COVID-19 Vaccine Acceptability: A Cross-Sectional Mixed Methods Study in Sierra Leone

Abstract Background: Global immunization is critical to combat the COVID-19 pandemic and the public's willingness to be vaccinated will determine the success of elimination efforts. We measured the acceptability of COVID-19 vaccine and views in Sierra Leone.Method: We used a multi-method study including an online cross-sectional survey and semi-structured interviews to assess the acceptance of and perceptions about COVID-19 vaccination among 2146 Sierra Leoneans aged 18 years and above. Results: Most survey respondents (80.1%, n = 1719) would accept COVID-19 vaccination for themselves and close family,but 19.9% (n = 427) would reject vaccination. If vaccination was mandatory the acceptance rate would increase to 85.0%, (n = 1,823), while 15.0% (n = 318) of responders would still reject. COVID-19 vaccine awareness was high among respondents (yes: 75.2% n = 1613, no: 24.8%, n = 533).Safety, immunity, and trust in vaccines were the main reasons for vaccine acceptance. Distrust, uncertainties about vaccine safety and effectivenessand lack of belief in the COVID-19 pandemic triggered through media reports were the mainreasons for rejecting the COVID-19 vaccination. With respect to vaccine,a small majority would prefer a less reactogenic vaccine even at the cost of a lower efficacy over a more effective but more reactogenic vaccine (55.7%, n = 1195 vs 41.5%, n = 890) while2.8% (n = 61) of respondents said they would reject any vaccine.Country of origin had an important role in vaccine acceptance: 32.4% (n = 1121) would accept a vaccine from any country if licensed locally, but15.1%(n = 511) would rejectvaccines even if licensed from China,12.6% (n = 437), India11.4% (n = 393), USA 8.0% (n = 276), Germany7.8% (n = 271), Russia 7.7% (n = 267), UKand 5.0% (n = 173)from Belgium.Conclusion: Sensitizing the public about the COVID-19 infection risk, vaccine development processesand ensuring vaccine safety through continuous communication and community engagement, with community leaders leading by example as well as the independent role of regulatory authorities in safety and efficacy evaluation, would improve COVID-19 vaccine acceptance.