Table 4.

Major reasons for COVID-19 vaccine hesitancy in some African countries and the suggested ways-out.

Region	Country	Major Reasons for Hesitancy	Suggested Recommendations	References
Central Africa	Cameroon	Lack of confidence in COVID-19 vaccines Discriminatory COVID-19 vaccine distribution patterns in other parts of the world relative to Africa and improper COVID-19 vaccine approval timeline	Debunk myth and address concern for safety and efficacy Equitable distribution of available COVID-19 vaccines to all countries as a global good	Ajonina-ekoti et al. [58]
Eastern Africa	Ethiopia	Rumors on the content of the vaccine Concern about safety, effectiveness and adverse effects—teratogenicity Infodemic or disinformation of the public on the safety and efficacy of the vaccine Lack of adequate information about the vaccine Believe that the vaccine may be a biological weapon Concerns about the safety of vaccines due to the speed of the production	Education on side-effects and the importance of the vaccine to address trust deficit Health sector managers should stress awareness creation to alleviate misinformation Provision of clear information about COVID-19 and the vaccine side effects The public should rely on mass media platforms rather than social media Address safety concerns Continuous communication and health education Awareness creation on the safety and adverse effects Communications and training focusing on young health workers Vaccine literacy addressing misconception Targeted information, sensitisation and engagement campaigns bolstering confidence in the safety of approved vaccines	Aynalem et al. [61]; Mohammed et al. [30]; Angelo et al. [28]; Aemro et al. [26]; Mose et al. [65]; Berhe et al. [62]; Adane et al. [60]; Tolossa et al. [67]; Boche et al. [63]; Yilma et al. [68]; Dereje et al. [64]; Abay et al. [59]; Strupat et al. [65]; Kanyanda et al. [29]
Eastern Africa	Kenya	Lack of adequate information about the vaccine, concerns around vaccine safety and effectiveness, lack of trust and confidence in the vaccine	Evidence-based engagements	Osur et al. [84]; Carpio et al. [43]
Eastern Africa	Malawi	Exposure to negative information about the vaccine The primary reservations were safety concerns about the vaccine in general and its side effects specifically	Targeted information, sensitisation and engagement campaigns bolstering confidence in the benefits and safety of approved vaccines	Moucheraud et al. [77]; Kanyanda et al. [29]
Eastern Africa	Somalia	Misconceptions about the vaccine	Sensitization of the general public to dispel any misconceptions	Ahmed et al. [27]
Eastern Africa	Tanzania	Concerns on safety and side effects	Education on safety and benefits of the vaccine	Chilongola et al. [83]
Eastern Africa	Uganda	Mistrust among most community members regarding COVID-19 vaccines Safety concerns about the vaccine and its side effects	Targeted information, sensitisation and engagement campaigns bolstering confidence in the safety and effectiveness of approved vaccines	Echoru et al. [44] Kanyanda et al. [29]
Eastern Africa	Zambia	Doubt about the safety and effectiveness of vaccine	Provide accurate information through trusted sources of information on the benefits of the vaccine	Mudenda et al. [78]; Carcelen et al. [55]
Eastern Africa	Zimbabwe	Lack of trust in the government and uncertainty about vaccine effectiveness and safety	Targeted education and communication to address concerns about vaccine safety and country of manufacturer	Mundagowa et al. [79]; Mcabee et al. [41]
Northern Africa	Egypt	Absence of enough clinical trials Religious belief and safety concerns Fear of side effects of the vaccine Lack of trust in effectiveness and safety due to speedy production and roll-out of the vaccine. Lack of adequate information about side effects Fear of the hidden infective virus in the vaccine	Provision of sufficient and accurate information about the available vaccines Public health intervention campaigns to change negative attitudes, as an initial step to build trust Promote vaccine confidence with clear, precise, up-to-date information and involve medical personnel Structured awareness campaigns to offer transparent knowledge about the safety and efficacy of the vaccines and the technology	Fares et al. [33]; Omar et al. [37]; El-sokkary et al. [32]; Salem et al. [70]; Saied et al. [38]; Elgendy et al. [31]
Northern Africa	Morocco	Fear of the likely side effects and concern about the effectiveness of the vaccine	Assurance on effectiveness Awareness on safety and efficacy	Khalis et al. [35]; Khalis et al. [36]
Northern Africa	Sudan	Concerns about vaccine safety and effectiveness The risk of developing acute adverse events	Provide accurate information on vaccine safety and effectiveness Construction of health educational programs and more accurate information distributed and advertised by respective health authorities	Raja et al. [69] Yassin et al. [71]
Northern Africa	Tunisia	Fear of vaccine side effects	Effective national information campaign on safety and efficacy	Zammit et al. [72]; El-kefi et al. [34]
Southern Africa	Botswana	Religious beliefs and safety concerns	Target education towards hesitant population	Tlale et al. [82]
Southern Africa	South Africa	Lack of trust in the government Lack of trust in the safety and effectiveness of the vaccine Concerns about side effects, lack of access to the online vaccine registration platform, distrust of government, belief in conspiracy theories having no monthly income and depending on someone else to make vaccination decision Concerns about side effects, belief in conspiracy theories and speed of production	Easy-to-understand information regarding the safety and broader trust-building measures Increase confidence in vaccine efficacy. Clarify eligibility and ensure access to vaccines at times and places that are convenient Communication strategies reassuring safety and efficacy of COVID-19 vaccines and addressing sources of misinformation Trust-building intervention, intensify awareness to debunk misconception, increase vaccine literacy, awareness on efficacy of the vaccine, vaccination promotion campaigns, reinforce the message of vaccine safety and efficacy	Engelbrecht et al. [73]; Kahn et al. [75]; Govere-Hwenje et al. [74]; Wiysonge et al. [65]; Katoto et al. [80]; Kollamparambil et al. [40]; Burger et al. [81]; Burger et al. [81]; Modi et al. [76]; Oduwole et al. [42]; Adeniyi et al. [39]
Western Africa	Burkina Faso	Safety concerns about the vaccine and its side effects, insecurity and political instability	Targeted information, sensitisation and engagement campaigns to encourage confidence in the safety of the approved vaccines	Kanyanda et al. [29]
Western Africa	Ghana	Fear of vaccine’s side effects, safety concerns, mistrust, uncertainty, spiritual and religious beliefs Lack of confidence in the safety of the vaccines	Persuasion using public, religious and other influential figures, balanced and open discussion to frontally address the safety and religious concerns Public health educational intervention to address safety and side effects, strategy for attitudinal change, targeted and integrated public health education, intensify education on the benefits and side effects of COVID-19 vaccines	Yeboah et al. [54]; Acheampong et al. [64]; Botwe et al. [57]; Okai and Abekah-Nkrumah, [94]; Alhassan et al. [48]; Kyei-arthur et al. [90]
Western Africa	Mali	The primary reservations were safety concerns about the vaccine in general and its side effects specifically	Targeted information, sensitisation and engagement campaigns bolstering confidence in the safety of approved vaccines	Kanyanda et al. [29]
Western Africa	Nigeria	Difficulty in the vaccination request/registration protocols Bad feelings towards the vaccines due to negative social media Reports/rumors, personal ideology/religious beliefs against vaccination Concerned about the serious adverse effects of the vaccine Lack of trust in of the government’s policies Lack of confidence in the efficacy of the vaccine Perception of vaccine as being in trial stage, Insecurity and fear of being killed were scaring people from coming out to be vaccinated especially in insurgency-inflicted areas Corruption in procurement and distribution of the vaccines	Address the concerns of the local people rather than dispelling their concerns as merely superstitious and senseless More awareness, health education in indigenous language, targeted awareness creation Health education and promotion for a right attitude Targeted and appropriately designed advocacy and behavioral-change communication messages Liberalize access to vaccine, targeted education to debunk misconception and promote trust Structured educational programs to address safety concerns Improve government trustworthiness, improve health communication, implementation of formulated policies and strategies Awareness on safety and efficacy, provision of education and relevant information, ensure public trust is earned, intensify awareness and health education, national deployment and vaccination plan must be revised and robust enough to address the misinformation on vaccine safety	Ekowo et al. [88]; Onuminya and Onuminya, [95]; Reuben et al. [25]; Njoga et al. [91]; Soyannwo et al. [98]; Uzochukwu et al. [53]; Isah et al. [45]; Adebowale et al. [97]; Nri-ezedi et al. [93]; Mustapha et al. [51]; Amuzie et al. [49]; Al-mustapha et al. [86]; Ajibola et al. [89]; Habib et al. [50]; Okafor et al. [52]; Osuagwu et al. [96]; Adebisi et al. [47]; Adedeji-adenola et al. [85]; Kanyanda et al. [29]; Nomhwange et al. [92]
Western Africa	Senegal	Misinformation, fear of adverse effects and lack of adequate information from health workers	Promote vaccine confidence and reduce misinformation	Ba et al. [87]