COVID-19 Vaccine Hesitancy in Ethiopia: A Scoping Review for Equitable Vaccine Access

Senait Alemayehu Beshah^1,2*Jibril Adem³Melkamu Ayalew⁴Yohannes lakew⁴Sileshi Garoma⁴Elizabeth Naa Adukwei Adote¹Daniel Malik Achala¹Grace Njeri Muriithi¹Chinyere Ojiugo Mbachu⁵James Akazili^6,7Ifeanyichukwu Chikezie⁸Chijioke O Nwosu⁹John E Ataguba^1,10,11,12

• ¹Africa Health Economics and Policy Association, Accra, Ghana, Accra, Ghana
• ²Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
• ³Department of Public Health, College of Health Science, Arsi University,, Asella, Ethiopia
• ⁴Ethiopian Ministry of Health, Addis Ababa Ethiopia, Addis Abeba, Ethiopia
• ⁵Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu City, Nigeria
• ⁶C.K Tedam University of Technology and Applied Sciences, Navrongo, Upper East Region, Ghana
• ⁷BCEPS University, Bergen,, Norway
• ⁸12. Health Systems and Development Research Group, Veritas University Abuja Nigeria Catholic Secretariat, Abuja, Nigeria
• ⁹University of the Free State, Bloemfontein, Free State, South Africa
• ¹⁰Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
• ¹¹Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, CanadaPartnership for Economic Policy (PEP),, Nairobi, Kenya
• ¹²School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa

Introduction: COVID-19 vaccines are crucial for preventing severe illness from the virus.Despite their effectiveness; vaccine hesitancy, unequal access, and economic disparities hinder vaccination programs across Africa, posing significant challenges in Ethiopia.Method: This scoping review followed the methodological guidelines outlined in the Joanna Briggs Institute Reviewer's and employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -Extension for Scoping Reviews (PRISMA-ScR) checklist and explanation to ensure transparency. To analyze the data, we developed tailored search strategies for key databases (HINARI, PubMed, Cochrane, African Journals Online (AJOL), and Science Direct) and gray literature sources. These strategies combined controlled vocabulary and relevant keywords.A descriptive thematic analysis was then employed to identify and categorize the various findings within the included studies. The results are presented in a narrative format, summarizing the key themes and providing a clear and comprehensive overview of the current evidence base.A review of 34 Ethiopian studies revealed significant COVID-19 vaccine hesitancy, with rates exceeding 50% in over 40% of the studies. The lowest hesitancy was found in adults from Addis Ababa (19.1%), while the highest rates were seen among healthcare workers in Oromia (69.7%) and pregnant women in Southwest Ethiopia (68.8%).Factors contributing to vaccine hesitancy in Ethiopia include being female, having only primary education, residing in rural areas, younger age, limited knowledge about the vaccine, reduced trust in authorities, and misperceptions about the risk of the virus. To address this challenge effectively, policymakers should prioritize interventions that build public trust, enhance awareness of the vaccine's benefits, and counter misinformation.