ACADEMIA Letters Understanding the Determinants of COVID-19 Vaccine Acceptance or Refusal Elvis Dze Achuo Armand Mboutchouang Clemence Zite Kouhomou Kakeu Charles Pilag 1. Background and Literature Review This study is propelled by the recent polemics regarding the global immunisation against the COVID-19 pandemic. Unlike several studies examining the socioeconomic consequences of the COVID-19 pandemic (McKibbin and Fernando, 2021; Makin and Layton, 2021; Skare et al., 2021; Binder, 2020; Achuo et al., 2020; Maliszewska et al., 2020), this study explores the key factors likely to influence the acceptance or refusal of the COVID-19 vaccine. The novel coronavirus pandemic that has claimed millions of human lives in under two years has been the major challenge to political leaders, policymakers, scientists and researchers across the globe. Although COVID-19 deaths are predominant among the ageing than the youthful population, combatting the dreaded pandemic through individual and concerted efforts is imperative since the disease remains a threat to global public health (Lazarus et al., 2021; Achuo, 2020; Covello and Hyer, 2020). Although it is believed that vaccines offer preeminent hope for lasting solutions to curbing the devastating effects of pandemic diseases (Ward, 2021; Pogue et al., 2020), there have been wide debates among academic researchers, policy makers and practitioners regarding the COVID-19 vaccine. This is due to the rapidity with which the COVID-19 vaccine was developed compared to other vaccines. For example, while it took several years for a vaccine to Academia Letters, June 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Elvis Dze Achuo, elvisachuo9@gmail.com Citation: Dze Achuo, E., Mboutchouang, A., Zite Kouhomou, C., Charles Pilag, K. (2021). Understanding the Determinants of COVID-19 Vaccine Acceptance or Refusal. Academia Letters, Article 1038. https://doi.org/10.20935/AL1038. 1 be developed, proposed and validated by accredited scientific bodies for other pandemics, the COVID-19 vaccine was proposed and validated barely a year after the coronavirus outbreak. The rapid developments regarding the COVID-19 vaccine may be explained partly by the fact that the 21st century is marked with enormous advancements in technological innovation thanks to the growing use of ICT tools by scientists and academic researchers. Among the successfully tested and approved vaccines globally, Oxford/AstraZeneca, Moderna, Johnson&Johnson and Sinovac are the most widely administered. For example, as of May 31 2021, of the over 300 million doses of vaccines already administered, respectively about 160 million, 125 million, and 11 million doses of Oxford/AstraZeneca, Moderna and Johnson&Johnson have been administered since December 2020 (OWID, 2021). Nevertheless, just like any other vaccine, the coronavirus vaccine acceptance is not universal. However, hesitation to accept the vaccine may arise from factors such as characteristics of the vaccine, origin of the vaccine or political relationship with vaccine manufacturer, communication and vaccination strategy (Curiel and Ramírez, 2021) or policy objectives of the government in power. Cultural and religious practices may equally influence the populations’ willingness to accept or refuse a vaccine. For example the customary use of traditional medicine in Africa may discourage vaccine acceptance. Demographic factors such as age structure, area of residence, population size and density may also contribute to vaccine acceptance or refusal. Educational level and field of study may as well play a key role (Bai et al., 2021). Less educated people are susceptible to traditional believes which could be at the genesis of anti-vaccination campaigns predominant in rural Africa. Moreover, educational level constitutes an important determinant of income distribution among individuals. Thus, uneducated people are likely to remain poor and may not be able to afford the high cost of some vaccines. At times, poverty may render it very difficult people to detach themselves from traditional healing methods in favour of modern medicine in the form of vaccines. This may further explain why the COVID-19 vaccination rate is relatively lower in low income than in high or middle income countries. This claim can be highlighted in figure 1. Figure 1: COVID-19 vaccine doses administered by country income group Among the countries that have received at least a dose of the various vaccines across the world, over 46% have been Upper middle income countries, 39% (high income), 14% (Lower middle income) and barely 1% for Lower income countries. From these statistics, it is believed that a country’s level of development viewed from its per capita income level has a great impact Academia Letters, June 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Elvis Dze Achuo, elvisachuo9@gmail.com Citation: Dze Achuo, E., Mboutchouang, A., Zite Kouhomou, C., Charles Pilag, K. (2021). Understanding the Determinants of COVID-19 Vaccine Acceptance or Refusal. Academia Letters, Article 1038. https://doi.org/10.20935/AL1038. 2 Source: Adapted from OWID (2021) on the healthcare system of the country and population’s wellbeing. This explains why the African continent is the only continent with a vaccination rate below 3% since a majority of her countries are classified as less income countries. In a recent study, Schwarzinger et al. (2021) contend that a vaccine’s acceptance or refusal by the population is influenced to a greater extent by the vaccine’s characteristics (such as efficacy, risk of severe side effects, and manufacturing country) and vaccination strategies adopted (such as herd immunity target and where the vaccine is being administered). Schwarzinger and associates thus revealed that based on vaccine’s characteristics, about 9% to 43% of the French active population is likely to hesitate being vaccinated against COVID19, unlike about 29% of their counterparts who are likely to outrightly refuse COVID-19 vaccination (Verger and Peretti-Watel, 2021). Likewise,Bai et al. (2021) investigate the attitude of college students towards COVID-19 vaccination in China, and reveal that students in urban China and especially those studying health-related disciplines were more likely to accept being vaccinated against COVID-19 unlike their rural counterparts. Thus, the low vaccination level recorded in Africa may be justified partly by the low level of urbanisation of most economies as well as the low educational levels, high poverty rates and traditional practices. Moreover, the probability of insufficient Academia Letters, June 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Elvis Dze Achuo, elvisachuo9@gmail.com Citation: Dze Achuo, E., Mboutchouang, A., Zite Kouhomou, C., Charles Pilag, K. (2021). Understanding the Determinants of COVID-19 Vaccine Acceptance or Refusal. Academia Letters, Article 1038. https://doi.org/10.20935/AL1038. 3 vaccine supplies may be higher in rural than in urban areas. Although the global vaccination rate initially remained relatively low between December 31 2020 to march 31 2021, the rate has been impressive since April 2021. This evolution is depicted in figure 1.2. This may be due to successful sensitisation strategies employed by health experts, increasing COVID-19 related deaths around the world, as well as the increased funding by international financial bodies. Consequently, figure 1.2 further reveals that while the vaccination rate has increased considerably, the number of confirmed cases seem to be increasing at decreasing rate since April 2021. Figure 1.2 Global Trend of COVID-19 vaccination and Confirmed Cases Source: Authors, from OWID (2021) Data 2. Lessons and concluding remarks Disparate from numerous studies investigating the socioeconomic impacts of the COVID-19 pandemic, this study explores the determinants of COVID-19 vaccine acceptance or refusal. The explored literature reveals that vaccines are not universally acceptable. Vaccine acceptance or rejection depends on a host of factors encompassing vaccine characteristics, vaccination strategies adopted by administering authorities, level of education and field of study, Academia Letters, June 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Elvis Dze Achuo, elvisachuo9@gmail.com Citation: Dze Achuo, E., Mboutchouang, A., Zite Kouhomou, C., Charles Pilag, K. (2021). Understanding the Determinants of COVID-19 Vaccine Acceptance or Refusal. Academia Letters, Article 1038. https://doi.org/10.20935/AL1038. 4 traditional and religious believes, income level and place of residence. Moreover, the rate and speed of contamination across regions may also play a great role in influencing peoples’ decision to accept or refuse being vaccinated. Based on our findings, we thus recommend that governments should adopt appropriate communication strategies aimed at sensitising the populations on the importance of being vaccinated against the dreaded coronavirus pandemic. Moreover, various governments especially in Sub-Saharan Africa with very fragile health systems should increase health expenditures in order to develop the health sector. The transport sector should as well be improved upon since remote areas may not easily have access to vaccine supplies. Countries should equally allocate emergency funds when drafting the state budget, since the availability of such funds can enable the government to easily curb the devastating socioeconomic effects of future pandemics without having to rely on foreign aid. It is equally imperative for government officials to strive towards building trust between government communications vis-a-vis the public, as this may facilitate public acceptance following government vaccination campaigns. Nevertheless, given the subjective nature of human beings, and the fact that man’s behaviour is ever-changing, this study cannot claim to have exhaustively explored the determinants of the COVID-19 vaccine acceptance or refusal. However, further research could focus on the consequences of man’s hesitancy to vaccination against pandemic diseases. In addition, post-vaccination surveys could be conducted, in order to objectively ascertain the effectiveness of the COVID-19 vaccine. References Achuo, E. D. (2020). How efficient are government stringency responses in curbing the spread of the covid-19 pandemic? International Journal of Research and Innovation in Social Science, 4(8), 629-635. Achuo, E. D., Dinga, G. D., Njuh, C. J., & Ndam, N. L. (2020). The Socioeconomic Impacts of the COVID-19 Pandemic in Africa. International Journal of Progressive Sciences and Technologies, 22(2), 1-10. Bai, W., Cai, H., Liu, S., Liu, H., Qi, H., Chen, X.,…& Xiang, Y. T. (2021). Attitudes toward COVID-19 vaccines in Chinese college students. International Journal of Biological Sciences, 17(6), 1469-1475. Binder, C. (2020). Coronavirus fears and macroeconomic expectations. Review of Economics and Statistics, 102(4), 721-730. Academia Letters, June 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Elvis Dze Achuo, elvisachuo9@gmail.com Citation: Dze Achuo, E., Mboutchouang, A., Zite Kouhomou, C., Charles Pilag, K. (2021). Understanding the Determinants of COVID-19 Vaccine Acceptance or Refusal. Academia Letters, Article 1038. https://doi.org/10.20935/AL1038. 5 Covello, V. T., & Hyer, R. N. (2020). COVID-19 and the Seven Pillars of Effective Risk and Crisis Communication. In The Business of Pandemics (pp. 71-82). Auerbach Publications. Curiel, R. P., & Ramírez, H. G. (2021). Vaccination strategies against COVID-19 and the diffusion of anti-vaccination views. Scientific Reports, 11(1), 1-13. Lazarus, J. V., Ratzan, S. 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The French public’s attitudes to a future COVID-19 vaccine: The politicization Academia Letters, June 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Elvis Dze Achuo, elvisachuo9@gmail.com Citation: Dze Achuo, E., Mboutchouang, A., Zite Kouhomou, C., Charles Pilag, K. (2021). Understanding the Determinants of COVID-19 Vaccine Acceptance or Refusal. Academia Letters, Article 1038. https://doi.org/10.20935/AL1038. 6 of a public health issue. Social Science & Medicine, 265, 113414. Academia Letters, June 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Elvis Dze Achuo, elvisachuo9@gmail.com Citation: Dze Achuo, E., Mboutchouang, A., Zite Kouhomou, C., Charles Pilag, K. (2021). Understanding the Determinants of COVID-19 Vaccine Acceptance or Refusal. Academia Letters, Article 1038. https://doi.org/10.20935/AL1038. 7