absence of effective vaccines. These included hydroxychloroquine, lopinavir/ritonavir, ivermectin, remdesivir, and steroids [19,20,21,22,23,24], with their endorsement resulting in appreciably increased utilisation, especially hydroxychloroquine, fuelled by social media and other activities [16,20,25,26,27,28]. This surge was despite limited evidence regarding their effectiveness, apart from dexamethasone, initially and in subsequent studies, with their overuse increasing morbidity, mortality, and costs [16,26,29,30,31,32,33,34,35,36,37]. These concerns resulted in calls across countries to enhance the evidence base of treatments before they were routinely recommended, thereby minimising the potential for misinformation [28,38,39,40,41].
Alongside this, the unintended consequences of lockdown and social distancing measures, including limited access to healthcare services, were considerable, especially in low- and middle-income countries (LMICs), including African countries [13,42,43,44,45,46,47,48,49,50,51,52,53]. The unintended consequences also included increased morbidity and mortality from reduced routine vaccinations among children in Africa [54,55,56,57].
Consequently, there was an appreciable need for effective vaccines to limit the spread of the virus. Numerous published studies have demonstrated the effectiveness of COVID-19 vaccines in reducing the impact of COVID-19 across countries, including reducing mortality, especially for patients at risk of severe disease [58,59,60,61]. These effectiveness rates resulted in a generally high acceptance of COVID-19 vaccines when available across countries [62], with booster campaigns introduced to tackle new variants and the waning of vaccine effectiveness over time [60,63,64]. However, there have been concerns with the vaccines across countries increasing hesitancy [65].
High acceptance rates (up to 88.8% acceptance with a 95% effectiveness rate) for COVID-19 vaccines were seen in a study by Bono et al., (2021) involving LMICs, including five African countries [66], although they were lower (61%) in the pooled study of Norhayati et al., (2022) [67]. Kanyanda et al., (2021) also generally identified high acceptance rates for the vaccine across sub-Saharan Africa, although they were lower in Mali (64.5%) [68]. Norhayati et al., (2022) also showed an acceptance rate of only 53% among the 15 African countries in their systematic review [67]. However, high acceptance rates were seen among the public in Nigeria, ranging from 74.5% to 85.3% of those surveyed [69,70,71], although they were lower in the study by Tobin et al., (2021) at 50.2% [72]. The major reasons for the non-acceptance of COVID-19 vaccines in Nigeria included concerns with the robustness of the published clinical trials, including the length of the follow-up when first rolled-out and the age of the included patients in the trials [69,71].
However, as with the increasing administration of COVID-19 vaccines, concerns regarding some of the rare adverse effects of the vaccines have contributed to vaccine hesitancy [73,74,75,76,77], with vaccine hesitancy defined as ‘a delay in acceptance or refusal of vaccination, despite the availability of vaccination services’ [78,79]. These concerns have resulted in increased hesitancy towards the COVID-19 vaccines across countries, including African countries [65,80,81,82,83]. Across Africa, studies have documented that between 32–37% of adults would not accept the vaccine, with hesitancy rates influenced by age, education, source of information, income and/or employment status, and the potential for increased infection [84,85,86,87]. Variable acceptance rates were also seen among African countries in the study of Sallam et al., (2022) [80], with variable hesitancy between 21% to 84.6% of those surveyed also seen in Cameroon, Ghana, Kenya, South Africa, Zimbabwe, and Zambia [82,86,88,89,90,91,92]. Whilst there have been challenges with vaccine hesitancy in Zimbabwe when COVID-19 vaccines were first made available, this was reduced with national and local community engagement programmes [93].
In Tanzania, the Health Minister in early 2021 stated that the country would not partake in vaccination campaigns as they were not satisfied with the safety of the vaccines, relying on traditional and household herbs and medicines for prevention and treatment [94]. Whilst this situation changed later in the year, appreciable hesitancy remained [95]. Alongside this, there have also been concerns with hesitancy among healthcare workers (HCWs), including healthcare professionals (HCPs), and students across Africa [96,97,98].
COVID-19 vaccine hesitancy is a key issue to address, with vaccine hesitancy already in 2019 identified by the WHO as one of the top ten global threats to public health [99,100]. Overall, a considerable number of deaths could have been averted if target vaccination rates had been achieved, especially among low- and middle-income countries, including African countries [101]. As mentioned, key attributes among those hesitant to COVID-19 vaccines include age, level of education, income and/ or employment status, and locality [84,86,87,102,103,104,105]. Religious beliefs and political issues are also key areas influencing hesitancy across Africa [106]. Identifying key reasons regarding vaccine hesitancy is important among African countries given the documented effectiveness of the vaccines, their high rates of infectious diseases, as well as high rates of antimicrobial resistance (AMR) exacerbated by excessive use of antibiotics to treat patients with COVID-19 [93,107,108,109,110,111,112,113].
Identified concerns to address include confidence surrounding the vaccines, including their effectiveness and potential safety issues, as well as addressing complacency issues incorporating beliefs of a low risk of catching COVID-19 and a low disease severity if COVID-19 is caught [65,114,115,116,117,118]. Enhancing access (convenience) and instigating robust communication programmes adjusted to the socio-demographics of the target population (context) are also important to address misinformation and disinformation promulgated via social media [103,114,119,120]. Addressing COVID-19 vaccine hesitancy is also important for the acceptance of other vaccines, as well as helping to address high AMR rates across Africa [111,121,122].
Other important challenges affecting the availability and use of COVID-19 vaccines include the availability of supplies and trained HCWs, including HCPs, to administer the vaccines once available [123].
Consequently, there is a need to build on these studies. This includes documenting key issues regarding COVID-19 vaccines across Africa, including their acceptance and challenges. Subsequently, documenting key activities that can be undertaken by governments and HCPs to address hesitancy to improve future vaccination rates for this and future pandemics.

2. Materials and Methods

2.1. Study Design

A mixed methods approach was adopted. This is similar to other Pan-African projects undertaken by the co-authors to document and debate key issues surrounding both non-infectious diseases and infectious diseases, as well as general areas, to provide future guidance [10,15,26,124,125,126,127,128,129,130]. The first stage comprised a narrative review of the literature regarding the effectiveness and safety of current vaccines for COVID-19, along with acceptance rates and hesitancy across Africa and the reasons for this. As mentioned, hesitancy was defined as ‘a delay in acceptance or refusal of vaccination, despite the availability of vaccination services’ [78,79,131]. The principal objective was to derive key discussion points for the second stage of the research. This was not a systematic review since the principal aim of this paper was to document the current situation regarding the vaccines, including vaccine hesitancy and the challenges among sub-Saharan African countries to provide future direction. The literature review was largely based on the considerable knowledge of the senior-level co-authors. This included individual country studies documenting current vaccination and hesitancy rates known to the co-authors from each country, as well as Pan-African and Global studies discussing similar issues. We adopted this approach before when discussing key activities and their future implications across countries and continents including Africa, with the deliberations based on the considerable knowledge and experience of the senior-level co-authors [125,126,127,128,129,130,132,133].
The second part of the study comprised an explorative questionnaire survey among senior-level government, HCP, and academic personnel from a range of African countries. The countries were purposefully selected based on the availability and knowledge of the senior-level co-authors to address the key issues and objectives of the paper. An analytical framework approach was used alongside a pragmatic paradigm aimed at providing future guidance, including for future pandemics [134,135,136,137]. The participating countries (Table 1) provided a range of economic status (Gross Domestic Product (GDP)/capita) [138], population size [139], and geographies, as well as current infection and mortality rates [2], to meet study objectives. We are aware though that there can be concerns with reporting mortality rates, including definitions [140,141,142].

2.2. Questionnaire Design and Analysis

The key questions posed to participating countries following a narrative review of the literature included the following:
  • Did your country have a dedicated COVID-19 vaccine rollout programme? Was this in the public sector, private sector, or both, and were any specific age groups covered?
  • Which COVID-19 vaccines were made available and how were the costs covered for each (e.g., NGOs)?
  • What is the current coverage rate (different doses if known)?
  • What is being done to ensure access to COVID-19 vaccines, and how would you describe the acceptance (willingness) of the population to COVID-19 vaccinations?
  • What is the extent of any misinformation about the vaccine (if known), and how is misinformation being spread (e.g., social media)?
  • What are the challenges with COVID-19 vaccinations in addition to the above, and what are potential ways forward or measures being undertaken by national authorities and other key stakeholders to mitigate against these challenges?
Within each country, the co-authors collated the replies, which were subsequently reviewed and collated by the principal author (OO). The findings were then fed back to each country for clarification to enhance their accuracy. A common basis was used to compare vaccine findings across countries, building on country-specific information [143,144,145]. The final responses were subsequently analysed using thematic analysis techniques [10,146].
Common themes from the responses were identified and discussed with the co-authors to provide future guidance [10]. The findings were subsequently summarised into key themes and challenges faced by participating countries. Potential ways forward were broken down into the four Es where pertinent, namely ‘Education, Engineering, Economics and Enforcement’ [147,148], in order to consolidate approaches. We have used this methodology before when consolidating potential approaches and activities across disease areas to improve the use of medicine [124,127,149,150]. ‘Education’ includes disseminating information to key stakeholder groups and developing guidelines or formularies [151,152,153,154]. ‘Engineering’ includes organisational or managerial interventions such as instigating and monitoring prescribing targets and quality targets [148,150]. ‘Economics’ include financial incentives to key stakeholder groups and ‘Enforcement’ includes regulations by law including the banning of self-purchasing of antibiotics without a prescription [148,155,156].
Two timescales were employed to assess changes over time as more knowledge became available regarding the effectiveness and safety of the vaccines including boosters. These were up to the end of December 2021 and up to the end of June 2022.

2.3. Ethical Considerations

No ethical approval was sought for this study as no human subjects were involved. In addition, the co-authors, who were very knowledgeable in their country concerning these matters, voluntarily provided the information, which are typically available in the public domain. This mirrors similar studies conducted by the co-authors across Africa and wider, involving general subjects as well as both infectious and non-infectious diseases, and is in accordance with institutional guidance [10,15,26,124,125,126,127,129,157,158].

3. Results

We will first document the initial sources of COVID-19 vaccines across Africa before discussing initial and subsequent coverage rates as well as key issues surrounding access, hesitancy and challenges.

3.1. Vaccine Sources and Deployment

Vaccine roll-out commenced in a number of African countries in the first quarter of 2021, with Egypt the first African country among those studied to commence vaccination on 24 January 2021, followed by South Africa on 17 February 2021 and Zimbabwe on 18 February 2021. Other countries studied, apart from Tanzania, introduced their COVID-19 vaccines between March and April 2021 [94]. Most of the countries had dedicated vaccine roll-out programmes involving both the public and private sectors (Supplementary Table S1).
The sources of vaccines among the countries were typically from donations by multilateral agencies, non-governmental organisations, and higher income economies, including the UK and USA, with some countries, including South Africa, entering into bilateral agreements (Supplementary Table S1). Agencies and other organisations included the COVAX-WHO initiative, the African Union Vaccine Acquisition Trust (AVAT) and GAVI, the Vaccine Alliance, and the Serum Institute of India. COVAX is co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), GAVI, the Vaccine Alliance, and the WHO, alongside a key delivery partner, UNICEF [159]. Typically, vaccines from multiple sources were administered across Africa (Supplementary Table S1).

3.2. Vaccination Coverage

As of 31 December 2021, vaccination coverage in the studied countries varied from very low rates in Tanzania and Nigeria, with higher rates reported in Botswana, Egypt, Eswatini, and South Africa (Table 2 and Table 3). Most of the studied African countries deployed vaccination programmes in phases, prioritising HCWs, followed by elderly patients and patients with co-morbidities at high risk of severe COVID-19 disease, hospitalisation, or death should they be infected with SARS-CoV-2 (Supplementary Table S2). A number of these countries also commenced the vaccination of children of certain age groups and began administering booster doses to the adult population by the end of December 2021 (Supplementary Table S2).
The most widely administered vaccines by the end of June 2022 across Afria were Johnson & Johnson (30.3% of the total number administered), Pfizer BioNtech (19.1%), Sinopharm (14.2%), Oxford AstraZeneca (13.7%), Sinovac (7.9%), and Moderna (5.5%) [143].
By the end of June 2022, COVID-19 vaccination coverage had increased across Africa, with an overall 18.4% full vaccination coverage, up from 8.9% at the end of December 2021. This was considerably lower though than the global rate of 60.7%, up from 49.2% in December 2021. However, again, appreciable variation was observed across the various countries (Table 2 and Table 3), with the greatest increases seen in Uganda (20.4%), Botswana (18.5%), Zambia (17.9%), and Ghana (14.8%) and with varied increase in coverage seen in the other studied countries (Table 2). Figure 1 depicts the overall increase in the administration of COVID-19 vaccines by the end of June 2022. The lowest coverage rate among the studied countries was recorded in Cameroon, with only 4.5% of the population being fully vaccinated by mid-2022.

3.3. Access, Hesitancy, and Challenges with the COVID-19 Vaccine Roll-Out

Table 4 summarises the levels of access, acceptance, hesitancy, and challenges with the COVID-19 vaccine roll-out across Africa, which builds on Pan-African and other African studies [66,67,68,69,70,71,72,80,81,82,83,84,85,86]. Access was generally well facilitated by the different measures and initiatives among the various African governments; however, there were concerns in some African countries, including the variable availability of the different vaccines.
There were also concerns with the level of acceptance for the vaccine among a number of the studied countries, with subsequent high rates of vaccine hesitancy in some of these. In Cameroon, poor acceptance levels were observed, and Egypt and Eswatini initially presented with low levels of acceptance; however, there were considerable improvements over time.
Misinformation concerning the side-effects of the vaccine coupled with other key issues, including fertility and other conspiracy theories, were widely circulated on social media platforms. This resulted in issues of trust and high hesitancy rates among some of the studied countries. Addressing these and other highlighted challenges will be key to improving vaccination rates in Africa going forward.

3.4. Lessons Learnt and Ways Forward

A considerable number of lessons learned and ways forward to improve future vaccination rates were identified across countries. These are summarised in Table 5 and include increasing trust in governments and other key stakeholder groups, including HCPs, which has been eroded with increasing vaccine hesitancy rates [199]. This involves reducing doubts about the vaccines, including COVID-19 vaccines, among HCWs including HCPs [175,199,200,201], through social media and other channels, with social media playing an increasing role in promulgating misinformation [120,202]. Trusted politicians endorsing COVID-19 vaccines can also reduce hesitancy [203].

4. Discussion

We believe this is the first study to comprehensively review current African vaccination and hesitancy rates alongside current challenges, as well as propose potential ways forward given current concerns. This is particularly important in Africa with high existing rates of infectious diseases as well as high rates of AMR [111,121,130]. The overuse of antibiotics in treating patients with COVID-19 has further enhanced AMR rates, which urgently need to be addressed to reduce future morbidity, mortality, and costs [112,113,124,227]. The majority of African countries started their roll-out of COVID-19 vaccines in early 2021, in many cases with vaccines donated as part of COVAX, GAVI, AVAT, or bilateral agreements for specific countries (Supplementary Table S1). Tanzania was the last of the African countries to initiate its vaccine roll-out due to denial initially [94]. However, some of the COVID-19 vaccines donated were near their expiration date, creating additional challenges.
There was appreciable growth in vaccination rates in a number of the African countries surveyed between the end of 2021 and mid-2022, enhanced by greater availability and access, with Uganda, Botswana, and Zambia recording the greatest increase in vaccination coverage rates (Table 2, Figure 1). However, coverage rates continued to remain relatively low in some of the African countries surveyed, including Cameroon, Nigeria, Sudan, and Tanzania (Table 1), exacerbated by high hesitancy rates fuelled by misinformation (Table 4). These low rates impacted the global coverage rate of 60.7% in mid-year of 2022, which is below the target of 70% set by the WHO [228]. Botswana and Egypt continued to have high coverage rates among the African countries surveyed, enhanced by pro-active activities by regional and national governments (Table 2 and Table 4). The multi-faceted activities they undertook provide guidance to other African countries, including measures used to ensure availability among the general population.
There are still concerns with low vaccination rates of children in a number of the surveyed countries, with only 7% of doses administered among 23 African countries by the end of June 2022 to children and adolescents younger than 18 years of age [229]. This low vaccination rate may have been exacerbated by supply challenges as well as concerns about the safety of the vaccines among children. We will be following this up in future studies, as concerns with vaccinating children with the COVID-19 vaccines may negatively impact routine immunisation programmes among children, which were already severely compromised by the pandemic [54,55,230].
Hesitancy continued to be a concern across Africa. This is fuelled by the level of misinformation including false claims about its side-effects, the disease mainly targeting rich urban populations, it being the disease of the west, it likely to be only a mild disease among Africans, it interfering with fertility, and the ‘mark of the beast’, exacerbated by social media activities [120,215] (Table 4).
Several activities were identified to improve vaccination rates during the current and future pandemics (Table 5). These include the greater involvement of African countries in basic research and clinical research, epidemiology, as well as improving current pharmacovigilance activities, which are a concern across Africa [205,206,231]. In addition, these include improving the education of HCPs during undergraduate training and post-qualification using a variety of hybrid approaches, with hybrid learning here to stay post-pandemic [10]. Community pharmacists can also play a key role in improving vaccination rates. This is because they are often the first point of contact between patients and HCPs, particularly in rural areas and where there are high patient co-payments [208,209,210]. Alongside this, governments should make the vaccines easily available to reduce travelling times and associated costs, which could negatively impact uptake. The government and key HCPs also need to actively engage in social media activities [120]. This is because misinformation can rapidly circulate via social media, with significant implications for trust in governments as well as the prevention and management of COVID-19 if this continues [20,120,175,215]. Compulsory vaccination of certain groups has been instigated in some countries to reduce transmission rates. However, before doing this, governments need to carefully consider legal, ethical, and other major issues [225,226].
We will continue to monitor key areas across Africa regarding current vaccination rates and challenges, including continued hesitancy. This will enable African countries to continue to learn from each other. As a result, the impact of the virus can be reduced, which includes the unintended consequences of measures that were initially implemented to contain the pandemic. In addition, the continued high inappropriate use of antibiotics across Africa needs to be reduced, building on current national action plans to reduce AMR [124,130].

5. Conclusions

It is widely acknowledged that the introduction of COVID-19 vaccines was a significant step forward across countries to reduce the morbidity, mortality, and costs associated with the virus. This includes the unintended consequences of public health measures instigated to reduce its spread and impact. There were appreciable variations in vaccine coverage and hesitancy across Africa. This was fuelled by critical issues, including access, irregular supply, and the level of misinformation circulating within communities and on various media platforms. Key among these included was misinformation fuelled by social media. A number of activities were identified to address this situation across Africa, which included instigating improved pharmacovigilance activities and addressing the negative impact of social media, which will be followed up in future studies.

Supplementary Materials

The following supporting information can be downloaded at:, Table S1: COVID-19 vaccination deployment across African countries: commencement, rollout Programmes, and vaccine sources, Table S2: COVID-19 vaccination coverage across African countries (up to the end of 2021). Refs [232,233,234,235,236,237,238,239,240,241,242,243,244,245,246,247,248,249,250,251,252,253,254,255,256,257,258,259,260,261,262,263,264,265,266,267,268,269,270,271,272,273,274] in Supplementary Tables.

Author Contributions

Conception/design: O.O.O., B.G., J.O.F., S.M., E.T.T., A.A.J., S.M.C. and J.C.M. (Johanna C. Meyer); acquisition and analysis: O.O.O., B.G., J.O.F., S.M., A.O.A., A.F.Y.-O., S.O.O., M.R.O., M.S., W.M.R., A.M.G., N.M., T.Z., A.C.K., O.O.M., D.K., A.M., I.C., F.K., T.T., A.A., E.M., M.O, S.O., D.N.A.A., I.A.S., D.A., A.A.A., M.P.M., A.E., M.E.A., P.O., L.L.N., J.C.M. (Julius C. Mwita), G.M.R., J.K., C.E., R.T.M., I.M.-W. and J.C.M. (Johanna C. Meyer); interpretation of the data: O.O.O., B.G., J.O.F., S.M., A.O.A., A.F.Y.-O., S.O.O., M.R.O., M.S., W.M.R., A.M.G., N.M., T.Z., A.C.K., O.O.M., D.K., A.M., I.C., F.K., T.T., A.A., E.M., M.O., S.O., D.N.A.A., I.A.S., D.A., A.A.A., M.P.M., A.E., M.E.A., P.O., L.L.N., J.C.M. (Julius C. Mwita), G.M.R., J.K., C.E., R.T.M., I.M.-W., S.M.C. and J.C.M. (Johanna C. Meyer); drafting the work: O.O.O., B.G., J.O.F. and J.C.M. (Johanna C. Meyer); critically revising the paper: all authors; accuracy of the data appropriately collected and included in the analysis as well as resolving queries: O.O.O., B.G., J.O.F., S.M., A.O.A., A.F.Y.-O., S.O.O., M.R.O., M.S., W.M.R., A.M.G., N.M., T.Z., A.C.K., O.O.M., D.K., A.M., I.C., F.K., T.T., A.A., E.M., M.O., S.O., D.N.A.A., I.A.S., D.A., A.A.A., M.P.M., A.E., M.E.A., P.O., L.L.N., J.C.M. (Julius C. Mwita), G.M.R., J.K., C.E., R.T.M., I.M.-W., S.M.C. and J.C.M. (Johanna C. Meyer) Project management: O.O.O., B.G., J.O.F. and J.C.M. (Johanna C. Meyer). Final approval: all authors. All authors have read and agreed to the published version of the manuscript.


This research received no external funding.

Institutional Review Board Statement

No ethical approval was sought for this study as no human subjects were involved. In addition, the co-authors, who were very knowledgeable in their country concerning these matters, voluntarily provided the information, which is available in the public domain in some settings.

Data Availability Statement

Additional data can be obtained on reasonable request from the corresponding author.

Conflicts of Interest

The authors declare no conflict of interest. However, a number of the co-authors are employed by National Health Services or Ministries of Health, or are advisers to Ministries of Health, the WHO or other leading Infectious Disease Groups.


  1. Bedford, J.; Enria, D.; Giesecke, J.; Heymann, D.L.; Ihekweazu, C.; Kobinger, G.; Lane, H.C.; Memish, Z.; Oh, M.-D.; Sall, A.A.; et al. COVID-19: Towards controlling of a pandemic. Lancet 2020, 395, 1015–1018. [Google Scholar] [CrossRef]
  2. World Health Organization. WHO COVID-19 Dashboard. 2021. Available online: (accessed on 1 August 2022).
  3. Hopman, J.; Allegranzi, B.; Mehtar, S. Managing COVID-19 in Low- and Middle-Income Countries. JAMA 2020, 323, 1549. [Google Scholar] [CrossRef] [PubMed]
  4. Choi, A.J.; Hean, A.C.; Lee, J.K.; Tran, N.D.; Lin, T.K.; Apollonio, D.E. A Retrospective Global Assessment of Factors Associated With COVID-19 Policies and Health Outcomes. Front. Public Health 2022, 10, 843445. [Google Scholar] [CrossRef] [PubMed]
  5. Nussbaumer-Streit, B.; Mayr, V.; Dobrescu, A.I.; Chapman, A.; Persad, E.; Klerings, I.; Wagner, G.; Siebert, U.; Ledinger, D.; Zachariah, C.; et al. Quarantine alone or in combination with other public health measures to control COVID-19: A rapid review. Cochrane Database Syst. Rev. 2020, 9, cd013574. [Google Scholar] [PubMed]
  6. Tang, K.H.D. Movement control as an effective measure against COVID-19 spread in Malaysia: An overview. J. Public Health 2022, 30, 583–586. [Google Scholar] [CrossRef]
  7. Ng, Y.; Li, Z.; Chua, Y.X.; Chaw, W.L.; Zhao, Z.; Er, B.; Pung, R.; Chiew, C.J.; Lye, D.; Heng, D.; et al. Evaluation of the Effectiveness of Surveillance and Containment Measures for the First 100 Patients with COVID-19 in Singapore—January 2–February 29, 2020. MMWR Morb. Mortal. Wkly. Rep. 2020, 69, 307–311. [Google Scholar] [CrossRef]
  8. Keni, R.; Alexander, A.; Nayak, P.G.; Mudgal, J.; Nandakumar, K. COVID-19: Emergence, Spread, Possible Treatments, and Global Burden. Front. Public Health 2020, 8, 216. [Google Scholar] [CrossRef]
  9. Talic, S.; Shah, S.; Wild, H.; Gasevic, D.; Maharaj, A.; Ademi, Z.; Li, X.; Xu, W.; Mesa-Eguiagaray, I.; Rostron, J.; et al. Effectiveness of public health measures in reducing the incidence of COVID-19, SARS-CoV-2 transmission, and COVID-19 mortality: Systematic review and meta-analysis. BMJ 2021, 375, e068302. [Google Scholar] [CrossRef]
  10. Etando, A.; Amu, A.A.; Haque, M.; Schellack, N.; Kurdi, A.; Alrasheedy, A.A.; Timoney, A.; Mwita, J.C.; Rwegerera, G.M.; Patrick, O.; et al. Challenges and Innovations Brought about by the COVID-19 Pandemic Regarding Medical and Pharmacy Education Especially in Africa and Implications for the Future. Healthcare 2021, 9, 1722. [Google Scholar] [CrossRef]
  11. Shiraef, M.A.; Friesen, P.; Feddern, L.; Weiss, M.A. Did border closures slow SARS-CoV-2? Sci. Rep. 2022, 12, 1709. [Google Scholar] [CrossRef]
  12. Cheng, V.C.; Wong, S.C.; Chuang, V.W.; So, S.Y.; Chen, J.H.; Sridhar, S.; To, K.K.-W.; Chan, J.F.-W.; Hung, I.F.-N.; Ho, P.-L.; et al. The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. J. Infect. 2020, 81, 107–114. [Google Scholar] [CrossRef] [PubMed]
  13. Congressional Research Services. Global Economic Effects of COVID-19—Updated 10 November 2021. Available online: (accessed on 2 August 2022).
  14. Verma, B.K.; Verma, M.; Msc, V.K.V.; Abdullah, R.B.; Nath, D.C.; Khan, H.T.A.; Verma, A.; Vishwakarma, R.K.; Verma, V. Global lockdown: An effective safeguard in responding to the threat of COVID -19. J. Eval. Clin. Pract. 2020, 26, 1592–1598. [Google Scholar] [CrossRef] [PubMed]
  15. Ogunleye, O.O.; Basu, D.; Mueller, D.; Sneddon, J.; Seaton, R.A.; Yinka-Ogunleye, A.F.; Wamboga, J.; Miljković, N.; Mwita, J.C.; Rwegerera, G.M.; et al. Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future. Front. Pharmacol. 2020, 11, 1205. [Google Scholar] [CrossRef] [PubMed]
  16. Godman, B.; Haque, M.; Islam, S.; Iqbal, S.; Urmi, U.L.; Kamal, Z.M.; Shuvo, S.A.; Rahman, A.; Kamal, M.; Haque, M.; et al. Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future. Front. Public Health 2020, 8, 585832. [Google Scholar] [CrossRef]
  17. Chan, D.K.C.; Zhang, C.-Q.; Weman-Josefsson, K. Why people failed to adhere to COVID-19 preventive behaviors? Perspectives from an integrated behavior change model. Infect. Control Hosp. Epidemiol. 2020, 42, 375–376. [Google Scholar] [CrossRef]
  18. Levin, A.T.; Owusu-Boaitey, N.; Pugh, S.; Fosdick, B.K.; Zwi, A.B.; Malani, A.; Soman, S.; Besançon, L.; Kashnitsky, I.; Ganesh, S.; et al. Assessing the burden of COVID-19 in developing countries: Systematic review, meta-analysis and public policy implications. BMJ Glob. Health 2022, 7, e008477. [Google Scholar] [CrossRef]
  19. Pan, H.; Peto, R.; Henao-Restrepo, A.M.; Preziosi, M.P.; Sathiyamoorthy, V.; Abdool Karim, Q.; Alejandria, M.M.; García, C.H.; Kieny, M.; Malekzadeh, R.; et al. Repurposed Antiviral Drugs for Covid-19—Interim WHO Solidarity Trial Results. N. Engl. J Med. 2021, 384, 497–511. [Google Scholar]
  20. Schellack, N.; Strydom, M.; Pepper, M.S.; Herd, C.L.; Hendricks, C.L.; Bronkhorst, E.; Meyer, J.C.; Padayachee, N.; Bangalee, V.; Truter, I.; et al. Social Media and COVID-19—Perceptions and Public Deceptions of Ivermectin, Colchicine and Hydroxychloroquine: Lessons for Future Pandemics. Antibiotics 2022, 11, 445. [Google Scholar] [CrossRef]
  21. Bryant, A.; Lawrie, T.A.; Dowswell, T.; Fordham, E.J.; Mitchell, S.; Hill, S.R.; Tham, T.C. Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines. Am. J. Ther. 2021, 28, e434–e460. [Google Scholar] [CrossRef]
  22. Uzunova, K.; Filipova, E.; Pavlova, V.; Vekov, T. Insights into antiviral mechanisms of remdesivir, lopinavir/ritonavir and chloroquine/hydroxychloroquine affecting the new SARS-CoV-2. Biomed. Pharmacother. 2020, 131, 110668. [Google Scholar] [CrossRef]
  23. Abubakar, A.R.; Sani, I.H.; Godman, B.; Kumar, S.; Islam, S.; Jahan, I.; Haque, M. Systematic Review on the Therapeutic Options for COVID-19: Clinical Evidence of Drug Efficacy and Implications. Infect. Drug Resist. 2020, 13, 4673–4695. [Google Scholar] [CrossRef]
  24. Medhi, B.; Sarma, P.; Bhattacharyya, A.; Kaur, H.; Prajapat, M.; Prakash, A.; Kumar, S.; Bansal, S.; Kirubakaran, R.; Reddy, D.; et al. Efficacy and safety of steroid therapy in COVID-19: A rapid systematic review and Meta-analysis. Indian J. Pharmacol. 2020, 52, 535–550. [Google Scholar] [CrossRef] [PubMed]
  25. Sulis, G.; Batomen, B.; Kotwani, A.; Pai, M.; Gandra, S. Sales of antibiotics and hydroxychloroquine in India during the COVID-19 epidemic: An interrupted time series analysis. PLoS Med. 2021, 18, e1003682. [Google Scholar] [CrossRef] [PubMed]
  26. Sefah, I.A.; Ogunleye, O.O.; Essah, D.O.; Opanga, S.A.; Butt, N.; Wamaitha, A.; Guantai, A.N.; Chikowe, I.; Khuluza, F.; Kibuule, D.; et al. Rapid Assessment of the Potential Paucity and Price Increases for Suggested Medicines and Protection Equipment for COVID-19 Across Developing Countries With a Particular Focus on Africa and the Implications. Front. Pharmacol. 2021, 11, 588106. [Google Scholar] [CrossRef]
  27. Charan, J.; Dutta, S.; Kaur, R.; Bhardwaj, P.; Ambwani, S.; Godman, B.; Jha, P.; Sukhija, S.; Venkatesh, S.; Lugova, H.; et al. Demand of COVID-19 medicines without prescription among community pharmacies in Jodhpur, India: Findings and implications. J. Fam. Med. Prim. Care 2022, 11, 503. [Google Scholar] [CrossRef] [PubMed]
  28. Haque, M.; Gowere, M.; Nusrat, N.; Chowdhury, K.; Godman, B. The response to COVID 19 across countries and the implications for future pandemics. Bangladesh J. Med Sci. 2021, 20, 7–14. [Google Scholar] [CrossRef]
  29. Manivannan, E.; Karthikeyan, C.; Moorthy, N.S.H.N.; Chaturvedi, S.C. The Rise and Fall of Chloroquine/Hydroxychloroquine as Compassionate Therapy of COVID-19. Front. Pharmacol. 2021, 12, 584940. [Google Scholar] [CrossRef]
  30. Charan, J.; Kaur, R.J.; Bhardwaj, P.; Haque, M.; Sharma, P.; Misra, S.; Godman, B. Rapid review of suspected adverse drug events due to remdesivir in the WHO database; findings and implications. Expert Rev. Clin. Pharmacol. 2020, 14, 95–103. [Google Scholar] [CrossRef]
  31. Abena, P.M.; Decloedt, E.H.; Bottieau, E.; Suleman, F.; Adejumo, P.; Sam-Agudu, N.A.; Muyembe TamFum, J.-J.; Seydi, M.; Eholie, S.P.; Mills, E.J.; et al. Chloroquine and Hydroxychloroquine for the Prevention or Treatment of novel coronavirus disease (COVID-19) in Africa: Caution for Inappropriate Off-label Use in Healthcare Settings. Am. J. Trop. Med. Hyg. 2020, 102, 1184–1188. [Google Scholar] [CrossRef]
  32. RECOVERY Collaborative Group; Horby, P.; Lim, W.S.; Emberson, J.R.; Mafham, M.; Bell, J.L.; Linsell, L.; Staplin, N.; Brightling, C.; Ustianowski, A.; et al. Dexamethasone in Hospitalized Patients with Covid-19. N. Engl. J. Med. 2021, 384, 693–704. [Google Scholar] [CrossRef]
  33. RECOVERY Collaborative Group. Lopinavir-ritonavir in patients admitted to hospital with COVID-19 (RECOVERY): A randomised, controlled, open-label, platform trial. Lancet 2020, 396, 1345–1352. [Google Scholar] [CrossRef]
  34. WHO. WHO Discontinues Hydroxychloroquine and Lopinavir/Ritonavir Treatment Arms for COVID-19. 2020. Available online: (accessed on 1 August 2022).
  35. Dyer, O. COVID-19: Remdesivir Has Little or No Impact on Survival, WHO Trial Shows. BMJ 2020, 371, m4057. [Google Scholar] [CrossRef] [PubMed]
  36. Deng, J.; Zhou, F.; Ali, S.; Heybati, K.; Hou, W.; Huang, E.; Wong, C.Y. Correction to: Efficacy and safety of ivermectin for the treatment of COVID-19: A systematic review and meta-analysis. QJM Int. J. Med. 2022, 114, 721–734. [Google Scholar] [CrossRef] [PubMed]
  37. RECOVERY Collaborative Group; Horby, P.; Mafham, M.; Linsell, L.; Bell, J.L.; Staplin, N.; Emberson, J.R.; Wiselka, M.; Ustianowski, A.; Elmahi, E.; et al. Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19. N. Engl. J. Med. 2020, 383, 2030–2040. [Google Scholar] [CrossRef] [PubMed]
  38. CIOMS. Medicines Assessment during Public Health Emergencies Needs Good Science, Best Practices and Proper Communication. 2020. Available online: (accessed on 2 August 2022).
  39. Grimes, D.R. Medical disinformation and the unviable nature of COVID-19 conspiracy theories. PLoS ONE 2021, 16, e0245900. [Google Scholar] [CrossRef] [PubMed]
  40. Neil, S.J.; Campbell, E.M. Fake Science: XMRV, COVID-19, and the Toxic Legacy of Dr. Judy Mikovits. AIDS Res. Hum. Retrovir. 2020, 36, 545–549. [Google Scholar] [CrossRef]
  41. Carley, S.; Horner, D.; Body, R.; Mackway-Jones, K. Evidence-based medicine and COVID-19: What to believe and when to change. Emerg. Med. J. 2020, 37, 572–575. [Google Scholar] [CrossRef]
  42. Kluge, H.H.P.; Wickramasinghe, K.; Rippin, H.L.; Mendes, R.; Peters, D.H.; Kontsevaya, A.; Breda, J. Prevention and control of non-communicable diseases in the COVID-19 response. Lancet 2020, 395, 1678–1680. [Google Scholar] [CrossRef]
  43. Fatoye, F.; Gebrye, T.; Arije, O.; Fatoye, C.T.; Onigbinde, O.; Mbada, C. Economic Impact of COVID-19 Lockdown on households. Pan Afr. Med. J. 2021, 40, 225. [Google Scholar] [CrossRef]
  44. Glied, S.; Levy, H. The Potential Effects of Coronavirus on National Health Expenditures. JAMA 2020, 323, 2001. [Google Scholar] [CrossRef]
  45. Richards, F.; Kodjamanova, P.; Chen, X.; Li, N.; Atanasov, P.; Bennetts, L.; Patterson, B.J.; Yektashenas, B.; Mesa-Frias, M.; Tronczynski, K.; et al. Economic Burden of COVID-19: A Systematic Review. Clin. Outcomes Res. 2022, 14, 293–307. [Google Scholar] [CrossRef] [PubMed]
  46. Buheji, M.; da Costa Cunha, K.; Beka, G.; Mavric, B.; De Souza, Y.L.; da Costa Silva, S.S.; Hanafi, M.; Yein, T.C. The Extent of COVID-19 Pandemic Socio-Economic Impact on Global Poverty. A Global Integrative Multidisciplinary Review. Am. J. Econ. 2020, 10, 213–224. [Google Scholar] [CrossRef]
  47. Martin, A.; Markhvida, M.; Hallegatte, S.; Walsh, B. Socio-Economic Impacts of COVID-19 on Household Consumption and Poverty. Econ. Disasters Clim. Chang. 2020, 4, 453–479. [Google Scholar] [CrossRef] [PubMed]
  48. The Economist. What Is the Economic Cost of COVID-19? 2021. Available online: (accessed on 1 August 2022).
  49. Suthar, S.; Das, S.; Nagpure, A.; Madhurantakam, C.; Tiwari, S.B.; Gahlot, P.; Tyagi, V.K. Epidemiology and diagnosis, environmental resources quality and socio-economic perspectives for COVID-19 pandemic. J. Environ. Manag. 2020, 280, 111700. [Google Scholar] [CrossRef]
  50. Riera, R.; Bagattini, M.; Pacheco, R.L.; Pachito, D.V.; Roitberg, F.; Ilbawi, A. Delays and Disruptions in Cancer Health Care Due to COVID-19 Pandemic: Systematic Review. JCO Glob. Oncol. 2021, 7, 311–323. [Google Scholar] [CrossRef]
  51. Moraliyage, H.; De Silva, D.; Ranasinghe, W.; Adikari, A.; Alahakoon, D.; Prasad, R.; Lawrentschuk, N.; Bolton, D. Cancer in Lockdown: Impact of the COVID -19 Pandemic on Patients with Cancer. Oncologist 2020, 26, e342–e344. [Google Scholar] [CrossRef]
  52. Jiang, H.; Zhou, Y.; Tang, W. Maintaining HIV care during the COVID-19 pandemic. Lancet HIV 2020, 7, e308–e309. [Google Scholar] [CrossRef]
  53. Ataguba, J.E. COVID-19 Pandemic, a War to be Won: Understanding its Economic Implications for Africa. Appl. Health Econ. Health Policy 2020, 18, 325–328. [Google Scholar] [CrossRef]
  54. Abbas, K.; Procter, S.R.; van Zandvoort, K.; Clark, A.; Funk, S.; Mengistu, T.; Hogan, D.; Dansereau, E.; Jit, M.; Flasche, S.; et al. Routine childhood immunisation during the COVID-19 pandemic in Africa: A benefit-risk analysis of health benefits versus excess risk of SARS-CoV-2 infection. Lancet Glob. Health 2020, 8, e1264–e1272. [Google Scholar] [CrossRef]
  55. Causey, K.; Fullman, N.; Sorensen, R.J.D.; Galles, N.C.; Zheng, P.; Aravkin, A.; Danovaro-Holliday, M.C.; Martinez-Piedra, R.; Sodha, S.V.; Velandia-González, M.P.; et al. Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: A modelling study. Lancet 2021, 398, 522–534. [Google Scholar] [CrossRef]
  56. Shet, A.; Carr, K.; Danovaro-Holliday, M.C.; Sodha, S.V.; Prosperi, C.; Wunderlich, J.; Wonodi, C.; Reynolds, H.W.; Mirza, I.; Gacic-Dobo, M.; et al. Impact of the SARS-CoV-2 pandemic on routine immunisation services: Evidence of disruption and recovery from 170 countries and territories. Lancet Glob. Health 2022, 10, e186–e194. [Google Scholar] [CrossRef]
  57. Evans, B.; Jombart, T. Worldwide routine immunisation coverage regressed during the first year of the COVID-19 pandemic. Vaccine 2022, 40, 3531–3535. [Google Scholar] [CrossRef] [PubMed]
  58. Mohammed, I.; Nauman, A.; Paul, P.; Ganesan, S.; Chen, K.-H.; Jalil, S.M.S.; Jaouni, S.H.; Kawas, H.; Khan, W.A.; Vattoth, A.L.; et al. The efficacy and effectiveness of the COVID-19 vaccines in reducing infection, severity, hospitalization, and mortality: A systematic review. Hum. Vaccines Immunother. 2022, 18, 2027160. [Google Scholar] [CrossRef] [PubMed]
  59. Wang, K.; Wang, L.; Li, M.; Xie, B.; He, L.; Wang, M.; Zhang, R.; Hou, N.; Zhang, Y.; Jia, F. Real-Word Effectiveness of Global COVID-19 Vaccines Against SARS-CoV-2 Variants: A Systematic Review and Meta-Analysis. Front. Med. 2022, 9, 820544. [Google Scholar] [CrossRef]
  60. Feikin, D.R.; Higdon, M.M.; Abu-Raddad, L.J.; Andrews, N.; Araos, R.; Goldberg, Y.; Groome, M.J.; Huppert, A.; O’Brien, K.L.; Smith, P.G. Duration of effectiveness of vaccines against SARS-CoV-2 infection and COVID-19 disease: Results of a systematic review and meta-regression. Lancet 2022, 399, 924–944. [Google Scholar] [CrossRef]
  61. Korang, S.K.; von Rohden, E.; Veroniki, A.A.; Ong, G.; Ngalamika, O.; Siddiqui, F.; Juul, S.; Nielsen, E.E.; Feinberg, J.B.; Petersen, J.J.; et al. Vaccines to prevent COVID-19: A living systematic review with Trial Sequential Analysis and network meta-analysis of randomized clinical trials. PLoS ONE 2022, 17, e0260733. [Google Scholar] [CrossRef]
  62. Sallam, M. COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates. Vaccines 2021, 9, 160. [Google Scholar] [CrossRef]
  63. Zeng, B.; Gao, L.; Zhou, Q.; Yu, K.; Sun, F. Effectiveness of COVID-19 vaccines against SARS-CoV-2 variants of concern: A systematic review and meta-analysis. BMC Med. 2022, 20, 200. [Google Scholar] [CrossRef]
  64. Chenchula, S.; Karunakaran, P.; Sharma, S.; Chavan, M. Current evidence on efficacy of COVID-19 booster dose vaccination against the Omicron variant: A systematic review. J. Med. Virol. 2022, 94, 2969–2976. [Google Scholar] [CrossRef]
  65. Fajar, J.K.; Sallam, M.; Soegiarto, G.; Sugiri, Y.J.; Anshory, M.; Wulandari, L.; Kosasih, S.A.P.; Ilmawan, M.; Kusnaeni, K.; Fikri, M.; et al. Global Prevalence and Potential Influencing Factors of COVID-19 Vaccination Hesitancy: A Meta-Analysis. Vaccines 2022, 10, 1356. [Google Scholar] [CrossRef]
  66. Bono, S.A.; Faria de Moura Villela, E.; Siau, C.S.; Chen, W.S.; Pengpid, S.; Hasan, M.T.; Sessou, P.; Ditekemena, J.D.; Amodan, B.O.; Hosseinipour, M.C.; et al. Factors Affecting COVID-19 Vaccine Acceptance: An International Survey among Low- and Middle-Income Countries. Vaccines 2021, 9, 515. [Google Scholar] [CrossRef] [PubMed]
  67. Norhayati, M.N.; Yusof, R.C.; Azman, Y.M. Systematic Review and Meta-Analysis of COVID-19 Vaccination Acceptance. Front. Med. 2022, 8, 783982. [Google Scholar] [CrossRef] [PubMed]
  68. Kanyanda, S.; Markhof, Y.; Wollburg, P.; Zezza, A. Acceptance of COVID-19 vaccines in sub-Saharan Africa: Evidence from six national phone surveys. BMJ Open 2021, 11, e055159. [Google Scholar] [CrossRef] [PubMed]
  69. Adebisi, Y.A.; Alaran, A.J.; Bolarinwa, O.A.; Akande-Sholabi, W.; Lucero-Prisno, D.E. When it is available, will we take it? Social media users’ perception of hypothetical COVID-19 vaccine in Nigeria. Pan Afr. Med. J. 2021, 38, 230. [Google Scholar] [CrossRef] [PubMed]
  70. Adedeji-Adenola, H.; Olugbake, O.A.; Adeosun, S.A. Factors influencing COVID-19 vaccine uptake among adults in Nigeria. PLoS ONE 2022, 17, e0264371. [Google Scholar] [CrossRef]
  71. Oyekale, A.S. Factors Influencing Willingness to Be Vaccinated against COVID-19 in Nigeria. Int. J. Environ. Res. Public Health 2022, 19, 6816. [Google Scholar] [CrossRef]
  72. Tobin, E.A.; Okonofua, M.; Adeke, A.; Obi, A. Willingness to Accept a COVID-19 Vaccine in Nigeria: A Population-based Cross-sectional Study. Cent. Afr. J. Public Health 2021, 7, 53. [Google Scholar] [CrossRef]
  73. Al-Ali, D.; Elshafeey, A.; Mushannen, M.; Kawas, H.; Shafiq, A.; Mhaimeed, N.; Mhaimeed, O.; Mhaimeed, N.; Zeghlache, R.; Salameh, M.; et al. Cardiovascular and haematological events post COVID-19 vaccination: A systematic review. J. Cell. Mol. Med. 2021, 26, 636–653. [Google Scholar] [CrossRef]
  74. Hippisley-Cox, J.; Patone, M.; Mei, X.W.; Saatci, D.; Dixon, S.; Khunti, K.; Zaccardi, F.; Watkinson, P.; Shankar-Hari, M.; Doidge, J.; et al. Risk of thrombocytopenia and thromboembolism after covid-19 vaccination and SARS-CoV-2 positive testing: Self-controlled case series study. BMJ 2021, 374, n1931. [Google Scholar] [CrossRef]
  75. Kouhpayeh, H.; Ansari, H. Adverse events following COVID-19 vaccination: A systematic review and meta-analysis. Int. Immunopharmacol. 2022, 109, 108906. [Google Scholar] [CrossRef]
  76. Lau, C.L.; Galea, I. Risk-benefit analysis of COVID-19 vaccines—A neurological perspective. Nat. Rev Neurol. 2022, 18, 69–70. [Google Scholar] [CrossRef] [PubMed]
  77. Tabong, P.T.; Opoku Mensah, K.; Asampong, E. Preparation for COVID-19 vaccines rollout: Interventions to increase trust, acceptability, and uptake in West African countries. Int. J. Health Plan. Manag. 2022, 37, 1221–1228. [Google Scholar] [CrossRef]
  78. MacDonald, N.E.; Eskola, J.; Liang, X.; Chaudhuri, M.; Dube, E.; Gellin, B.; Goldstein, S.; Larson, H.; Manzo, M.L.; Reingold, A.; et al. Vaccine Hesitancy: Definition, Scope and Determinants. Vaccine 2015, 33, 4161–4164. [Google Scholar] [CrossRef] [PubMed]
  79. Pires, C. Global Predictors of COVID-19 Vaccine Hesitancy: A Systematic Review. Vaccines 2022, 10, 1349. [Google Scholar] [CrossRef] [PubMed]
  80. Sallam, M.; Al-Sanafi, M.; Sallam, M. A Global Map of COVID-19 Vaccine Acceptance Rates per Country: An Updated Concise Narrative Review. J. Multidiscip. Healthc. 2022, 15, 21–45. [Google Scholar] [CrossRef] [PubMed]
  81. Leach, M.; MacGregor, H.; Akello, G.; Babawo, L.; Baluku, M.; Desclaux, A.; Grant, C.; Kamara, F.; Nyakoi, M.; Parker, M.; et al. Vaccine anxieties, vaccine preparedness: Perspectives from Africa in a COVID-19 era. Soc. Sci. Med. 2022, 298, 114826. [Google Scholar] [CrossRef] [PubMed]
  82. Dinga, J.N.; Sinda, L.K.; Titanji, V.P.K. Assessment of Vaccine Hesitancy to a COVID-19 Vaccine in Cameroonian Adults and Its Global Implication. Vaccines 2021, 9, 175. [Google Scholar] [CrossRef] [PubMed]
  83. Faye, S.L.B.; Krumkamp, R.; Doumbia, S.; Tounkara, M.; Strauss, R.; Ouedraogo, H.G.; Sagna, T.; Barry, A.M.; Mbawah, A.K.; Doumbia, C.O.; et al. Factors influencing hesitancy towards adult and child COVID-19 vaccines in rural and urban West Africa: A cross-sectional study. BMJ Open 2022, 12, e059138. [Google Scholar] [CrossRef]
  84. Ahiakpa, J.K.; Cosmas, N.T.; Anyiam, F.E.; Enalume, K.O.; Lawan, I.; Gabriel, I.B.; Oforka, C.L.; Dahir, H.G.; Fausat, S.T.; Nwobodo, M.A.; et al. COVID-19 vaccines uptake: Public knowledge, awareness, perception and acceptance among adult Africans. PLoS ONE 2022, 17, e0268230. [Google Scholar] [CrossRef]
  85. Anjorin, A.A.; Odetokun, I.A.; Abioye, A.I.; Elnadi, H.; Umoren, M.V.; Damaris, B.F.; Eyedo, J.; Umar, H.I.; Nyandwi, J.B.; Abdalla, M.M.; et al. Will Africans take COVID-19 vaccination? PLoS ONE 2021, 16, e0260575. [Google Scholar] [CrossRef]
  86. Katoto, P.D.M.C.; Parker, S.; Coulson, N.; Pillay, N.; Cooper, S.; Jaca, A.; Mavundza, E.; Houston, G.; Groenewald, C.; Essack, Z.; et al. Predictors of COVID-19 Vaccine Hesitancy in South African Local Communities: The VaxScenes Study. Vaccines 2022, 10, 353. [Google Scholar] [CrossRef] [PubMed]
  87. Nindrea, R.D.; Usman, E.; Katar, Y.; Sari, N.P. Acceptance of COVID-19 vaccination and correlated variables among global populations: A systematic review and meta-analysis. Clin. Epidemiol. Glob. Health 2021, 12, 100899. [Google Scholar] [CrossRef] [PubMed]
  88. Shah, J.; Abeid, A.; Sharma, K.; Manji, S.; Nambafu, J.; Korom, R.; Patel, K.; Said, M.; Mohamed, M.A.; Sood, M.; et al. Perceptions and Knowledge towards COVID-19 Vaccine Hesitancy among a Subpopulation of Adults in Kenya: An English Survey at Six Healthcare Facilities. Vaccines 2022, 10, 705. [Google Scholar] [CrossRef]
  89. Mudenda, S.; Hikaambo, C.N.; Daka, V.; Chileshe, M.; Mfune, R.L.; Kampamba, M.; Kasanga, M.; Phiri, M.; Mufwambi, W.; Banda, M.; et al. Prevalence and factors associated with COVID-19 vaccine acceptance in Zambia: A web-based cross-sectional study. Pan Afr. Med. J. 2022, 41, 112. [Google Scholar] [CrossRef]
  90. Cooper, S.; van Rooyen, H.; Wiysonge, C.S. COVID-19 vaccine hesitancy in South Africa: How can we maximize uptake of COVID-19 vaccines? Expert Rev. Vaccines 2021, 20, 921–933. [Google Scholar] [CrossRef] [PubMed]
  91. Mundagowa, P.T.; Tozivepi, S.N.; Chiyaka, E.T.; Mukora-Mutseyekwa, F.; Makurumidze, R. Assessment of COVID-19 vaccine hesitancy among Zimbabweans: A rapid national survey. PLoS ONE 2022, 17, e0266724. [Google Scholar] [CrossRef] [PubMed]
  92. Acheampong, T.; Akorsikumah, E.; Osae-Kwapong, J.; Khalid, M.; Appiah, A.; Amuasi, J. Examining Vaccine Hesitancy in Sub-Saharan Africa: A Survey of the Knowledge and Attitudes among Adults to Receive COVID-19 Vaccines in Ghana. Vaccines 2021, 9, 814. [Google Scholar] [CrossRef]
  93. Murewanhema, G.; Musuka, G.; Mukwenha, S.; Chingombe, I.; Mapingure, M.P.; Dzinamarira, T. Hesitancy, ignorance or uncertainty? The need for effective communication strategies as Zimbabwe’s uptake of COVID-19 vaccine booster doses remains poor. Public Health Pract. 2022, 3, 100244. [Google Scholar] [CrossRef]
  94. Nyalile, T.; Loo, L. Situating COVID-19 Vaccine Hesitancy in Tanzania. 2021. Available online: (accessed on 2 August 2022).
  95. Sippy, P. Is It Too Late to Fight Covid Skepticism and Vaccine Hesitancy in Tanzania? 2021. Available online: (accessed on 2 August 2022).
  96. Ackah, M.; Ameyaw, L.; Salifu, M.G.; Asubonteng, D.P.A.; Yeboah, C.O.; Annor, E.N.; Ankapong, E.A.K.; Boakye, H. COVID-19 vaccine acceptance among health care workers in Africa: A systematic review and meta-analysis. PLoS ONE 2022, 17, e0268711. [Google Scholar] [CrossRef]
  97. Kanyike, A.M.; Olum, R.; Kajjimu, J.; Ojilong, D.; Akech, G.M.; Nassozi, D.R.; Agira, D.; Wamala, N.K.; Asiimwe, A.; Matovu, D.; et al. Acceptance of the coronavirus disease-2019 vaccine among medical students in Uganda. Trop. Med. Health 2021, 49, 37. [Google Scholar] [CrossRef]
  98. Kabamba Nzaji, M.; Kabamba Ngombe, L.; Ngoie Mwamba, G.; Banza Ndala, D.B.; Mbidi Miema, J.; Lungoyo, C.L.; Mwimba, B.L.; Bene, A.C.M.; Musenga, E.M. Acceptability of Vaccination Against COVID-19 Among Healthcare Workers in the Democratic Republic of the Congo. Pragmatic Obs. Res. 2020, 11, 103–109. [Google Scholar] [CrossRef] [PubMed]
  99. World Health Organization (WHO). Ten Threats to Global Health in 2019. 2019. Available online: (accessed on 15 February 2022).
  100. Anakpo, G.; Mishi, S. Hesitancy of COVID-19 vaccines: Rapid systematic review of the measurement, predictors, and preventive strategies. Hum. Vaccines Immunother. 2022, 18, 2074716. [Google Scholar] [CrossRef] [PubMed]
  101. Watson, O.J.; Barnsley, G.; Toor, J.; Hogan, A.B.; Winskill, P.; Ghani, A.C. Global impact of the first year of COVID-19 vaccination: A mathematical modelling study. Lancet Infect. Dis. 2022, 22, P1293–P1302. [Google Scholar] [CrossRef]
  102. Kricorian, K.; Civen, R.; Equils, O. COVID-19 vaccine hesitancy: Misinformation and perceptions of vaccine safety. Hum. Vaccines Immunother. 2021, 18, 1950504. [Google Scholar] [CrossRef]
  103. Razai, M.S.; Chaudhry, U.A.R.; Doerholt, K.; Bauld, L.; Majeed, A. Covid-19 vaccination hesitancy. BMJ 2021, 373, n1138. [Google Scholar] [CrossRef] [PubMed]
  104. Gerretsen, P.; Kim, J.; Caravaggio, F.; Quilty, L.; Sanches, M.; Wells, S.; Brown, E.E.; Agic, B.; Pollock, B.G.; Graff-Guerrero, A. Individual determinants of COVID-19 vaccine hesitancy. PLoS ONE 2021, 16, e0258462. [Google Scholar] [CrossRef]
  105. Litaker, J.R.; Tamez, N.; Bray, C.L.; Durkalski, W.; Taylor, R. Sociodemographic Factors Associated with Vaccine Hesitancy in Central Texas Immediately Prior to COVID-19 Vaccine Availability. Int. J. Environ. Res. Public Health 2021, 19, 368. [Google Scholar] [CrossRef]
  106. Kabakama, S.; Konje, E.T.; Dinga, J.N.; Kishamawe, C.; Morhason-Bello, I.; Hayombe, P.; Adeyemi, O.; Chimuka, E.; Lumu, I.; Amuasi, J.; et al. Commentary on COVID-19 Vaccine Hesitancy in sub-Saharan Africa. Trop. Med. Infect. Dis. 2022, 7, 130. [Google Scholar] [CrossRef]
  107. Chan, N.N.; Ong, K.W.; Siau, C.S.; Lee, K.W.; Peh, S.C.; Yacob, S.; Chia, Y.C.; Seow, V.K.; Ooi, P.B. The lived experiences of a COVID-19 immunization programme: Vaccine hesitancy and vaccine refusal. BMC Public Health 2022, 22, 296. [Google Scholar] [CrossRef]
  108. Afolabi, A.A.; Ilesanmi, O.S. Dealing with vaccine hesitancy in Africa: The prospective COVID-19 vaccine context. Pan Afr. Med. J. 2021, 38, 3. [Google Scholar] [CrossRef]
  109. Dzinamarira, T.; Nachipo, B.; Phiri, B.; Musuka, G. COVID-19 Vaccine Roll-Out in South Africa and Zimbabwe: Urgent Need to Address Community Preparedness, Fears and Hesitancy. Vaccines 2021, 9, 250. [Google Scholar] [CrossRef] [PubMed]
  110. Ekwebelem, O.C.; Yunusa, I.; Onyeaka, H.; Ekwebelem, N.C.; Nnorom-Dike, O. COVID-19 vaccine rollout: Will it affect the rates of vaccine hesitancy in Africa? Public Health 2021, 197, e18–e19. [Google Scholar] [CrossRef]
  111. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet 2022, 399, 629–655. [Google Scholar] [CrossRef]
  112. Alshaikh, F.S.; Godman, B.; Sindi, O.N.; Seaton, R.A.; Kurdi, A. Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19: A systematic review and meta-analysis. PLoS ONE 2022, 17, e0272375. [Google Scholar] [CrossRef] [PubMed]
  113. Founou, R.C.; Blocker, A.J.; Noubom, M.; Tsayem, C.; Choukem, S.P.; Van Dongen, M.; Founou, L.L. The COVID-19 pandemic: A threat to antimicrobial resistance containment. Futur. Sci. OA 2021, 7, FSO736. [Google Scholar] [CrossRef]
  114. Razai, M.S.; Oakeshott, P.; Esmail, A.; Wiysonge, C.S.; Viswanath, K.; Mills, M.C. COVID-19 vaccine hesitancy: The five Cs to tackle behavioural and sociodemographic factors. J. R. Soc. Med. 2021, 114, 295–298. [Google Scholar] [CrossRef] [PubMed]
  115. Roy, D.N.; Biswas, M.; Islam, E.; Azam, S. Potential factors influencing COVID-19 vaccine acceptance and hesitancy: A systematic review. PLoS ONE 2022, 17, e0265496. [Google Scholar] [CrossRef]
  116. Rutten, L.J.F.; Zhu, X.; Leppin, A.L.; Ridgeway, J.L.; Swift, M.D.; Griffin, J.M.; Sauver, J.L.S.; Virk, A.; Jacobson, R.M. Evidence-Based Strategies for Clinical Organizations to Address COVID-19 Vaccine Hesitancy. Mayo Clin. Proc. 2021, 96, 699–707. [Google Scholar] [CrossRef] [PubMed]
  117. Trogen, B.; Pirofski, L.-A. Understanding vaccine hesitancy in COVID-19. Nat. Med. 2021, 2, 498–501. [Google Scholar] [CrossRef]
  118. Ekowo, O.E.; Manafa, C.; Isielu, R.C.; Okoli, C.M.; Chikodi, I.; Onwuasoanya, A.F.; Echendu, S.T.; Ihedoro, I.; Nwabueze, U.D.; Nwoke, O.C. A cross sectional regional study looking at the factors responsible for the low COVID-19 vaccination rate in Nigeria. Pan Afr. Med. J. 2022, 41, 114. [Google Scholar] [CrossRef]
  119. Wilson, S.L.; Wiysonge, C. Social media and vaccine hesitancy. BMJ Glob. Health 2020, 5, e004206. [Google Scholar] [CrossRef] [PubMed]
  120. Wawrzuta, D.; Klejdysz, J.; Jaworski, M.; Gotlib, J.; Panczyk, M. Attitudes toward COVID-19 Vaccination on Social Media: A Cross-Platform Analysis. Vaccines 2022, 10, 1190. [Google Scholar] [CrossRef] [PubMed]
  121. Iwu, C.J.; Jordan, P.; Jaja, I.F.; Iwu, C.D.; Wiysonge, C.S. Treatment of COVID-19: Implications for antimicrobial resistance in Africa. Pan Afr. Med. J. 2020, 35 (Suppl. 2), 119. [Google Scholar] [CrossRef] [PubMed]
  122. Troisi, M.; Andreano, E.; Sala, C.; Kabanova, A.; Rappuoli, R. Vaccines as remedy for antimicrobial resistance and emerging infections. Curr. Opin. Immunol. 2020, 65, 102–106. [Google Scholar] [CrossRef]
  123. Tagoe, E.T.; Sheikh, N.; Morton, A.; Nonvignon, J.; Sarker, A.R.; Williams, L.; Megiddo, I. COVID-19 Vaccination in Lower-Middle Income Countries: National Stakeholder Views on Challenges, Barriers, and Potential Solutions. Front. Public Health 2021, 9, 709127. [Google Scholar] [CrossRef]
  124. Godman, B.; Egwuenu, A.; Haque, M.; Malande, O.; Schellack, N.; Kumar, S.; Saleem, Z.; Sneddon, J.; Hoxha, I.; Islam, S.; et al. Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries. Life 2021, 11, 528. [Google Scholar] [CrossRef]
  125. Godman, B.; Basu, D.; Pillay, Y.; Almeida, P.H.R.F.; Mwita, J.C.; Rwegerera, G.M.; Paramadhas, B.D.A.; Tiroyakgosi, C.; Patrick, O.; Niba, L.L.; et al. Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa; implications for the future. Hosp. Prac. 2020, 48, 51–67. [Google Scholar] [CrossRef]
  126. Godman, B.; Basu, D.; Pillay, Y.; Mwita, J.C.; Rwegerera, G.M.; Paramadhas, B.D.A.; Tiroyakgosi, C.; Okwen, P.M.; Niba, L.L.; Nonvignon, J.; et al. Review of Ongoing Activities and Challenges to Improve the Care of Patients with Type 2 Diabetes Across Africa and the Implications for the Future. Front. Pharmacol. 2020, 11, 108. [Google Scholar] [CrossRef]
  127. Mwita, J.C.; Ogunleye, O.O.; Olalekan, A.; Kalungia, A.C.; Kurdi, A.; Saleem, Z.; Sneddon, J.; Godman, B. Key Issues Surrounding Appropriate Antibiotic Use for Prevention of Surgical Site Infections in Low- and Middle-Income Countries: A Narrative Review and the Implications. Int. J. Gen. Med. 2021, 14, 515–530. [Google Scholar] [CrossRef]
  128. Godman, B.; Leong, T.; Abubakar, A.R.; Kurdi, A.; Kalemeera, F.; Rwegerera, G.M.; Patrick, O.; Lum Niba, L.; Ibrahim, K.; Adefolarin, A.A.; et al. Availability and Use of Long-Acting Insulin Analogues Including Their Biosimilars across Africa: Findings and Implications. Intern. Med. 2021, 11, 343. [Google Scholar]
  129. Godman, B.; Grobler, C.; Van-De-Lisle, M.; Wale, J.; Barbosa, W.B.; Massele, A.; Opondo, P.; Petrova, G.; Tachkov, K.; Sefah, I.; et al. Pharmacotherapeutic interventions for bipolar disorder type II: Addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries. Expert Opin. Pharmacother. 2019, 20, 2237–2255. [Google Scholar] [CrossRef] [PubMed]
  130. Godman, B.; Egwuenu, A.; Wesangula, E.; Schellack, N.; Kalungia, A.C.; Tiroyakgosi, C.; Kgatlwane, J.; Mwita, J.C.; Patrick, O.; Niba, L.L.; et al. Tackling antimicrobial resistance across sub-Saharan Africa; current challenges and implications for the future. Expert Opin. Drug Saf. 2022, 21, 1089–1111. [Google Scholar] [CrossRef]
  131. Mudenda, S.; Mukosha, M.; Hikaambo, C.N.; Meyer, J.C.; Fadare, J.; Kampamba, M.; Kalungia, A.C.; Munsaka, S.; Okoro, R.; Daka, V.; et al. Awareness and acceptance of COVID-19 vaccines and associated factors among pharmacy students in Zambia. Malawi Med. J. 2022, 34, 236–243. [Google Scholar]
  132. Godman, B.; Hill, A.; Simoens, S.; Selke, G.; Selke Krulichová, I.; Zampirolli Dias, C.; Martin, A.P.; Oortwijn, W.; Timoney, A.; Gustafsson, L.L.; et al. Potential approaches for the pricing of cancer medicines across Europe to enhance the sustainability of healthcare systems and the implications. Expert Rev. Pharmacoecon. Outcomes Res. 2021, 21, 527–540. [Google Scholar] [CrossRef] [PubMed]
  133. Godman, B.; Haque, M.; McKimm, J.; Abu Bakar, M.; Sneddon, J.; Wale, J.; Campbell, S.; Martin, A.P.; Hoxha, I.; Abilova, V.; et al. Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: Findings and implications for the future. Curr. Med. Res. Opin. 2019, 36, 301–327. [Google Scholar] [CrossRef] [PubMed]
  134. Gale, N.K.; Heath, G.; Cameron, E.; Rashid, S.; Redwood, S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med. Res. Methodol. 2013, 13, 117. [Google Scholar] [CrossRef]
  135. Allemang, B.; Sitter, K.; Dimitropoulos, G. Pragmatism as a paradigm for patient-oriented research. Health Expect. 2021, 25, 38–47. [Google Scholar] [CrossRef]
  136. Kaushik, V.; Walsh, C.A. Pragmatism as a Research Paradigm and Its Implications for Social Work Research. Soc. Sci. 2019, 8, 255. [Google Scholar] [CrossRef]
  137. Palinkas, L.A.; Horwitz, S.M.; Green, C.A.; Wisdom, J.P.; Duan, N.; Hoagwood, K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Adm. Policy Ment. Health Ment. Health Serv. Res. 2015, 42, 533–544. [Google Scholar] [CrossRef]
  138. World Bank. World Bank National Accounts Data—GDP Per Capita (Current US$). Available online: (accessed on 11 September 2020).
  139. Worldometer. African Countries by Population. 2021. Available online: (accessed on 7 September 2022).
  140. The Economist. How We Estimated the True Death Toll of the Pandemic—Dealing with Potential Outcomes, Known Unknowns, and Uncertainty. 2021. Available online: (accessed on 7 September 2022).
  141. Cox, L.; Yah, C. Estimating actual COVID-19 case numbers using cumulative death count-A method of measuring effectiveness of lockdown of non-essential activities: A South African case study. Pan Afr. Med. J. 2020, 35 (Suppl. 2), 97. [Google Scholar] [CrossRef]
  142. Bradshaw, D.; Dorrington, R.E.; Laubscher, R.; Moultrie, T.A.; Groenewald, P. Tracking mortality in near to real time provides essential information about the impact of the COVID-19 pandemic in South Africa in 2020. S. Afr. Med J. 2021, 111, 732. [Google Scholar] [CrossRef] [PubMed]
  143. WHO. COVID-19 Vaccination in the WHO African Region. Monthly Bulletin June 2022. Available online: (accessed on 7 September 2022).
  144. Ritchie, H.E.; Mathieu, L.; Rodés-Guirao, C.; Appel, C.; Giattino, E.; Ortiz-Ospina, J.; Hasell, B.; Macdonald, D.; Roser, B.A.M. Coronavirus (COVID-19) Vaccinations. 2020. Available online: (accessed on 28 December 2021).
  145. Mathieu, E.; Ritchie, H.; Ortiz-Ospina, E.; Roser, M.; Hasell, J.; Appel, C.; Giattino, C.; Rodés-Guirao, L. A global database of COVID-19 vaccinations. Nat. Hum. Behav. 2021, 5, 947–953. [Google Scholar] [CrossRef] [PubMed]
  146. Rolfe, R.; Kwobah, C.; Muro, F.; Ruwanpathirana, A.; Lyamuya, F.; Bodinayake, C.; Nagahawatte, A.; Piyasiri, B.; Sheng, T.; Bollinger, J.; et al. Barriers to implementing antimicrobial stewardship programs in three low- and middle-income country tertiary care settings: Findings from a multi-site qualitative study. Antimicrob. Resist. Infect. Control 2021, 10, 60. [Google Scholar] [CrossRef] [PubMed]
  147. Wettermark, B.; Godman, B.; Jacobsson, B.; Haaijer-Ruskamp, F.M. Soft regulations in pharmaceutical policy making: An overview of current approaches and their consequences. Appl. Health Econ. Health Policy 2009, 7, 137–147. [Google Scholar]
  148. Godman, B. Health authority activities to enhance the quality and efficiency of medicine use and their impact. Adv. Hum. Biol. 2021, 11, 11. [Google Scholar] [CrossRef]
  149. Moon, J.; Godman, B.; Petzold, M.; Alvarez-Madrazo, S.; Bennett, K.; Bishop, I.; Bucsics, A.; Hesse, U.; Martin, A.; Simoens, S.; et al. Different initiatives across Europe to enhance losartan utilization post generics: Impact and implications. Front. Pharmacol. 2014, 5, 219. [Google Scholar] [CrossRef]
  150. Godman, B.; Wettermark, B.; Van Woerkom, M.; Fraeyman, J.; Alvarez-Madrazo, S.; Berg, C.; Bishop, I.; Bucsics, A.; Campbell, S.; Finlayson, A.E.; et al. Multiple policies to enhance prescribing efficiency for established medicines in Europe with a particular focus on demand-side measures: Findings and future implications. Front. Pharmacol. 2014, 5, 106. [Google Scholar] [CrossRef]
  151. Godman, B.; Malmström, R.E.; Diogene, E.; Gray, A.; Jayathissa, S.; Timoney, A.; Acurcio, F.; Alkan, A.; Brzezinska, A.; Bucsics, A.; et al. Are new models needed to optimize the utilization of new medicines to sustain healthcare systems? Expert Rev. Clin. Pharmacol. 2015, 8, 77–94. [Google Scholar]
  152. Lima-Dellamora, E.D.C.; Caetano, R.; Gustafsson, L.L.; Godman, B.B.; Patterson, K.; Osorio-De-Castro, C.G.S. An Analytical Framework for Assessing Drug and Therapeutics Committee Structure and Work Processes in Tertiary Brazilian Hospitals. Basic Clin. Pharmacol. Toxicol. 2014, 115, 268–276. [Google Scholar] [CrossRef]
  153. Matsitse, T.B.; Helberg, E.; Meyer, J.C.; Godman, B.; Massele, A.; Schellack, N. Compliance with the primary health care treatment guidelines and the essential medicines list in the management of sexually transmitted infections in correctional centres in South Africa: Findings and implications. Expert Rev. Anti-Infect. Ther. 2017, 15, 963–972. [Google Scholar] [CrossRef]
  154. Matlala, M.; Gous, A.G.; Godman, B.; Meyer, J. Structure and activities of pharmacy and therapeutics committees among public hospitals in South Africa; findings and implications. Expert Rev. Clin. Pharmacol. 2017, 10, 1273–1280. [Google Scholar] [CrossRef] [PubMed]
  155. Nguyen, T.T.P.; Do, T.X.; Nguyen, H.A.; Nguyen, C.T.T.; Meyer, J.C.; Godman, B.; Skosana, P.; Nguyen, B.T. A National Survey of Dispensing Practice and Customer Knowledge on Antibiotic Use in Vietnam and the Implications. Antibiotics 2022, 11, 1091. [Google Scholar] [CrossRef] [PubMed]
  156. Alrasheedy, A.A.; Alsalloum, M.A.; Almuqbil, F.A.; Almuzaini, M.A.; Alkhayl, B.S.A.; Albishri, A.S.; Alharbi, F.F.; Alharbi, S.R.; Alodhayb, A.K.; Alfadl, A.A.; et al. The impact of law enforcement on dispensing antibiotics without prescription: A multi-methods study from Saudi Arabia. Expert Rev. Anti-Infect. Ther. 2019, 18, 87–97. [Google Scholar] [CrossRef] [PubMed]
  157. Godman, B.; Haque, M.; Abubakar, A.R.; Ogunleye, O.O.; Sani, I.H.; Sefah, I.; Kurdi, A.; Islam, S. Changes in availability, utilization, and prices of medicines and protection equipment for COVID-19 in an Urban population of Northern Nigeria. J. Res. Pharm. Prac. 2021, 10, 17–22. [Google Scholar] [CrossRef] [PubMed]
  158. Gad, M.; Salem, A.; Oortwijn, W.; Hill, R.; Godman, B. Mapping of Current Obstacles for Rationalizing Use of Medicines (CORUM) in Europe: Current Situation and Potential Solutions. Front. Pharmacol. 2020, 11, 144. [Google Scholar] [CrossRef] [PubMed]
  159. World Health Organization. COVAX. Working for Global Equitable Access to COVID-19 Vaccines. 2020. Available online: (accessed on 19 February 2021).
  160. Ritchie, H.; Mathieu, E.; Rodés-Guirao, L.; Appel, C.; Giattino, C.; Ortiz-Ospina, E.; Hasell, J.; Macdonald, B.; Beltekian, D.; Roser, M. Coronavirus Pandemic (COVID-19). 2020. Available online: (accessed on 7 September 2022).
  161. Xinhua. Botswana Launches Drive-through COVID-19 Caccination Campaign. 2021. Available online: (accessed on 1 August 2022).
  162. Reliefweb. Learning from Botswana’s COVID-19 Vaccine Rollout. 2021. Available online: (accessed on 1 August 2022).
  163. Daily News Egypt. Egypt Launches Campaign to Encourage Public to Register for COVID-19 Vaccination. 2021. Available online: (accessed on 2 August 2022).
  164. Saied, S.M.; Saied, E.M.; Kabbash, I.A.; Abdo, S.A.E. Vaccine hesitancy: Beliefs and barriers associated with COVID-19 vaccination among Egyptian medical students. J. Med. Virol. 2021, 93, 4280–4291. [Google Scholar] [CrossRef]
  165. Qunaibi, E.; Basheti, I.; Soudy, M.; Sultan, I. Hesitancy of Arab Healthcare Workers towards COVID-19 Vaccination: A Large-Scale Multinational Study. Vaccines 2021, 9, 446. [Google Scholar] [CrossRef]
  166. Nabeth, P.; Hassan, M.; Adib, K.; Abubakar, A.; Brennan, R. New COVID-19 resurgence in the WHO Eastern Mediterranean region. Lancet 2021, 397, 1348–1349. [Google Scholar] [CrossRef]
  167. Reliefweb. Eswatini: Vaccinating People against COVID-19 in Hard-to-Reach Communities. 2022. Available online: (accessed on 2 August 2022).
  168. Reliefweb. In Eswatini, Pact Launches App to Fight COVID Misinformation, Vaccine Hesitancy. 2021. Available online: (accessed on 2 August 2022).
  169. Head, M.; Brackstone, K.; Boateng, L. Vaccine Hesitancy Has Risen in Ghana: A Closer Look at WHO’S Worried. 2021. Available online: (accessed on 2 August 2022).
  170. Brackstone, K.; Boateng, L.A.; Atengble, K.; Head, M.; Akinocho, H.; Osei, K.; Nuamah, K. Examining Drivers of COVID-19 Vaccine Hesitancy in Ghana; University of Southampton: Southampton, UK, 2021. [Google Scholar] [CrossRef]
  171. Alhassan, R.K.; Owusu-Agyei, S.; Ansah, E.K.; Gyapong, M. COVID-19 vaccine uptake among health care workers in Ghana: A case for targeted vaccine deployment campaigns in the global south. Hum. Resour. Health 2021, 19, 136. [Google Scholar] [CrossRef]
  172. Agyekum, M.W.; Afrifa-Anane, G.F.; Kyei-Arthur, F.; Addo, B. Acceptability of COVID-19 Vaccination among Health Care Workers in Ghana. Adv. Public Health 2021, 2021, 9998176. [Google Scholar] [CrossRef]
  173. Rufai, N. After Botched Ebola Vaccine Trial, Ghana Struggles with Vaccine Hesitancy. 2021. Available online: (accessed on 1 August 2022).
  174. Afriyie, D.K.; Asare, G.A.; Amponsah, S.K.; Godman, B. COVID-19 pandemic in resource-poor countries: Challenges, experiences and opportunities in Ghana. J. Infect. Dev. Ctries 2020, 14, 838–843. [Google Scholar] [CrossRef] [PubMed]
  175. Fan, J.; Wang, X.; Du, S.; Mao, A.; Du, H.; Qiu, W. Discussion of the Trust in Vaccination against COVID-19. Vaccines 2022, 10, 1214. [Google Scholar] [CrossRef] [PubMed]
  176. Osur, J.; Muinga, E.; Carter, J.; Kuria, S.; Hussein, S.; Ireri, E.M. COVID-19 vaccine hesitancy: Vaccination intention and attitudes of community health volunteers in Kenya. PLoS Glob. Public Health 2022, 2, e0000233. [Google Scholar] [CrossRef]
  177. Orangi, S.; Pinchoff, J.; Mwanga, D.; Abuya, T.; Hamaluba, M.; Warimwe, G.; Austrian, K.; Barasa, E. Assessing the Level and Determinants of COVID-19 Vaccine Confidence in Kenya. Vaccines 2021, 9, 936. [Google Scholar] [CrossRef]
  178. Oyekale, A.S. Compliance Indicators of COVID-19 Prevention and Vaccines Hesitancy in Kenya: A Random-Effects Endogenous Probit Model. Vaccines 2021, 9, 1359. [Google Scholar] [CrossRef]
  179. Republic of Kenya Ministry of Health. National COVID-19 Vaccine Deployment Plan, 2021. National Vaccine & Immunization Program—Acceleration of COVID-19 Vaccination Program in Kenya. Available online: (accessed on 2 August 2022).
  180. The World Bank. Rolling Out COVID-19 Vaccines in Malawi Amid Hesitancy and Supply Challenges. 2021. Available online: (accessed on 1 August 2022).
  181. WHO Malawi. Malawi Marks One Year of COVID-19 Vaccination, 828, 080 People Receive Full Dose. 2022. Available online: (accessed on 1 August 2022).
  182. Masina, L. Malawi Fears Its COVID Vaccines Will Expire Due to Hesitancy. 2021. Available online: (accessed on 1 August 2022).
  183. Tembo, L. Tackling COVID-19 Vaccine Misinformation Through Faith Leaders—Faith Leaders Are Key in Behaviour Change. 2022. Available online: (accessed on 1 August 2022).
  184. Ezigbo, O. Nigeria: Tackling Vaccine Hesitancy Fuelled by Misinformation, Propaganda. 2021. Available online: (accessed on 2 August 2022).
  185. Nomhwange, T.; Wariri, O.; Nkereuwem, E.; Olanrewaju, S.; Nwosu, N.; Adamu, U.; Danjuma, E.; Onuaguluchi, N.; Enegela, J.; Nomhwange, E.; et al. COVID-19 vaccine hesitancy amongst healthcare workers: An assessment of its magnitude and determinants during the initial phase of national vaccine deployment in Nigeria. eClinicalMedicine 2022, 50, 101499. [Google Scholar] [CrossRef]
  186. Njoga, E.O.; Mshelbwala, P.P.; Abah, K.O.; Awoyomi, O.J.; Wangdi, K.; Pewan, S.B.; Oyeleye, F.A.; Galadima, H.B.; Alhassan, S.A.; Okoli, C.E.; et al. COVID-19 Vaccine Hesitancy and Determinants of Acceptance among Healthcare Workers, Academics and Tertiary Students in Nigeria. Vaccines 2022, 10, 626. [Google Scholar] [CrossRef]
  187. Iliyasu, Z.; Umar, A.A.; Abdullahi, H.M.; Kwaku, A.A.; Amole, T.G.; Tsiga-Ahmed, F.I.; Garba, R.M.; Salihu, H.M.; Aliyu, M.H. “They have produced a vaccine, but we doubt if COVID-19 exists”: Correlates of COVID-19 vaccine acceptability among adults in Kano, Nigeria. Hum. Vaccines Immunother. 2021, 17, 4057–4064. [Google Scholar] [CrossRef]
  188. Chukwu, O.A.; Nnogo, C.C. Surmounting inherent challenges in healthcare service delivery for effective procurement and distribution of COVID-19 vaccines; A developing country context. Health Policy Technol. 2021, 10, 100518. [Google Scholar] [CrossRef]
  189. Nkanjeni, U. Over 50? The Health Department Is Offering You Free Transport to Vaccination Sites. 2021. Available online: (accessed on 2 August 2022).
  190. Department of Health Republic of South Africa. Vooma Voucher Communication. 2021. Available online: (accessed on 1 August 2022).
  191. Engelbrecht, M.; Heunis, C.; Kigozi, G. COVID-19 Vaccine Hesitancy in South Africa: Lessons for Future Pandemics. Int. J. Environ. Res. Public Health 2022, 19, 6694. [Google Scholar] [CrossRef]
  192. Kollamparambil, U.; Oyenubi, A.; Nwosu, C. COVID-19 vaccine intentions in South Africa: Health communication strategy to address vaccine hesitancy. BMC Public Health 2021, 21, 2113. [Google Scholar] [CrossRef] [PubMed]
  193. Swed, S.; Mohamed, T.; Sakkour, R.; Motawea, K.R.; Bohsas, H. COVID-19 vaccine hesitancy among indigenous people in Sudan: An incipient crisis. Ann. Med. Surg. 2022, 75, 103379. [Google Scholar] [CrossRef] [PubMed]
  194. Udoh, K. COVID-19 Vaccine Hesitancy in South Sudan; What Lessons Can be Learned From Angola’s Success Story? Am. J. Health Promot. 2022, 36, 579–581. [Google Scholar] [CrossRef] [PubMed]
  195. Raja, S.M.; Osman, M.E.; Musa, A.O.; Hussien, A.A.; Yusuf, K. COVID-19 vaccine acceptance, hesitancy, and associated factors among medical students in Sudan. PLoS ONE 2022, 17, e0266670. [Google Scholar] [CrossRef]
  196. Bongomin, F.; Olum, R.; Andia-Biraro, I.; Nakwagala, F.N.; Hassan, K.H.; Nassozi, D.R.; Kaddumukasa, M.; Byakika-Kibwika, P.; Kiguli, S.; Kirenga, B.J. COVID-19 vaccine acceptance among high-risk populations in Uganda. Ther. Adv. Infect. Dis. 2021, 8, 20499361211024376. [Google Scholar] [CrossRef]
  197. Carcelen, A.C.; Prosperi, C.; Mutembo, S.; Chongwe, G.; Mwansa, F.D.; Ndubani, P.; Simulundu, E.; Chilumba, I.; Musukwa, G.; Thuma, P.; et al. COVID-19 vaccine hesitancy in Zambia: A glimpse at the possible challenges ahead for COVID-19 vaccination rollout in sub-Saharan Africa. Hum. Vaccines Immunother. 2021, 18, 1–6. [Google Scholar] [CrossRef]
  198. McAbee, L.; Tapera, O.; Kanyangarara, M. Factors Associated with COVID-19 Vaccine Intentions in Eastern Zimbabwe: A Cross-Sectional Study. Vaccines 2021, 9, 1109. [Google Scholar] [CrossRef]
  199. Dubé, E. Addressing vaccine hesitancy: The crucial role of healthcare providers. Clin. Microbiol. Infect. 2017, 23, 279–280. [Google Scholar] [CrossRef]
  200. Dror, A.A.; Eisenbach, N.; Taiber, S.; Morozov, N.G.; Mizrachi, M.; Zigron, A.; Srouji, S.; Sela, E. Vaccine hesitancy: The next challenge in the fight against COVID-19. Eur. J. Epidemiol. 2020, 35, 775–779. [Google Scholar] [CrossRef]
  201. Freeman, D.; Waite, F.; Rosebrock, L.; Petit, A.; Causier, C.; East, A.; Jenner, L.; Teale, A.-L.; Carr, L.; Mulhall, S.; et al. Coronavirus conspiracy beliefs, mistrust, and compliance with government guidelines in England. Psychol. Med. 2020, 52, 251–263. [Google Scholar] [CrossRef]
  202. Huangfu, L.; Mo, Y.; Zhang, P.; Zeng, D.D.; He, S. COVID-19 Vaccine Tweets After Vaccine Rollout: Sentiment–Based Topic Modeling. J. Med. Internet Res. 2022, 24, e31726. [Google Scholar] [CrossRef] [PubMed]
  203. Robertson, C.T.; Bentele, K.; Meyerson, B.; Wood, A.S.A.; Salwa, J. Effects of political versus expert messaging on vaccination intentions of Trump voters. PLoS ONE 2021, 16, e0257988. [Google Scholar] [CrossRef] [PubMed]
  204. Ajayi, O. COVID-19: Nigeria Develops Two Vaccines, Awaits Clinical Trials, Certification. 2021. Available online: (accessed on 1 August 2022).
  205. WHO. Pan African Clinical Trials Registry (PACTR). 2022. Available online: (accessed on 2 August 2022).
  206. AHRI. The PAVIA Project Aims to Strengthen Pharmacovigilance (PV) in Four African Countries. 2018. Available online: (accessed on 2 August 2022).
  207. Kibuule, D.; Nambahu, L.; Sefah, I.A.; Kurdi, A.; Phuong, T.N.T.; Kwon, H.-Y.; Godman, B. Activities in Namibia to Limit the Prevalence and Mortality from COVID-19 Including Community Pharmacy Activities and the Implications. Sch. Acad. J. Pharm. 2021, 10, 82–92. [Google Scholar] [CrossRef]
  208. Schellack, N.; Coetzee, M.; Schellack, G.; Gijzelaar, M.; Hassim, Z.; Milne, M.; Bronkhorst, E.; Padayachee, N.; Singh, N.; Kolman, S.; et al. COVID-19: Guidelines for pharmacists in South Africa. S. Afr. J. Infect. Dis. 2020, 35, a206. [Google Scholar] [CrossRef] [PubMed]
  209. Cadogan, C.A.; Hughes, C.M. On the frontline against COVID-19: Community pharmacists’ contribution during a public health crisis. Res. Soc. Adm. Pharm. 2020, 17, 2032–2035. [Google Scholar] [CrossRef]
  210. Hedima, E.W.; Adeyemi, M.S.; Ikunaiye, N.Y. WITHDRAWN: Community pharmacists: On the frontline of health service against COVID-19 in LMICs. Res. Soc. Adm. Pharm. 2020. [Google Scholar] [CrossRef]
  211. Kharel, R.; Baird, J.; Vaishnav, H.; Chillara, N.; Lee, J.A.; Genisca, A.; Hayward, A.; Uzevski, V.; Elbenni, A.; Levine, A.C.; et al. Development and assessment of novel virtual COVID-19 trainer-of trainers course implemented by an academic–humanitarian partnership. Glob. Health Action 2022, 15, 2010391. [Google Scholar] [CrossRef]
  212. WHO. Second Training of Trainers on Infection Prevention and Control. 2021. Available online: (accessed on 6 September 2022).
  213. Xinhua. Skepticism Still Rife Despite Rollout of COVID-19 Vaccine in Zambia. 2021. Available online: (accessed on 1 August 2022).
  214. Shaaban, R.; Ghazy, R.M.; Elsherif, F.; Ali, N.; Yakoub, Y.; Aly, M.O.; ElMakhzangy, R.; Abdou, M.S.; McKinna, B.; Elzorkany, A.M.; et al. COVID-19 Vaccine Acceptance among Social Media Users: A Content Analysis, Multi-Continent Study. Int. J. Environ. Res. Public Health 2022, 19, 5737. [Google Scholar] [CrossRef]
  215. Muric, G.; Wu, Y.; Ferrara, E. COVID-19 Vaccine Hesitancy on Social Media: Building a Public Twitter Data Set of Antivaccine Content, Vaccine Misinformation, and Conspiracies. JMIR Public Health Surveill. 2021, 7, e30642. [Google Scholar] [CrossRef]
  216. IMF. Seven Finance & Trade Lessons from COVID-19 for Future Pandemics. 2022. Available online: (accessed on 2 August 2022).
  217. Chavula, J. COVID-19 Vaccines on Wheels. 2022. Available online: (accessed on 1 August 2022).
  218. Rahman, W. Egypt Allocates Mobile COVID-19 Vaccination Clinics for Elderly, Pensioners. 2021. Available online: (accessed on 1 August 2022).
  219. WHO. New Consortium Working to Boost Vaccine Production in South Africa. 2021. Available online: (accessed on 2 August 2022).
  220. DW. COVID-19: South Africa Develops Own Coronavirus Vaccine. 2021. Available online: (accessed on 2 August 2022).
  221. Sun, T. Boosting COVID-19 Vaccine Production in Nigeria, Others. 2022. Available online: (accessed on 1 August 2022).
  222. Al-Monitor. Egypt Establishes Largest Coronavirus Vaccine Factory in Middle East. 2021. Available online: (accessed on 2 August 2022).
  223. Bloomberg. Aspen’s Covid Flop Bodes Ill for Africa’s Vaccine Making Drive. 2022. Available online: (accessed on 6 September 2022).
  224. Van Nguyen, D.; Nguyen, P.-H. Social media and COVID-19 vaccination hesitancy: The mediating role of the COVID-19 vaccine perception. Heliyon 2022, e10575. [Google Scholar] [CrossRef]
  225. WHO. COVID-19 and Mandatory Vaccination: Ethical Considerations. 2022. Available online: (accessed on 2 August 2022).
  226. Gibelli, F.; Ricci, G.; Sirignano, A.; De Leo, D. COVID-19 Compulsory Vaccination: Legal and Bioethical Controversies. Front. Med. 2022, 9, 821522. [Google Scholar] [CrossRef] [PubMed]
  227. Hsu, J. How COVID-19 Is Accelerating the Threat of Antimicrobial Resistance. BMJ 2020, 369, m1983. [Google Scholar] [CrossRef] [PubMed]
  228. WHO. Strategy to Achieve Global Covid-19 Vaccination by Mid-2022. Available online: (accessed on 2 August 2022).
  229. WHO. COVID-19 Vaccination in Africa Increases by Almost Three-Quarters in June 2022. 2022. Available online: (accessed on 6 September 2022).
  230. Lassi, Z.; Naseem, R.; Salam, R.; Siddiqui, F.; Das, J. The Impact of the COVID-19 Pandemic on Immunization Campaigns and Programs: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 988. [Google Scholar] [CrossRef] [PubMed]
  231. Godman, B.; Sefah, I.A.; Kordorwu, H.E.; Essah, D.O.; Kurdi, A. Prevalence rate of spontaneously reported adverse events and determinants of serious adverse events amongst three outpatient care settings in Ghana: Findings and implications. Adv. Hum. Biol. 2021, 11, 97. [Google Scholar] [CrossRef]
  232. ECA. African Vaccine Acquisition Trust Delivers 108,000 Doses of COVID-19 Vaccine to Botswana. 2021. Available online: (accessed on 2 August 2022).
  233. Ndi, N. Cameroon Receives 200,000 Doses of COVID-19 Vaccines from China. 2021. Available online: (accessed on 1 August 2022).
  234. Amani, A.; Djossaya, D.; Njoh, A.A.; Fouda, A.A.B.; Ndoula, S.; Abba-Kabir, H.M.; Mossus, T.; Nguefack-Tsague, G.; Kamgno, J. The first 30 days of COVID-19 vaccination in Cameroon: Achievements, challenges, and lessons learned. Pan Afr. Med. J. 2022, 41, 201. [Google Scholar]
  235. Unicef Egypt. Egypt Receives 546,400 Doses of COVID-19 Vaccine Donated by France Through AVAT and COVAX Platforms. 2021. Available online: (accessed on 2 August 2022).
  236. Al-Monitor. Spanish Leader Promises COVID-19 Vaccines to Egypt. 2021. Available online: (accessed on 2 August 2022).
  237. Reliefweb. Giving 110%: Eswatini’s Early Rollout of COVID-19 Vaccines. 2021. Available online: (accessed on 1 August 2022).
  238. MyJoyOnline. Akufo-Addo, Bawumia, Others Get Vaccinated against COVID-19. 2021. Available online: (accessed on 2 August 2022).
  239. United Nations News. Ghana Receives First Historic Shipment of COVID-19 Vaccinations from International COVAX Facility. 2021. Available online: (accessed on 2 August 2022).
  240. UNICEF. Another 410,000 COVID-19 Vaccine Doses Arrive in Kenya, Donated by the, U.K. 2021. Available online: (accessed on 1 August 2022).
  241. Njeru, B. Kenya Receives Another Vaccine Donation. 2021. Available online: (accessed on 2 August 2022).
  242. UNICEF. UK Donates COVID-19 Vaccines to Malawi. 2021. Available online: (accessed on 1 August 2022).
  243. UNICEF. Malawi Receives First Shipment of COVID-19 Vaccines from COVAX. 2021. Available online: (accessed on 2 August 2022).
  244. WHO Africa. COVID-19 Vaccines Shipped by COVAX Arrive in Nigeria. 2021. Available online: (accessed on 1 August 2022).
  245. Loembé, M.M.; Nkengasong, J.N. COVID-19 Vaccine Access in Africa: Global Distribution, Vaccine Platforms, and Challenges Ahead. Immunity 2021, 54, 1353–1362. [Google Scholar] [CrossRef]
  246. Ezigbo, O. Nigeria Receives 501, 600 Doses of COVID-19 Vaccine from France. 2022. Available online: (accessed on 2 August 2022).
  247. Adebowale-Tambe, N. COVID-19: Italian Govt Donates over Three Million Doses of Vaccine to Nigeria. 2022. Available online: (accessed on 1 August 2022).
  248. Premium Times. COVID-19: Japanese Govt Donates over 800,000 Doses of AstraZeneca Vaccine to Nigeria. 2022. Available online: (accessed on 1 August 2022).
  249. Chocomilo, S. Spain Donates 4.4m COVID-19 Vaccines To Nigeria. 2022. Available online: (accessed on 2 August 2022).
  250. US Mission. U.S. Donates an Additional 2.5 Million Doses of COVID-19 Vaccines to Nigeria This Week. 2021. Available online: (accessed on 2 August 2022).
  251. Adepegba, A. India Donates 100,000 Doses of COVID-19 Vaccines to Nigeria. 2021. Available online: (accessed on 1 August 2022).
  252. Unicef Sudan. Sudan Joins the COVAX Facility to Ensure Equitable Access to COVID-19 Vaccines—Frequently Asked Questions about COVAX and Sudan’s Participation. 2021. Available online: (accessed on 2 August 2022).
  253. Ryeng, H. The First COVID-19 Vaccines Have Arrived in Tanzania—An Important Milestone in the Fight against COVID-19. 2021. Available online: (accessed on 1 August 2022).
  254. Africanews. Tanzania Receives 500,000 Sinopharm Vaccines from China. 2021. Available online: (accessed on 2 August 2022).
  255. Kamoga, J. Uganda to Roll Out First Round of COVID-19 Vaccine on March 10. 2021. Available online: (accessed on 1 August 2022).
  256. UNICEF. Uganda to Benefit from UK COVID-19 Vaccines Donation. 2021. Available online: (accessed on 2 August 2022).
  257. The Independent. Uganda Receives COVID-19 Vaccine Donation from India. 2021. Available online: (accessed on 1 August 2022).
  258. James, J. COVID-19 Vaccines Shipped by COVAX Arrive in Zambia—Donation by France; COVAX Local Press Statement on Arrival of 228,000 Vaccines in Zambia. 2021. Available online: (accessed on 2 August 2022).
  259. Madhi, S.A.; Baillie, V.; Cutland, C.L.; Voysey, M.; Koen, A.L.; Fairlie, L.; Padayachee, S.D.; Dheda, K.; Barnabas, S.L.; Bhorat, Q.E.; et al. Efficacy of the ChAdOx1 nCoV-19 COVID-19 Vaccine against the B.1.351 Variant. N. Engl. J. Med. 2021, 384, 1885–1898. [Google Scholar] [CrossRef]
  260. Sisonke Programme—Sisonke Study Protecting Healthcare Workers. 2021. Available online: (accessed on 1 August 2022).
  261. SAMRC. Vast Majority of Breakthrough Infections in Vaccinated Health Workers Are Mild. 2021. Available online: (accessed on 1 August 2022).
  262. APA-Mbabane. Eswatini Adds AstraZeneca to COVID-19 Booster Doses. 2022. Available online: (accessed on 2 August 2022).
  263. Wikipedia. COVID-19 Vaccination in Ghana. 2021. Available online: (accessed on 1 August 2022).
  264. Larbie, S. GHS Begins Administering COVID-19 Vaccine Booster Shots. 2022. Available online: (accessed on 2 August 2022).
  265. Saya, M. Kenya Starts Giving COVID-19 Vaccine Booster Shots. 2021. Available online: (accessed on 1 August 2022).
  266. Kalekye, M. Kenya Administers 114,007 Covid Booster Jabs. 2022. Available online: (accessed on 2 August 2022).
  267. Silas, D. FG Govt Approves COVID-19 Vaccines Booster for Nigerians. 2021. Available online: (accessed on 1 August 2022).
  268. The Independent. Uganda Alters COVID-19 Vaccine Roll-Out Plan to Cover More People. 2021. Available online: (accessed on 2 August 2022).
  269. Nabatanzi, V. COVID-19: Govt to Roll Out Vaccination to Children. 2022. Available online: (accessed on 1 August 2022).
  270. Unicef Uganda. Country Office Annual Report 2021. Available online: (accessed on 2 August 2022).
  271. AllAfrica. Uganda: Health Ministry Approves COVID-19 Booster Shots for Ugandans. 2021. Available online: (accessed on 1 August 2022).
  272. Jere, J. Booster Jab Available in All Public Health Centers. 2021. Available online: (accessed on 2 August 2022).
  273. Cajnewsafrica. Zimbabwe Takes Lead in COVID-19 Rollout. 2021. Available online: (accessed on 1 August 2022).
  274. Gonye, V. Govt Gives Guidelines on Booster Shots. 2021. Available online: (accessed on 2 August 2022).
Figure 1. Changes in full vaccination coverage between December 2021 and June 2022. NB: DEC-21-F = fully vaccinated by protocol as of 31 December 2021, JUN-22-F = fully vaccinated by the protocol as of 30 June 2022. Based on [143,144,145,160].
Figure 1. Changes in full vaccination coverage between December 2021 and June 2022. NB: DEC-21-F = fully vaccinated by protocol as of 31 December 2021, JUN-22-F = fully vaccinated by the protocol as of 30 June 2022. Based on [143,144,145,160].
Vaccines 10 01553 g001
Table 1. Current population size, GDP/capita, and COVID-19 infection rates among participating African countries.
Table 1. Current population size, GDP/capita, and COVID-19 infection rates among participating African countries.
CountryPopulation Size (Thousands)GDP/Capita (US$)Accumulated Infection Rate (Thousands)Accumulated Mortality Rate (Thousands)
South Africa59,308.695090.74010.2102.1
Table 2. COVID-19 vaccination coverage across African countries as of 31 December 2021 and 30 June 2022.
Table 2. COVID-19 vaccination coverage across African countries as of 31 December 2021 and 30 June 2022.
CountryVaccination Coverage—31 December 2021—% of the Total PopulationVaccination Coverage—30 June 2022—% of the Total Population
Full (Completed)PartialFull (Completed)Partial
Ghana 7.110.521.99.9
South Africa26.
Uganda 3.918.824.311.1
NB: Data sources—[143,144,145,160]. NB: Full coverage means the total number of people who received all doses prescribed by the initial vaccination programme divided by the total population of the country [144].
Table 3. Number of vaccine doses utilised by the countries as of 31 December 2021 and 30 June 2022.
Table 3. Number of vaccine doses utilised by the countries as of 31 December 2021 and 30 June 2022.
CountriesDoses as of 31 December 2021Doses as of 30 June 2022
BotswanaNA2.73 million
Cameroon1.02 million1.85 million
Egypt57.49 million91.45 million
Ghana 7.76 million18.24 million
Kenya10.12 million18.54 million
Malawi1.8 million3.17 million
Nigeria14.84 million55.47 million
South Africa27.97 million36.82 million
Sudan3.64 millionNA
Tanzania2.43 million12.07 million
Uganda 12.09 million21.76 million
Zambia1.73 million7.2 million
Zimbabwe 7.26 million11.97 million
Africa303.51 million550.21 million
World9.18 billion12.1 billion
NB: Data sources—[144,145,160].
Table 4. Levels of access, acceptance, hesitancy, and challenges with COVID-19 vaccines across Africa.
Table 4. Levels of access, acceptance, hesitancy, and challenges with COVID-19 vaccines across Africa.
CountryAccess, Acceptance, Hesitancy and Challenges
Botswana [161,162]Access:
  • Typically, good and easy access, with District Health Management Teams (DHMT) opening vaccination sites across Botswana.
  • Access was also improved by involving selected private facilities.
  • Drive-through COVID-19 vaccination campaigns at the University of Botswana, Gaborone, and in Francistown also improved access.
  • High acceptance rates as evidenced by people travelling some distance to seek vaccinations potentially enhanced by most people in Botswana either having been previously affected by COVID-19 or having lost a close family member/friend to COVID-19.
  • A deployment plan was undertaken a few weeks before the first vaccine arrived, and the survey showed an acceptance rate of 76%.
  • Some hesitancy was identified in an early survey at the beginning of the vaccination rollout program among younger HCWs exacerbated by the spread of misinformation; however, this is changing.
  • Initially, social media was the main source of information generally across Botswana, which reported mainly selected AEFIs. The government’s Task Force counteracted that by providing updates on COVID-19 and vaccinations, as well as campaigns such as ‘Arm Ready’.
  • The Botswana Medicines Regulatory Authority was also involved in sharing information on vaccinations and AEFIs.
  • Shortage of vaccinators, HCPs, and support staff.
  • Equipment shortages and low internet bandwidth in some areas hampering the use of the electronic data systems to track the administration of vaccines and adverse effects.
Cameroon [82,143,144]Access:
  • Access was high with availability across all health facilities.
  • Typically, poor acceptance reflected in high levels of hesitancy in Cameroon.
  • High hesitancy because of mistrust of the vaccine and the ongoing myth that the COVID-19 is not a serious disease in black Africans.
  • Considerable spread of misinformation and propaganda such as “you can light a bulb from vaccination sites on the skin”, “plot to use genetic coded molecule to make humans barren through vaccination”.
  • Difficulties with accessing hard to reach locations for vaccination.
  • Poor storage conditions with frequent power outages.
  • Limited human resources to cover a large population.
  • Successfully addressing the misinformation and increasing trust in the COVID-19 vaccines.
Egypt [85,163,164,165,166]Access:
  • Access appears easy for the whole population, with the Egyptian Ministry of Health and Population deploying a web-based vaccine management system active in effect on March 2021. This system allows citizens to register with their national passports and mobile numbers and to receive notifications on assigned date, time, and place for vaccination.
  • In mid-September 2021, the Egyptian Prime Minister launched a campaign called “Together To Reassure” to encourage citizens to register on the Health Ministry’s website to obtain their COVID-19 vaccines in three governorates (Cairo, Giza, and Alexandria) in the initial stage and later in other governorates. The campaign lasted 10 days from 10 h to 22 h and included three open-topped and equipped buses touring each governorate.
  • The acceptance of the COVID-19 vaccine has been variable across Egypt.
  • Based on a cross-sectional study undertaken among medical students in Egypt, 90.5% of study participants recognised the importance of COVID-19 vaccination, but 46% were vaccine hesitant.
Vaccine hesitancy has been reported in many studies across Egypt due to a number of reasons. These include:
  • Signing informed consent before vaccination gives the perception to people that they will be part of a clinical trial, thereby increasing public fear and refusal.
  • A false belief that the COVID-19 vaccination would be offered to only a specific segment of the population.
  • False claims on social media about AEFIs and including information/misinformation about patients who died after their vaccination.
  • Circulation of conspiracy theories on various social media platforms.
  • Reports of blood clotting in people after their vaccination increased public panic and hesitancy.
  • There are concerns especially among highly educated people regarding the safety and efficacy of the vaccines.
  • Other challenges include limited data regarding the COVID-19 vaccine’s adverse effects, the perceived unsafe nature of the vaccine, and fear of genetic alterations (especially the Pfizer vaccine).
  • Effectively addressing misinformation regarding COVID-19 vaccines circulating in various social medica platforms and increasing trust in the vaccines where there are concerns.
Eswatini [167,168]Access:
  • Access is good, decentralization to the ‘Tinkhundla’ centres (Chiefdoms) bringing services to the rural population eliminating traveling cost.
  • Vaccination is also available in shopping malls and all public centres.
  • Acceptance was low at the beginning of the vaccination program but has gradually improved with increasing educational and awareness campaigns.
  • The increase in fatalities from COVID-19 has also made the public increasingly consider the vaccine.
  • Awareness was strengthened and acceptance was improved through public media campaigns with the sharing of evidence-based information on vaccine safety and differential mortality between vaccinated and unvaccinated groups.
  • Public figures, e.g., governors, religious leaders, and celebrities, aired receiving vaccines and testifying to their safety and benefits.
  • Vaccine hesitancy was exacerbated in Eswatini by misinformation and myths, especially on social media alongside social and religious beliefs. This included fake news relating to the level of side-effects, speculated alteration of the DNA sequence, and an alleged plan of the G5 network to reduce the world population.
  • There are ongoing activities to try and address this. These include strengthening awareness through social and public media regarding the effectiveness and safety of current vaccines alongside the morbidity and mortality associated with COVID-19 among unvaccinated patients. In addition, potentially posting documentaries as well as testaments from key personnel including HCPs, religious leaders, and others regarding the benefits of the vaccine to the population.
  • Speculations that the vaccine design might not be effective against all the possible variants or mutations.
  • Lack of mutational analysis or genetic sequences to map the genetic variants and mutations currently in circulation.
  • Non-compliance with pharmacological interventions alongside continued vaccine hesitancy could lead to further lockdowns. This needs to be avoided going forward through proactive communications via social media and other platforms.
Ghana [15,92,169,170,171,172,173,174]Access:
  • COVID-19 vaccination is currently free in Ghana, but access to vaccination has been a challenge due to frequent shortages.
  • Different acceptability levels among different populations in Ghana, including HCPs.
  • Vaccine acceptance in Ghana ranges from 41% to 71% of the surveyed population, according to several studies undertaken in Ghana.
  • Hesitancy has been observed in Ghana as a threat to controlling the pandemic among the general population, which needs to be addressed.
  • The most common reasons for vaccine hesitancy include misinformation through the media, fear of harmful side-effects, and mistrust of the authorities.
  • Vaccine availability is a real challenge for Ghana, as quantities are not sufficient at vaccination points to ensure continuous vaccination.
  • In addition, there is a need for pro-active approaches form key stakeholder groups, including Ministry of Health personnel, to address the misinformation that is exacerbating vaccine hesitancy as well as restore trust in the government. Ghana was very proactive with a number of public health and other measures at the start of the pandemic, which needs to continue.
Kenya [120,175,176,177,178,179]Access:
  • The Ministry of Health (MoH) website is full of information urging citizens to get vaccinated, with increased availability of different types of vaccines so that citizens can choose.
  • Increased use of public places including markets, churches, mosques, bus stops, and other public areas for vaccination so that a variety of HCWs can reach out to the population—with variable acceptance among community health volunteers.
  • Vaccination production/manufacture has been introduced in Kenya to supplement donated vaccines.
  • There are concerns with current acceptance rates. In August 2021, 36% of Kenyans surveyed were unsure about COVID-19 vaccines due to conflicting information, rumours, misinformation, and conspiracy theories.
  • Social and mainstream media was used to try and address this, building on the increasing role of social media worldwide with influencing vaccine hesitancy coupled with the need to address issues of trust, with information emanating from the MoH and other key stakeholder groups.
  • The government also suggested restricting the access of certain services to citizens who are not fully vaccinated.
  • Vaccine hesitancy exists and was estimated at 15% in March 2021 before the vaccine roll out program.
  • The principal reasons for hesitancy include beliefs that vaccines will affect the reproductive system; people in rural areas do not believe COVID 19 is real; anti-vaxxers on social media (typically outside of Kenya); and concerns with the safety of current vaccines.
  • Conspiracy theories, e.g., vaccines are an effort by global leaders to reduce the population size among African nations, that the vaccine might cause infertility, or that vaccinated people might “drop dead” in a few years.
  • Beliefs by some that the COVID-19 vaccine is the biblical “mark of the beast,” with those accepting the “mark” as signifying their allegiance to Satan.
  • Remarks by those vaccinated but still contracting the virus stating: “What’s the point of getting the vaccine if you can still get sick?”.
  • Transportation to hard-to-reach rural areas and issues of storage and cold chain storage.
  • The extensive use of the internet in the communication of vaccination schedules and other critical information regarding the vaccines meant that older people were left behind.
  • Shortage of doses and their unpredictability impacting programmes.
  • Lack of structured risk communications as well as public health messaging addressing concerns that were exacerbated via social media platforms.
Malawi [180,181,182,183]Access:
  • There were limited quantities of the vaccines available for the population.
  • Various programmes were instigated to increase uptake, including visiting trading places to vaccinate the populous and visiting churches and mobile village clinics.
  • Ongoing programs, in which, if there are at least ten people in a household/homestead/village (or any one place) willing to be vaccinated, they can call authorities who will send a mobile van to vaccinate them.
  • Acceptance of COVID-19 vaccines was affected by concerns with their actual effectiveness following misinformation.
  • The other major issue is that the rural people (who are in majority, approximately 80–85% of the population) believe that COVID-19 is a disease for the rich and town/city people, as most recognised deaths are from the educated/rich people who in most cases reside in urban areas.
  • There is high hesitancy among the population, resulting in slow COVID-19 vaccine uptake exacerbated by misinformation that the vaccine will cause infertility, that it is the ‘’mark of the beast (666)’’, as well as the notion that the authorities in Malawi are getting financial rewards for the COVID-19 crisis while the poor should just receive the vaccine.
  • This has resulted in faith leaders being approached to help address misinformation promulgated via social media and other channels.
  • The vaccination program was faced with limited supply, hesitancy caused by misinformation, and fear of adverse reactions and access challenges.
  • The short lifespan of the vaccine has resulted in the destruction of expired vaccines, which is a concern of wasting valuable resources.
  • Long distances and poor road infrastructures in some areas where people live chalenged attendance at the vaccination sites. This needs to be proactively addressed going forward.
Nigeria [184,185,186,187,188]Access:
  • Initially, access was restricted, with the vaccines only administered in government-owned public facilities.
  • More recently, some state governments (including Lagos State) have included private healthcare facilities.
  • There is general apathy and unwillingness to have the vaccine among the general population in Nigeria.
  • This is due to the spread of misinformation and conspiracy theories by those opposed to the COVID-19 vaccines via social media and other platforms.
  • Hesitancy occasioned by the spread of misinformation mainly through social media (WhatsApp, Facebook especially), including misinformation about fertility and adverse effects.
  • There is also the belief that COVID-19 is an illness of the affluent; consequently, there is no need for people in lower socio-economic groups to be vaccinated.
  • The fact that fully vaccinated individuals are infected again has made people believe that there is no need to have the vaccine if one still catches the disease.
  • Proper storage facilities.
  • Donation of vaccines with short shelf lives (this has led to the destruction of a million vaccine doses recently in Nigeria).
  • Ensuring a steady supply of the vaccines to address disruptions in supply.
  • Addressing the considerable misinformation via social media, as well as enhancing trust in government and other bodies that seek to address pertinent misinformation.
South Africa [90,189,190,191,192]Access:
  • The Electronic Vaccination Data System (EVDS) was introduced with the roll-out for registration of vaccinators, scheduling of appointments and reminders for vaccinees, and generation of personal vaccination records and to support the constant flow of data and information in all directions between area-based, district, and provincial vaccine rollout teams.
  • Department of Health online resource and news portal ( 1 August 2022 with a hotline, WhatsApp contact numbers, and email addresses to facilitate communication on all aspects of COVID-19 and vaccination very early in the pandemic.
  • Good public-and private-sector collaboration to open as many vaccination sites as possible across the country.
  • Access was made easier by allowing ‘walk-in’ to clinics with an ID and no need to pre-register and/or make an appointment on the EVDS.
  • Variety of vaccination sites, as well as bringing the vaccines closer to people enhanced access, e.g., mass vaccination sites, pop-up sites, mobile units, drive-through facilities, and vaccination services being available over weekends.
  • Free transport to vaccination sites for people ≥ 50 years old in selected provinces.
  • Incentives created through Vooma vouchers worth R200 for people aged ≥50 years who were vaccinated for the first time (from 1 November 2021 for those ≥ 60 years and from 18 November 2021 for those aged 50–59 years until 28 February 2022).
  • Vaccine acceptance reasonable; however, room for improvement.
  • Increase in acceptance was not reflected in the levels of vaccine uptake seen.
  • Inclusion of community organisations was important to ensure vaccination information is addressing community needs and is responsive to social norms.
  • There were concerns with vaccine hesitancy in South Africa influencing uptake rates—with issues of trust in the government being a contributing factor.
  • High levels of hesitancy around the safety of the vaccines.
  • Perceptions of people that their current physical state whether pregnant or breastfeeding, or having an underlying condition, precluded them from getting vaccinated.
  • Other factors influencing hesitancy include age, education, geographical location, employment, and ethnicity.
  • General low vaccine uptake by the 18–34 years of age cohort.
  • Decrease in vaccine demand from September 2021, while access was not a significant challenge.
  • Vaccination mandates remained a difficult topic in South Africa for most of 2021
  • Public trust in the government is a concern that needs to be proactively addressed, as it is identified as one of the reasons for the current vaccine hesitancy in South Africa.
  • Low acceptance of vaccines by certain HCWs and influential figures.
Sudan [193,194,195]Access:
  • Vaccines are administered to the target groups at their residential areas in selected PHC facilities to enhance access.
  • Awareness campaigns through different social media and other channels to enhance uptake.
  • There is moderate level of acceptance to be vaccinated, although there are variable rates across Sudan and among different groups.
  • Variable levels of hesitancy throughout the country due to circulating misinformation, a particular challenge in South Sudan.
  • There are also high levels of hesitancy among medical students, which needs to be addressed going forward.
  • The source of misinformation is typically social media.
  • Vertical delivery of the vaccines (with limited use of EPI facilities) makes the distribution sub -optimal.
  • Need to actively address the extent of misinformation that is circulating via social media to reduce current hesitancy.
  • Access is now good with ready availability of the vaccines in all public and some private tertiary health care facilities, overcoming previous concerns.
  • Improving, but from low rates of vaccinations initially. Public education has been improved to increase acceptance.
  • Vaccine hesitancy seen in the early days following negative publicity. This is now reducing, leading to higher vaccination rates.
  • Coverage remains low.
  • Need to continue to address misinformation and beliefs through social media and other platforms to improve vaccination rates from a low base.
Uganda [68,81,196]Access:
  • Very high level; practically all types of vaccines are readily available across the country.
  • Overall, fairly good acceptance, although there are variations seen among different groups.
  • Exists especially for Chinese vaccines and for children under 12 years of age, where the school vaccination program widely resisted forcing the ministry to halt the planned roll out.
  • Expiration of vaccines due to poor uptake in some areas.
  • Inadequate social mobilization.
Zambia [89,131,197]Access:
  • Zambia has 265 designated COVID-19 vaccination sites across the country.
  • Accessibility to the vaccine is higher for those in urban areas compared to those in rural areas.
  • High public sensitisation (through electronic, social, and print media) by the government.
  • A large proportion of adult Zambians are currently either uncertain or unwilling to be administered the COVID-19 vaccine, including pharmacy students. A third (33.4%) of surveyed adult Zambians would accept to be vaccinated according to a study that was conducted in April 2021, when the Oxford/AstraZeneca vaccine was just being rolled out.
  • Another survey reported an acceptance of 66% among caregivers in selected districts in Zambia.
  • Vaccine hesitancy from fear of potential adverse effects, concerns about the effectiveness of the vaccines, misinformation regarding the constituents of the vaccines, and barriers to access.
  • Misinformation mostly propagated through social media and religious groups that COVID-19 vaccines cause premature death, including that COVID-19 vaccination is one large experiment and local populations are being used in experiments.
  • Most rural populations perceived COVID-19 as ‘a disease of the West’; consequently, they are uncertain about the need to get vaccinated on account of their belief that COVID-19 poses no risk to them.
  • Insufficient information provided to the public on vaccines by authorities, especially given the relatively low literacy levels.
  • Strategies to counteract COVID-19 vaccine misinformation are currently not robust enough, with a need for all key stakeholder groups to actively engage in social media activities in the future to address misinformation and its consequences.
  • Inadequate human resource/specialists in immunisation, immunology, and vaccinology to address vaccine-related concerns.
Zimbabwe [93,106,109,175,198]Access:
  • Vaccines are widely accessible both in urban and rural areas throughout Zimbabwe.
  • Daily vaccination rates decreased after the third wave, indicating less willingness to get vaccinated, which needs to be addressed going forward.
  • Vaccine hesitancy has resulted in often low demand for the vaccine, especially after the third wave and during the omicron wave where there is low risk perception.
  • Religious beliefs, social media conspiracy theories, lack of trust and confidence in the government, and the desire to have children in the future where the vaccine is perceived to cause sterility are the main reasons for vaccine hesitancy in Zimbabwe.
  • There is widespread misinformation now dubbed “the infodemic” spread through social media, including WhatsApp and Twitter, which can involve HCPs.
  • Convincing citizens to be vaccinated since vaccinated people still get infections, even though they are less likely to be hospitalized or die.
  • The changing dose regimens with the introduction of booster doses also makes those who are hesitant more sceptical.
  • Need to actively address misinformation promulgated via social media, as well as increase trust in the government and other key stakeholder groups going forward
NB: AEFI = adverse events following immunization; HCPs = healthcare professionals; HCW = healthcare workers; PHCs: Primary healthcare centres.
Table 5. Key activities to improve vaccination rates in current and future pandemics.
Table 5. Key activities to improve vaccination rates in current and future pandemics.
Key ActivitiesWays Forward
Research activities
  • Greater involvement of African countries in basic research surrounding the science of infectious diseases and participation in clinical trials is important going forward to help inform the public, building on key activities initially surrounding COVID-19, including genomic sequencing and the local manufacture of ventilators to address shortages [15,174]. This also builds on current research activities among African countries to develop and test vaccines [204].
  • Improving pharmacovigilance (PV) activities is also crucial for the future to rapidly capture and convey accurate information regarding the effectiveness and safety of current and future vaccines in the real world to address misinformation, especially misinformation promulgated via various social media platforms [120]. This builds on initiatives, including a Pan-African clinical trial registry [205], as well as strengthening current PV activities [206].
  • Assessing the potential for using performance-based financing and incentives for HCWs, including HCPs, to improve vaccination coverage where there are concerns.
  • Qualitative, context-specific social and behavioural research to complement quantitative surveys to enhance the understanding of perceptions and reasons for vaccine hesitancy in order to help develop future pertinent interventions that build trust and confidence in vaccines and vaccination.
  • Development of context-specific vaccine hesitancy measurement tools to measure the impact of interventions, including those designed for various social media platforms, on vaccine confidence and acceptance and their overall cost-effectiveness, to provide future guidance.
Healthcare professionals (HCPs)
  • Improving HCPs’ education regarding the science behind vaccines and the importance of the vaccinations for themselves and the general population. This includes addressing key concerns regarding COVID-19 vaccines during university education, as well as continuous professional development post-qualification given current concerns among a number of HCPs.
  • Through educational programmes, community pharmacists, and other HCPs, people can be empowered with additional knowledge and skills to play a key role in addressing misinformation and reducing hesitancy [207,208,209,210].
  • Such programmes can be part of e-learning approaches, with hybrid learning approaches growing post the current pandemic [10].
  • Expand on the training of trainers (TOT) approach for capacity development to help address concerns among HCPs, given their increasing role with addressing misinformation and hesitancy and restoring trust [120,175,211,212].
Medical journalists and other key influencers
  • Governments need to work closely with medical journalists and other key influencers to promote key issues regarding the effectiveness and safety of vaccines to help counter misinformation.
  • This is especially the case for misinformation spread via social media platforms, given their increasing influence and role in promulgating misinformation regarding COVID-19 [120].
General Public
  • Ensure programmes are in place, including those via pertinent social media platforms, to convey the benefits of vaccines. As a result, enhance uptake as well as address possible areas of misinformation co-ordinated by key national government and regional groups, as well as involve groups such as religious leaders and elders [120,213]. This should also include educational programmes in schools.
  • Social media platforms are considered a key focus area given the rapidity with which misinformation can spread with its subsequent impact on accelerating the inappropriate use of medicines alongside increasing vaccine hesitancy [20,40,120,214,215].
  • This can also include government educational posters in major sites across countries conveying the benefits of vaccines during the current and future pandemics. Such posters/campaigns need to be in native languages and sensitive to local cultures.
  • Governments need to introduce or enhance online data management systems with key information regarding the effectiveness and safety of vaccines, as well as their availability and uptake, to incentivise people to come forward and be vaccinated. This includes robust systems to capture possible side-effects.
Communication strategies
  • Context-specific and comprehensive communication strategies for vaccines, aimed at disseminating accurate and transparent information and in a timely manner, are essential going forward. In addition, so is ensuring communication through appropriate social media channels [120,215].
  • Content of any communication and messaging should be evidence-based, given the level of misinformation seen to date surrounding COVID-19, its prevention with vaccines, and treatment [16,20,28,120].
  • Collaboration between government, regulatory authorities, civil society, and academia to coordinate the content of communication and speak as one co-ordinated voice. Similar engagement with pharmaceutical companies where there are concerns with the level of misinformation regarding current vaccines and the potential negative impact.
  • Continuous and structured social and community listening to inform communication strategies and interventions to enhance vaccine confidence.
Access and availability [216]
  • Improving access to vaccination, including rural areas, is crucial to future success.
  • This will involve multiple groups delivering the vaccines, including community pharmacists, as well as the use of mobile vaccination clinics [217].
  • Improving storage facilities for vaccines especially in rural areas, which includes upgrading the available cold chains and the installation and maintenance of solar systems that support cold chains and water supplies. Such activities would help with readily available vaccines during pandemics and minimise the burden on government planning and financing.
Patient Incentives
  • Consider offering incentives to the public to enhance vaccination rates.
  • Alongside this, reduce any travelling time to obtain vaccines by ensuring the availability of vaccination sites locally, which can include mobile clinics [217,218].
Local production
  • Increasing knowledge transfer to enhance the local production of vaccines to help address concerns with possible shortages and to reduce costs and misinformation with current and future pandemics, building on current initiatives [219,220,221,222]. However, there needs to be a market for locally produced vaccines; otherwise, plants may close [223].
  • In the meantime, African governments should continue with global groups such as the World Bank and GAVI to help secure adequate local supplies of vaccines.
Financial support
  • Financial support to enable demand creation strategies, social mobilisation, and comprehesive communication strategies incorporating motivational messaging, including pertinent social medial platforms, given their increasing influence [120,224].
Compulsory vaccination [225,226]
  • Compulsory vaccination programmes were instigated in some countries for key workers, such as those dealing with the elderly, and in at least four countries worldwide for all citizens (Federated States of Micronesia, Indonesia, Tajikistan, and Turkmenistan).
  • However, before instigating compulsory vaccination, there are key legal, ethical, and other issues that need to be considered, including necessity and proportionality, as well as public trust in the effectiveness and safety of the vaccine.
Health system
  • Integration of COVID-19 vaccination with routine EPI services at the primary healthcare level.
NB: HCPs = healthcare professionals.
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MDPI and ACS Style

Ogunleye, O.O.; Godman, B.; Fadare, J.O.; Mudenda, S.; Adeoti, A.O.; Yinka-Ogunleye, A.F.; Ogundele, S.O.; Oyawole, M.R.; Schönfeldt, M.; Rashed, W.M.; et al. Coronavirus Disease 2019 (COVID-19) Pandemic across Africa: Current Status of Vaccinations and Implications for the Future. Vaccines 2022, 10, 1553.

AMA Style

Ogunleye OO, Godman B, Fadare JO, Mudenda S, Adeoti AO, Yinka-Ogunleye AF, Ogundele SO, Oyawole MR, Schönfeldt M, Rashed WM, et al. Coronavirus Disease 2019 (COVID-19) Pandemic across Africa: Current Status of Vaccinations and Implications for the Future. Vaccines. 2022; 10(9):1553.

Chicago/Turabian Style

Ogunleye, Olayinka O., Brian Godman, Joseph O. Fadare, Steward Mudenda, Adekunle O. Adeoti, Adesola F. Yinka-Ogunleye, Sunday O. Ogundele, Modupe R. Oyawole, Marione Schönfeldt, Wafaa M. Rashed, and et al. 2022. "Coronavirus Disease 2019 (COVID-19) Pandemic across Africa: Current Status of Vaccinations and Implications for the Future" Vaccines 10, no. 9: 1553.

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