Background: Raising immunization coverage against COVID-19, in particular in low- and middle-income countries (LMICs), is crucial in addressing the current pandemic. Additionally, in Africa reaching the necessary herd immunity threshold is jeopardized by factors, such as vaccine hesitancy. To build confidence in COVID-19 vaccines, it is important to understand and address the reasons for vaccine hesitancy. Yet, few studies for rural and urban Sub-Saharan Africa exist, which have analyzed these factors. Methods: This study reports on a cross-sectional survey in five West African countries (Burkina Faso, Guinea, Mali, Senegal, and Sierra Leone) to identify and describe factors influencing COVID-19 vaccine hesitancy in rural and urban settings. The survey was conducted at a time when in these countries the roll-out of COVID-19 vaccines had not yet or only just begun. Data were analyzed using descriptive statistics and Poisson regression models, with robust standard errors. The general protocol is registered on clinicaltrial.gov (protocol number: NCT04912284)Results: Findings show that in West Africa COVID-19 adult vaccine acceptance ranges from 60% in Guinea and 50% in Sierra Leone to 11% in Senegal. This is largely congruent with acceptance levels of COVID-19 vaccinations for children. Multivariable regression analysis shows that perceived effectiveness and safety of COVID-19 vaccines increased the willingness to get vaccinated, rather than socio-demographic factors, such as educational attainment and rural/urban residence. Primary sources of information about COVID-19 vaccines, include television, radio, and social media. Conclusions: Communication strategies addressed at the adult population using mass and social media, which emphasize COVID-19 vaccine effectiveness and safety, could encourage greater acceptance also of COVID-19 child vaccinations in Sub-Saharan countries.
