Sierra Leone Demonstrates High COVID-19 Vaccine Acceptance, but Hesitancy and Geopolitical Biases Persist: Study Highlights Need for Targeted Education and Trust-Building
A recent study presented at the 2025 Annual Conference on Vaccinology Research revealed a surprisingly high level of COVID-19 vaccine acceptance in Sierra Leone, with over 80% of surveyed adults expressing willingness to receive the vaccine for themselves or their families. This positive finding, however, is tempered by persistent vaccine hesitancy and a concerning undercurrent of distrust based on the vaccine’s country of origin. The study, conducted by researchers from Emory University, the University of Siena, and other institutions, underscores the urgent need for tailored vaccine education campaigns that address specific concerns and build public trust in the safety and efficacy of vaccines.
The survey, involving 2,146 adults in Sierra Leone, aimed to gauge public awareness, acceptance, and hesitancy regarding COVID-19 vaccines. The results indicated that 75.2% of respondents were aware of the vaccines, and acceptance soared to 85% when vaccination was mandated. This suggests a strong underlying predisposition towards vaccination, particularly when framed within a public health imperative. The primary drivers of vaccine acceptance were identified as belief in vaccine safety and effectiveness, coupled with trust in vaccine science.
However, the study also uncovered a significant level of vaccine hesitancy, fueled by concerns about potential side effects, doubts about vaccine efficacy, and skepticism about the pandemic itself. This hesitancy was often exacerbated by misinformation circulating on social media platforms. The influence of unsubstantiated claims and conspiracy theories highlights the critical need for accurate and accessible information to counter the spread of misinformation and build public confidence in vaccines.
A particularly alarming finding was the prevalence of geopolitical biases influencing vaccine acceptance. Despite local approval of various vaccines, a significant portion of respondents expressed distrust based on the country of origin. While 32.4% were willing to accept any locally approved vaccine, 15.1% rejected vaccines from China, 12.6% from India, and 11.4% from the United States. Smaller, yet notable, percentages expressed reservations about vaccines from Germany, Russia, the United Kingdom, and Belgium. This "vaccine nationalism" presents a significant challenge to global vaccination efforts and underscores the need to address these biases directly.
Mahmud Sheku, MPH, MSc, a PhD student at Emory University and the lead investigator of the study, attributes these biases to the proliferation of misinformation and narratives on social media platforms. These narratives often portray vaccines from certain countries as experimental or unsafe, contributing to geopolitical perceptions and mistrust. Sheku emphasizes the crucial role of trusted local messengers, such as community leaders and healthcare professionals, in countering these narratives and reinforcing the safety and efficacy of vaccines. He highlights the rigorous approval processes undertaken by national regulatory authorities and the WHO, emphasizing that locally approved vaccines meet stringent safety and development standards.
The study further revealed a widespread preference for vaccines with minimal side effects, even if it meant compromising on efficacy. This finding, reported by 55.7% of participants, indicates a limited understanding of how vaccines work and the difference between protective efficacy and reactogenicity. Sheku stresses the importance of educating the public about these concepts, explaining that side effects are often a sign of the immune system responding to the vaccine and not necessarily an indication of harm.
To effectively combat vaccine hesitancy and address geopolitical biases, Sheku advocates for targeted communication strategies that go beyond simple slogans. He recommends tailoring messaging to specific populations, translating vaccine development concepts into local languages, and utilizing targeted campaigns for communities exhibiting high hesitancy. Furthermore, he underscores the importance of explaining the stages of vaccine development and the role of various agencies in ensuring vaccine safety, thereby building trust and transparency.
The findings of this study offer crucial insights for vaccine developers and public health officials. While safety remains paramount, building public trust requires comprehensive education and transparent communication. Explaining the significance of side effects as an immune response, rather than a sign of danger, is crucial. Moreover, addressing geopolitical biases through targeted information campaigns delivered by trusted local messengers can significantly improve vaccine uptake and contribute to achieving widespread immunity. The study’s findings provide a valuable roadmap for future vaccine communication and outreach efforts, not only in Sierra Leone but also in other regions grappling with vaccine hesitancy and misinformation. By understanding the drivers of hesitancy and tailoring messaging accordingly, public health officials can foster greater confidence in vaccines and pave the way for more successful vaccination campaigns.