The Drivers of Low Vaccination Utilization in Niger.

Vaccination adherence involves the expected benefit of a vaccine and the perceived risk of the disease. To develop an evidence-based communication strategy aimed at improving vaccination coverage in Niger, we conducted a mixed socio-anthropological study of the perceptions among the population on the benefit and the risk of the childhood (Expanded Program on Immunization) and the COVID-19 vaccines. Our results show that negative rumors are not a significant driver of vaccine refusal. The insufficient level of fully vaccinated, compared with partially vaccinated, children might be explained by misunderstandings around the side effects of vaccines and the necessity for full vaccination. Approximately one-fourth of the population is vaccinated against COVID-19, whereas 73.3% think that vaccines against the disease are a "good thing," and 83% of those who have heard messages promoting the vaccination approve of them. This apparent contradiction is explained by a low perception of the risks of COVID-19. More than half of the population surveyed believe that the disease is not present in the country. A large majority believe that only ill people can transmit the disease, whereas only 12.8% think they know anybody who has ever been sick with COVID-19. Three-fourths of the interviewees have seen images from around the world of persons sick or deceased from COVID-19; the same proportion has not seen any such images of affected patients in Niger. Communication to improve COVID-19 uptake should focus on the reality of the disease presence and its transmission and not on rumors surrounding the vaccines.