The institutional roots of vaccine uptake and hesitancy: evidence from Africa
Vaccine·
- DOI
- 10.1016/j.vaccine.2026.128980
- PMID
- 42508328
- PMCID
- —
- OpenAlex
- W7171385728
- Study type
- Journal article
- Publisher
- Elsevier BV
- Article type
- journal-article
- Integrity
- current
Why this research matters now
The findings suggest that improving vaccination rates in Africa requires both strengthened governance and credible vaccine communication as complementary interventions, given that institutional factors represent significant demand-side barriers even when vaccine supply is adequate.
Structured evidence summary
Research question
The study investigates how institutional quality—specifically corruption perceptions and trust in government—affects COVID-19 vaccination uptake and hesitancy across African countries.
Study design
Cross-sectional analysis using instrumental variable probit models applied to survey data from 37,876 respondents across 34 African countries. Corruption perceptions and institutional trust were instrumented using leave-one-out regional means to address endogeneity.
Population and setting
The study analyzed 37,876 respondents from 34 African countries participating in the Afrobarometer Round 8 survey.
Main findings
General corruption perceptions decreased vaccine uptake by 2.7 percentage points and increased hesitancy by 6.3 percentage points. General institutional trust raised uptake by 9.0 percentage points and lowered hesitancy by 10.6 percentage points. Trust in government handling of vaccine safety showed the strongest associations, increasing uptake by 16.9 percentage points and reducing hesitancy by 24.9 percentage points, suggesting corruption operates indirectly through erosion of vaccine-specific confidence.
Public-health relevance
The findings suggest that improving vaccination rates in Africa requires both strengthened governance and credible vaccine communication as complementary interventions, given that institutional factors represent significant demand-side barriers even when vaccine supply is adequate.
Important limitations
This summary relies on the supplied single-article abstract and metadata. Full assessment of study limitations, including potential issues with cross-sectional design, instrument validity, unmeasured confounding, or generalizability, requires review of the complete published article.
GIDS interpretation
This article was identified through classifier links to COVID-19, vaccination, and vaccine safety topics. It provides context on institutional determinants of vaccine uptake in African settings but does not constitute surveillance data or real-time signal detection.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 9 auditable classifier relationships to diseases, places, topics, and study design.