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Journals (/about/journals) / Vaccines (/journal/vaccines) / Volume 9 (/2076-393X/9) / Issue 2 (/2076-393X/9/2) / 10.3390/vaccines9020175 /
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Table of Contents !
Abstract
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Introduction
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Results
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Discussion
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Author Contributions
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Funding
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Statement
Informed Consent Statement
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Acknowledgments
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Conflicts of Interest
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Appendix A. Questionnaire
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Appendix B
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References
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Assessment of Vaccine Hesitancy to a COVID-19 Vaccine in Cameroonian Adults and Its Glob
Implication
by Jerome Nyhalah Dinga (https://sciprofiles.com/profile/965003) 1,* " (mailto:please_login) (https://orcid.org/0000-0002-8457-4903)
Leontine Kouemou Sinda (https://sciprofiles.com/profile/author/R052elFBdVJrd1FDWU52bTRWTHgvdGxxS2tSTVBuSDBIcVZ4aE9KV
" (mailto:please_login) and
1 Biotechnology Unit, Faculty of Science, University of Buea, P.O. Box 63, Buea, Cameroon
2 Department of Microbiology and Parasitology, Faulty of Science, University of Buea, P.O. Box 63, Buea, Cameroon
3 Faculty of Science, Engineering and Technology, Cameroon Christian University Institute, P.O. Box 5, Bali, Cameroon
* Author to whom correspondence should be addressed.
Received: 15 January 2021 / Revised: 7 February 2021 / Accepted: 15 February 2021 / Published: 19 February 2021
(This article belongs to the Special Issue Vaccination and Public Health: Optimizing Vaccine Uptake through the Application of Social and
Science Theory, Principles, and Strategies ( /journal/vaccines/special_issues/Vaccination_vaccines ))
g001.png?1614303752) (https://pub.mdpi-res.com/vaccines/vaccines-09-00175/article_deploy/html/images/vaccines-09-00175-g002.png?
1614303752) (https://pub.mdpi-res.com/vaccines/vaccines-09-00175/article_deploy/html/images/vaccines-09-00175-g003.png?16143037
Since the outbreak of COVID-19 in December 2019, no global consensus treatment has been developed and generally accepted for the disea
eradicating the disease will require a safe and efficacious vaccine. In order to prepare for the eventual development of a safe and efficaciou
vaccine and to enhance its uptake, it is imperative to assess vaccine hesitancy in Cameroonians. After obtaining ethical clearance from the
Review Board of the University of Buea, a questionnaire was administered (May–August 2020) to consenting adults either online or in person.
thematic analysis was done to analyze the participants’ answers to the open questions. A deductive approach was used, that is, the codes
according to the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) Working Group Matrix of Determinants of vacci
The number of consenting adult Cameroonians who completed the questionnaire were 2512 (Two thousand five hundred and twelve). Vaccine h
COVID-19 vaccine was 84.6% in Cameroonians. Using the WHO recommended Matrix of Determinant of Vaccine hesitancy, the most prominent
observed in this study were: Communication and Media Environment, Perception of pharmaceutical industry, Reliability and/or source of vacc
Most Cameroonians agree that even though there are benefits of a clinical trial, they will prefer it should be done out of the continent and invo
scientists for eventual acceptance and uptake. The concerns of safety, efficacy and confidence has to be addressed using a Public Engagement
COVID-19 vaccine has to be administered successfully in Africa or Cameroon specifically. Since this study was carried out following WHO standa
can be compared to those of other studies carried out in different cultural settings using similar standards.
Keywords: COVID-19 pandemic (/search?q=COVID-19+pandemic); vaccine hesitancy (/search?q=vaccine+hesitancy); vaccine acceptan
q=vaccine+acceptance); clinical trials (/search?q=clinical+trials); Cameroon (/search?q=Cameroon)
1. Introduction
As of 17th August 2020, Cameroon had registered 18,599 cases of COVID-19 with 16,540 recoveries and 406 deaths. This gives a rec
88.9% and a with an overall death rate of 2.1% [1]. However, recent trends show that new cases of infection continue to emerge despite the cont
put in place by the World Health Organization (WHO) and the Ministry of Public Health in Cameroon. It is becoming evident that an efficacious v
be required to put COVID-19 under control and eventually eradicate it. There are currently 138 candidate vaccines in preclinical evaluation and
vaccines in clinical evaluation making a total of 167 vaccine candidates under development [2]. However, three COVID-19 vaccines have been d
only the Comirnaty COVID-19 mRNA vaccine has received WHO Emergency Use Listing Procedure/Prequalification (WHO EUL/PQ) authorizatio
the Pfizer/BioNTech vaccine the first to receive emergency validation from the WHO since the outbreak began a year ago [3]. Hence, in order to b
these vaccines to eradicate the disease, reluctance to accept them by the population has to be reduced to the barest minimum.
Vaccine hesitancy (VH) has been defined as “a delay in acceptance or refusal of vaccines despite availability of vaccine services” according
Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) Working Group on VH [4]. VH has become the focus of growing
attention worldwide, despite overwhelming evidence of the importance of vaccines [5]. This is increasingly affecting the rate at which immuniza
are effectively implemented. Since 2014, the number of countries reporting VH has been on a steady rise [6]. Only 14 countries out of 194
reported no VH according to a WHO/UNICEF Joint Reporting Form data from 2015–2017 [6], although an even lower number of seven (07) c
reported in 2017 [7]. Research shows that VH is rising, resulting in alarming figures on disease outbreaks reported globally. This led the WHO
that, as of 2019, VH is one of the top ten threats to global health (Figure 1) [8].
Figure 1. Top ten (10) threats to global health in 2019 according to the World Health Organization (WHO).
Apparently, there is no single cause of VH because many factors come into play. Important drivers of VH include: perception that vacc
beneficial, pain and needle fear, concern about the safety of vaccines or distrust of the pharmaceutical industry in the implementation of vaccinat
[9,10,11]. “Fake news” or negative information about vaccination online and in social media is also an important cause of VH. In fact, many
:
[9,10,11]. “Fake news” or negative information about vaccination online and in social media is also an important cause of VH. In fact, many
shown that the equivocal nature of anti-vaccination information on the Internet contributes to an increase in VH [12,13,14,15]. Another freque
cause of VH is lack of knowledge about vaccines [16,17]. As a matter of fact, socioeconomic status and education are related to vaccine acceptan
the same way as they are related to health conditions or adherence to public health recommendations. On the contrary, increased VH has bee
with both high and low socioeconomic status as well as high and low education, highlighting the complex array of interrelated factors at play [
It has been shown that vaccine behaviors are complex, like most health behaviors and knowledge is only one of many determinants o
decisions [9,18,19]. The three Cs model (confidence, complacency and convenience) indicates three key interrelated causes of VH [4]. With the
COVID-19 pandemic and with the numerous vaccine candidates under development, it is imperative that an eventual efficacious vaccine sh
excellent uptake worldwide and Cameroon specifically. Here we try to identify the prevalence and determinants of a COVID-19 vaccine VH in Cam
This method was chosen to ensure that the results are relevant worldwide. The approach developed by Braun and Clarke [24], used a co
:
This method was chosen to ensure that the results are relevant worldwide. The approach developed by Braun and Clarke [24], used a co
latent and semantic coding approaches to grasp both explicit and implicit content embedded within the data.
The following procedures were done by two separate researchers.
1. Familiarization with the MxDt of VH and the data.
2. The researchers then calibrate their understanding of how the dataset related to the 21 items of the SAGE MxDt.
3. After preliminary training, the two researchers identified 3697 statements that are directly linked to at least one of the 21 items. The bin
(item present in the statement: 1/item absent from the statement: 0) was then used tothen independently mapped the 3697 statements directly a
items of the Matrix, as previously reported [25].
4. Inter-coder reliability, using “ReCal2 0.1 (Alpha)” [26], an online utility which is compatible with Excel and computes reliability coefficien
nominal or ratio-level data, was calculated for each of the 21 items, across the 3697 statements, using percent agreement and Cohen’s Kappa.
The results for “percent agreement” are between 0 and 1, where “0” implies the authors coding did not perform better than if they had bee
random, while “1” implies perfect agreement between the researchers. Negative results mean the researchers did worse than if they would acc
cut-off values for Kappa were selected based on a method described by Hallgreen [27].
from 0.0 to 0.2 = slight agreement
0.21 to 0.40 = fair agreement
0.41 to 0.60 = moderate agreement
0.61 to 0.80 = substantial agreement
0.81 to 1.00 = near perfect or perfect agreement.
3. Results
Figure 2. Demographic information of study participants. (A) most of the participants were residing in Cameroon while 17% of them lived
:
Figure 2. Demographic information of study participants. (A) most of the participants were residing in Cameroon while 17% of them lived
country. (B) Those working in the education sector constituted more than half of the participants. (C) shows the percentage males and fe
shows the age of the participants with a majority of them being between the ages of 18–25.
Table 2. Inter-rater reliability measures for the items of the Matrix Determinant of Vaccine Hesitancy.
Table 3. Summary of how the study participants’ answers to some of the open questions are related to the determinants of vaccine hesita
model developed by SAGE WG.
Figure 3. Cameroonian perception of a COVID-19 vaccine clinical trial. (A) proposed venues of a COVID-19 vaccine clinical trial. (
respect to involvement of Cameroonian scientists in a COVID-19 vaccine clinical trial. (C) shows what Cameroonians think will be benefit
conducted clinical trial. (D) shows the percentage of the study participants who believe there are benefits/or not of a well-done clinical trial.
4. Discussion
Since the first diagnosed case of COVID-19 in December 2019, the number of new infections and fatalities continue to rise in some countrie
pandemic that is yet to be put under control. The World Health Organization (WHO) is yet to confirm and endorse a treatment of the disease an
:
pandemic that is yet to be put under control. The World Health Organization (WHO) is yet to confirm and endorse a treatment of the disease an
general consensus that the spread of the disease can be stopped by strict application of the barrier measures while eradicating the disease
vaccine. However, for the approved vaccines to achieve its intended goal, VH has to be reduced to under 30%–25%. It is therefore imperative
and its determinants locally in order to strategize and achieve significant vaccine acceptance. Here we report the first results of VH among C
using WHO SAGE recommendations.
It has been shown that a major source of access to health-related information is the Internet [28] and Social media in particular [29
used by activists to carry out campaigns against the scientific institutions [30]. Studying the Internet content has also shown that future
interventions need not only focus on the benefits of COVID-19 vaccination but, more so, on understanding the type of doubts around COVID-19
order to enhance communication strategies [31].
Another item of the Matrix of Determinant of VH that came up strongly in this study is “Reliability and/or source of vaccine”. This shows
confidence and trust issues Cameroonians will have with a COVID-19 vaccine. Comments from participants show that they are really concerned
producing the vaccine and what will be the true intention of administering these vaccines to Cameroonians.
The next most frequent item raised by the participants was “Perception of pharmaceutical industry”. This seems to be expected giving
pharmaceutical industries will be directly involved in producing and distributing a COVID-19 vaccine. From the comments of the participants, th
be a deep mistrust of pharmaceutical industries, especially those in the Western countries and in China. Respondents have the impression that th
are interested only in making profit instead of thinking of the health of the population. It has been shown that people turn to be worried about risks
people or institutions they do not trust [31].
This study shows that Cameroonians will like Cameroonians or African scientists to be involved in the development of a COVID-19 vaccin
has to do with the level of trust they have in foreign institutions and pharmaceutical companies when it comes to a COVID-19 vaccine. The assum
that seeing one of theirs in the research team developing a vaccine will increase confidence.
It is well known that travelling abroad broadens your horizon and makes you more knowledgeable [32] and so Cameroonians at home will u
their relatives/friends in the diaspora for pieces of advice on critical issues. Hence, it was imperative to access VH of a COVID-19 vaccine
Cameroonians. The opinions expressed by them followed the same trend as those back at home even though the tone was more objective
conspiracy-like tone. The issues raised were that of safety, efficacy and confidence.
Involving African scientists in general and Cameroonian scientists specifically, in the development of a COVID-19 vaccine will greatly enhan
This could be achieved by empowering these scientists through capacity building, infrastructure and funds to carry independent research in a con
As concerns carrying out clinical trials, Cameroonians, especially those in the diaspora agreed that there are many benefits for such to be
Cameroon including; infrastructure, capacity building, attracting foreign investments, instilling research culture and inspiring young people
scientists. However, it was emphasized that this can only be achieved if the trials are carried out to the highest standards and respecting WHO re
rules and regulations for a human clinical trial. This fear could be reflected in the fact that most of the Cameroonian respondents at home sug
COVID-19 vaccine clinical trial should be done either in Europe, where the vaccine was developed or where the disease is most prevalent.
The high prevalence of VH in Cameroon is worrisome and indicates a low appetite to have the vaccine and hence a low COVID-19 vac
Therefore, a lot of measures have to be put in place to reduce the VH value to around 30% in order to achieve herd immunity to COVID-1
Cameroonians.
Our projection is that the observations seen in the present study reflects the scenario one will encounter in other sub-Saharan countries. W
the WHO recommendations in assessing VH in a population, the results of the present study can be compared to that of other studies usi
approach in different geographical and cultural settings around the world.
Hence, community/public engagement will be the ultimate approach to significantly increase vaccine acceptance to a COVID-19 vaccine
general and Cameroonians specifically.
Author Contributions
Conceptualization, J.N.D. Formal analysis, J.N.D., L.K.S., V.P.K.T. Investigation, J.N.D., L.K.S. Methodology, J.N.D. and L.K.S. Supervi
Validation, J.N.D. and V.P.K.T. Writing—original draft, J.N.D., L.K.S. and V.P.K.T. Writing—review & editing, J.N.D., L.K.S. and V.P.K.T. All autho
and agreed to the published version of the manuscript.
Funding
Ethical clearance for this study was obtained from the Institutional Review Board of the Faculty of Science, University of Buea; Ref:
(tel:2020/1220-06)/UB/SG/IRB/FHS.
Informed consent was obtained from all subjects involved in the study.
Acknowledgments
We thank the 2512 participants who took part in this study and Stephanie Perimbie for administrative assistance. We also acknowledge instit
support from African Vaccinology Network (AfVANET; www.afvanet.org (http://www.afvanet.org)), Cameroon Christian University Institute, Univ
Buea and Michael Gahnyam Gbeugvat Foundation. We would also like to thank the Bill and Melinda Gates foundation for covering the Article Pub
Charge.
Conflicts of Interest
Appendix A. Questionnaire
Appendix B
Coding rules/guide used by researchers for 21 items of the MxDt of VH using study participants’ answers to questions 8, 10, 11, 12, and 13 o
Questionnaire (Appendix A).
:
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