COVID-19 vaccine hesitancy: Experiences from the Republic of the Congo, the Democratic Republic of the Congo and the Republic of Guinea-Bissau

The rollout of COVID-19 vaccines marked a turning point in pandemic control, yet vaccine hesitancy emerged as a significant obstacle in sub-Saharan Africa (SSA). The study aims to investigate socio-behavioural drivers of vaccine hesitancy in three high-resistance countries: the Republic of Congo, the Democratic Republic of the Congo, and the Republic of Guinea-Bissau. By employing a qualitative ethnographic design, in the period from April to October 2022, the study enrolled 752 participants in semi-structured in-depth interviews and focus group discussions, involving community leaders, women’s leaders, healthcare providers, traditional practitioners, traditional leaders, drivers, and youth leaders, ensuring diverse perspectives. Findings indicate that vaccine hesitancy is fluid and contextual with three principal drivers: (1) denial of COVID-19’s existence, often reinforced by scepticism among healthcare providers and the belief that the disease is foreign or a governmental scheme for financial gain; (2) misinformation, including rumours about vaccine incompatibility with certain foods, and fears of sterility and witchcraft; (3) a firm reliance on traditional medicine, seen as effective alternative to biomedical interventions. Vaccine hesitancy can only be addressed through culturally responsive, multisectoral approaches centred on community dialogue, improved communication, and the integration of trusted networks. Without inclusive strategies, resistance will undermine pandemic response and future health interventions in SSA.