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Vaccine hesitancy in low- and middle-income countries: potential implications for the COVID-19 response
  1. Sunil Bhopal1,2,
  2. Maryke Nielsen3,4,5
  1. 1 Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
  2. 2 Maternal & Child Health Intervention Research Group, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
  3. 3 Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
  4. 4 Early Life Infection Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
  5. 5 Liverpool Health Partners, Liverpool, UK
  1. Correspondence to Dr Sunil Bhopal, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; sunil.bhopal{at}

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At this point in the COVID-19 pandemic, children are relatively spared by the direct effects of the SARS-CoV-2 virus, but their role in transmission is less understood. Conclusions on these issues call for caution, as the nature of the pandemic and the virus changes. Global health organisations and national governments are pinning hopes for a return to quasinormality on the development of a safe and effective vaccine that can be quickly manufactured and supplied around the world for use at scale in record time. There are currently more than 100 such vaccine candidates with phase 1, 2 and 3 studies in progress. Adults who are at high-risk of COVID-19 may overwhelmingly choose to receive a vaccine, but it remains unclear if an exclusively adult targeted vaccine campaign would be sufficient to interrupt transmission. Some experts estimate that, at a minimum, 60% population level immunity will be required.1 This figure rises if R0 increases. Particularly in low-income and middle-income countries (LMICs) with a high proportion of young people and less well-established adult vaccination programmes, widespread childhood vaccination may also be necessary. This leads us to consider the likely acceptability of a novel COVID-19 vaccination for children, who are—at this stage of the pandemic—mostly not severely affected by COVID-19.

The good news is that vaccinations are largely accepted in LMICs. According to the results of the 2018 Wellcome Global Monitor, a survey of 140 000 individuals in …

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  • Twitter @sunilbhop, @MarykeJN

  • Funding MN is funded by a Wellcome Trust Training Fellowship (203919/Z/16/Z).

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Data availability statement No original data are presented in this piece