Assessment of Vaccine Hesitancy to a COVID-19 Vaccine in Cameroonian Adults and Its Global Implication

"[C]ommunity/public engagement will be the ultimate approach to significantly increase vaccine acceptance to a COVID-19 vaccine in Africans in general and Cameroonians specifically."

Vaccine hesitancy (VH), which has become the focus of growing concern and attention worldwide, has no single cause. It is becoming evident that an efficacious vaccine will be required to get the COVID-19 pandemic under control. In order for the vaccine to achieve the intended goal, VH has to be reduced. In this light, and in preparation for the eventual development of a safe and efficacious COVID-19 vaccine and to enhance its uptake, this study sought to assess VH among Cameroonians.

A cross-sectional survey was carried out among 2,512 Cameroonians living in the country or abroad from May to August 2020. The qualitative component involved using the Matrix of Determinants for VH designed by World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) Working Group on VH, while qualitative thematic analysis (QTA) was used to ensure the validity and reliability in detecting hesitancy. The survey also assessed Cameroonians' perception of a clinical trial.

The survey found that VH to a COVID-19 vaccine was 84.6% in Cameroonians, which is reflective of the number of the study participants who said they will need more information, do not know, or will not take a COVID-19 vaccine. The most prominent determinants observed in this study were:

• Communication and media environment: Of particular interest here is the role of the internet and the emergent role of social media such as Facebook, where it is known that anecdotal experiences, anti-vaccine messages, and science-denigrating content proliferate. This issue was raised across the narratives of both COVID-19 vaccine hesitant and non-hesitant participants, who cited "confusing information circulating on social media", "antivaccine campaigns saying Africans should not accept a COVID-19 vaccine"; another participant said, "I've seen on TV that Africans don't need a COVID-19 vaccine since there are herbal cures for the disease".
• Perception of the pharmaceutical industry: The issue of conflicts of interests and questions about respect for ethics by the pharmaceutical industry was raised by mostly COVID-19 vaccine hesitant individuals, when compared to the non-hesitant group. A few examples illustrate these negative attitudes: "I don't think these companies really care about our health" and "They take advantage of the political system to come and test vaccines and other products in Africa that they would not otherwise test in their own country and hence they will not respect standard ethical procedures".
• Reliability and/or source of vaccine: A majority of participants expressed worry about the quality of the vaccine distributed or sent to Africa in general and Cameroon specifically.
• Cost: Many said a COVID-19 vaccine should be made free for everyone, while some people said it should be made free only for children, the elderly, people with co-morbidities, and/or those working in hospitals.

Cameroonians, especially those in the diaspora, agreed that there are benefits of conducting a COVID-19 clinical trial in Cameroon, including: strengthening infrastructure, building capacity, attracting foreign investments, instilling a research culture, and inspiring young people to become scientists. However, it was emphasised that these gains can only be achieved if the trials are carried out to the highest standards and respecting WHO-recommended rules and regulations for a human clinical trial. Some also said Cameroon should build its own capacity (e.g., through capacity-building, infrastructure, and funds to carry out independent research in a consortium) to develop and produce a COVID-19 vaccine.

However, most proposed that a trial should be done in Europe, with a small fraction saying that it should be carried out where the vaccine was developed or where the disease is most prevalent. This attitude is reflective of the level of trust - or lack thereof - participants expressed in foreign institutions and pharmaceutical companies when it comes to a COVID-19 vaccine. The assumption here is that seeing one of their own on the research team developing a vaccine would increase confidence. In short, involving African scientists in the process could boost eventual acceptance and uptake.

In conclusion, the researchers stress that Cameroonians' concerns about safety, efficacy, and confidence have to be addressed using a public engagement approach if a COVID-19 vaccine is to be administered successfully in Africa or Cameroon specifically. Since this study was carried out following WHO standards, its result can be compared to those of other studies conducted in different cultural settings using similar standards.