High Vaccine Acceptance in Sierra Leone Highlights Role of Trust, Messaging, and Misinformation
More than 80% of adults support COVID-19 vaccination, but hesitancy linked to side effects, geopolitics, and misinformation remains a challenge, says lead researcher Mahmud Sheku, MPH, MSc.
More than 80% of adults in Sierra Leone said they would accept COVID-19 vaccines for themselves or their families, according to a study presented at the 2025 Annual Conference on Vaccinology Research. The study surveyed 2,146 adults to assess vaccine awareness, acceptance, and hesitancy.
Researchers from Emory University, the University of Siena, and other institutions found that 75.2% of respondents were aware of COVID-19 vaccines, and acceptance rose to 85% when vaccination was required. Main reasons for acceptance included beliefs in safety, immunity, and trust in vaccines.
Although, hesitancy was also reported. It was linked to concerns about side effects, doubts about effectiveness, and skepticism about the pandemic itself, often influenced by social media and misinformation.
Mahmud Sheku, MPH, MSc, a PhD student at Emory University and lead investigator on the study, explained the origins of the work, “I conducted this study around December or January, during the COVID-19 pandemic, just as the vaccines were about to hit the market. I had just graduated from my master’s program in vaccinology. I was listening to people from different backgrounds and wanted to get a deeper understanding of what was happening.” What Sheku found was a deep undercurrent of distrust in vaccines depending on their country of origin,even when those vaccines were locally approved.
“There was a buildup of social media narratives and misinformation within communities. These narratives framed vaccines from certain countries as experimental and unsafe compared to others,” he said. “That developed into geopolitical perceptions. People came to believe that the vaccine manufacturing processes were uncertain or risky, and that taking such vaccines might harm them.”
According to the survey, while 32.4% of respondents were willing to accept vaccines from any country as long as they were approved locally, 15.1% said they would reject vaccines from China, 12.6% from India, and 11.4% from the United States. Smaller but notable percentages expressed distrust in vaccines originating in Germany, Russia, the United Kingdom, and Belgium.
To overcome such biases, Sheku emphasized the role of trusted local messengers, “We have to look at community leaders and professionals as trusted messengers. They can re-emphasize the importance of vaccines, how safe they are, and the rigorous approval processes they go through before being released to the public,” he said. “Each country has a national regulatory authority that independently reviews vaccine data before granting a local license. And vaccines approved by the WHO’s Emergency Use Listing have met all international safety and development standards.”
The study also revealed a widespread preference for vaccines with fewer side effects, reported by 55.7% of participants, even when this meant lower efficacy, “This reflects limited understanding in some communities about how vaccines work,” Sheku noted. “People need to understand the difference between protective efficacy and the reactogenic profile of vaccines.”
According to Sheku, vaccine education efforts must go beyond slogans and address the root of people’s concerns, “We should tailor messaging to specific populations using locally relevant content. Translate vaccine development concepts into local languages. Use targeted campaigns for communities with high hesitancy. Explain the stages of development and the role of all the agencies involved in ensuring vaccines are safe.”
The study’s findings, he believes, can support vaccine developers as well, “Safety is paramount. Developers should aim to minimize side effects where possible. But public trust also depends on education. People need to know that a side effect doesn’t mean the vaccine is unsafe—it’s just the immune system responding.”
