New global survey data published in Health Affairs shows that half of unvaccinated respondents said they wanted a COVID-19 vaccine but were not able to obtain the shots, suggesting that unmet supply needs still drives low vaccine uptake in many low- and middle-income countries.
The survey came from 15,696 respondents in 17 countries in Africa and the Western Pacific. Surveys were conducted from May 2022 to January 2023.
'Twin barriers' to vaccination
The authors of the report said the finding sheds light on accessibility and acceptability, what they call the twin barriers to COVID-19 vaccination.
Nationally representative surveys included 8,518 responses from 10 Western Pacific countries (Cambodia, Fiji, Laos, Malaysia, Mongolia, the Philippines, Solomon Islands, Tonga, Vanuatu, and Vietnam), collected in May 2022 and January 2023, and 7,179 responses from 7 African countries (Cameroon, the Democratic Republic of the Congo [DRC], Kenya, Nigeria, Senegal, South Africa, and Uganda), collected in August 2022, the authors said.
Respondents were asked about vaccine status and number of doses.
"We estimated unmet immunization demand, as the dependent variable for regression, by using the question asking whether respondents would receive available COVID-19 vaccines for themselves," the authors wrote. "Respondents who replied 'definitely yes' or 'unsure but leaning towards yes' were treated as being willing to vaccinate."
Those questions were given only to participants who said they were unvaccinated.
Unmet demand highest in Africa
African countries had the highest rate of respondents who said they wanted to be vaccinated but were unable to obtain a vaccine. Unmet immunization demand was highest in the DRC (43%), Nigeria (39%), Cameroon (36%), Senegal (30%), and Kenya (27%).
In contrast, unmet demand was lower than 7% in Western Pacific countries, the authors said.
Among all survey respondents, 72% of people reported having received at least one vaccine dose. Again, African countries had the lowest percentage of people reporting at least one dose of COVID-19 vaccine, and in all seven African nations, less than 20% of the population had received a booster shot.
The findings, the authors wrote, shift the narrative away from vaccine hesitancy and development to vaccine access in low- and middle-income countries.
This proportion was substantially higher in sub-Saharan Africa, with unmet demand ranging from 11 percent to 43 percent.
"Across all seventeen countries, the percentage of the population with unmet demand for COVID-19 vaccination made up about 14 percent of the sample. However, this proportion was substantially higher in sub-Saharan Africa, with unmet demand ranging from 11 percent to 43 percent," the authors wrote.
"This suggests that a substantial proportion of nonvaccination is due to uneven accessibility of vaccines, as opposed to hesitancy, and it suggests that there is still much work to be done to build health care infrastructure and distribution capacity in low- and middle-income countries, especially in sub-Saharan Africa."
