Reasons for hesitancy and acceptance of COVID-19 vaccination among the Congolese population: A Scoping Review

GENESE LOBUKULU LOLIMO^1*Rodrigue Khonde²Herve Matondo²Junias Ngoy Mpemba Kabele²Yannick Musawu³Senait Beshah^4,5Daniel Malik Achala⁵Grace Njeri⁵Elizabeth Adote⁵Dr Elias Asfaw Zegeye⁶Chinyere Ojiugo Mbachu⁷John Ele-Ojo Ataguba^10,5,8,9Fadima YAYA BOCOUM¹¹Serge Manitu Mayaka¹

• ¹Department of Health Management and Policy, Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
• ²Environmental Health Department, Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
• ³Ministry of Public Health, Hygiene and Social Welfare Programme National, Kinshasa, Democratic Republic of Congo
• ⁴Ethiopian Public Health Institute, Addis Ababa, Ethiopia
• ⁵African Health Economics and Policy Association, Accra, Ghana
• ⁶Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
• ⁷Departement of Community Medecine, University of Nigeria, Enugu Campus, Nigeria
• ⁸University of Manitoba Max Rady College of Medicine, Winnipeg, Canada
• ⁹Partnership for Economic Policy (PEP), Nairobi, Kenya
• ¹⁰University of Pretoria School of Health Systems and Public Health, Pretoria, South Africa
• ¹¹Health Sciences Institute, Ouagadougou, Burkina Faso

Despite over 9.6 billion COVID-19 vaccine doses administered globally, vaccination access remains highly unequal. North America and Western Europe have over 50% vaccination coverage, contrasting sharply with African nations, like the Democratic Republic of Congo (DRC), which has under 10%. This scoping review explores the key factors contributing to the low COVID-19 vaccination rate in the Congolese population. We conducted a scoping review using the Arksey and O'Malley framework, searching PubMed, ProQuest, and Scopus databases for peer-reviewed manuscripts published between 2019 and 2023. Six studies met the inclusion criteria, focused on COVID-19 vaccine acceptance, hesitancy, and access in DRC. Although surveys indicated a high willingness to be vaccinated, only 2,7 % were fully vaccinated. The primary barrier was safety concerns, specifically, perceptions of the vaccine as new and experimental (84,4%) and fear of side effects (83,3%). Additional hesitancy factors included mistrust in vaccine effectiveness (60,4%) and general lack of confidence (60,0%). Facilitators of acceptance included prior family vaccination, perceived risk of infection, belief in the virus's existence, and awareness of vaccination strategies. Sociodemographic factors such as being a healthcare professional or male also positively influenced uptake. These findings highlight the gap between vaccine willingness and actual coverage in the DRC. Addressing safety concerns and building trust through targeted outreach, especially among key professional groups, may improve vaccine acceptance and equity.