Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.

Julio Saul Solís ArceShana WarrenNiccoló MeriggiAlexandra ScaccoNina McMurryMaarten VoorsGeorgiy SyunyaevAmyn MalikDean KarlanMichael CallenMatthieu TeachoutMacartan HumphreysMushfiq MobarakSaad B. OmerAndrea GuarisoJakob SvenssonMatthieu TeachoutMacartan HumphreysSaad B. Omer, Shana WarrenGloria Ayesiga EdenElliott CollinsMargarita Rosa Cabra GarciaSofia JaramilloAnthony KamwesigyeGisele ManirabarutaJean Leodomir Habarimana MfuraFatoma MomohMaría Juliana OtaloraBéchir Wendemi OuédraogoTouba Bakary PareMelina Platas IzamaLaura PolancoSarene ShakedAchille Mignondo TchibozoMichael CallenMushfiq Mobarak
Publication type: 
Published Paper
Developing Organization: 
Nature Medicine
July 16, 2021
Program area: 
Terms of Use: 

Open access with attribution.
Citation: Solís Arce, J.S., Warren, S.S., Meriggi, N.F. et al. COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries. Nat Med (2021). https://doi.org/10.1038/s41591-021-01454-y