Factors influencing vaccine acceptance and hesitancy in Lusaka, Zambia

25 February, 2019

Dear HIFA, CHIFA and HIFA-Zambia colleagues,

Vaccine hesitancy has been identified by WHO as one of the top 10 threats to global health in 2019. This study finds that: 'Traditional remedies, alcohol use and religious beliefs emerged as drivers of vaccine hesitancy, likely reinforced by a background of distrust towards western medicine.'

This is quite interesting in our discussion about the benefits and harms of traditional medicine. Among the indirect harms of traditional medicine can be added vaccine hesitancy and its resultant morbidity and mortality.

CITATION: Factors influencing vaccine acceptance and hesitancy in three informal settlements in Lusaka, Zambia

Miguel Pugliese-Garcia, Leonard W.Heyerdahl, Chanda Mwambaa, Sharon NkwemuaRomaChilengiaRachelDemolisbEliseGuillermetbAnjaliSharmaa



- Participants generally expressed acceptance for vaccines but described hesitant individuals.

- Alcohol, prayer and traditional remedies were alternatives reported in the community.

- Adverse effects combined with limited information were likely fostering vaccine hesitancy.

- Limited understanding and misconceptions about vaccines were common.

- Discussants supported delivery strategies that improved education and access.


Introduction: Heterogeneous coverage threatens to compromise the effectiveness of immunization programs in Zambia. Demand-creation initiatives are needed to address this; however, there is incomplete understanding of why vaccine coverage is suboptimal. We investigated overarching perceptions on vaccine acceptability, hesitancy, and accessibility at three informal settlements in Lusaka, Zambia.

Methods: Nested within a cholera vaccination uptake study, we sought to understand overarching perceptions on vaccines’ hesitancy in three informal settlements in Lusaka, Zambia. We conducted 48 focus group discussions with a convenience sample of laypersons, lay healthcare workers, neighbourhood health committee members and vaccinators.

Results: Both laypersons and community-based health actors reported high vaccine acceptance though several sources of hesitancy were reported. Traditional remedies, alcohol use and religious beliefs emerged as drivers of vaccine hesitancy, likely reinforced by a background of distrust towards western medicine. Also mentioned were previous adverse events, fear of injections and low perceived need for immunization. Limited understanding of how vaccines work and overlapping local terms for vaccine and other medical concepts created confusion and inaccurate views and expectations. Some reported refusing injections to avoid pain and perceived risk of infection. Discussants emphasised the importance of education and preferred mobile immunization campaigns, with weekend to reach those with poor access and delivered by a combination of professional and volunteer workers.

Conclusions: Vaccine hesitancy in Zambia is underpinned by many factors including personal experiences with vaccinations, alternative belief models, limited knowledge, deep misunderstanding about how vaccines work, and barriers to access. To overcome these, community-driven models that incorporate factual communication by professionals and operate outside of traditional hours, may help. Better research to understand community preferences for vaccine uptake could inform interventions to improve immunization coverage in Zambia.

Best wishes, Neil

Coordinator, HIFA Project on Information for Citizens, Parents and Children:


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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org

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