Can high-profile endorsements improve COVID-19 vaccine uptake and reduce hesitancy in Pakistan?

Abstract

Background

While low- and middle-income countries continue to struggle to secure adequate COVID-19 vaccine supply, a potentially greater challenge is to induce adequate demand to overcome widespread vaccine hesitancy; vaccination uptake has historically been a contentious political issue in Pakistan. High-level endorsements by trusted actors are one way to potentially increase public vaccine confidence. Methods: Employing a four-armed randomized trial with 2026 participants in June 2021, we examine whether endorsements by different actors (Prime Minister, prominent religious leader, doctors) influenced participants’ willingness to register for the COVID-19 vaccine.

Results

We find high levels of vaccine hesitancy with nearly 35% of participants reporting that they do not intend to vaccinate against COVID-19. Endorsements failed to influence participants' desire to register for vaccination, and only 37 % agreed to register on spot. However, we find that higher trust in government, male gender, and higher income/wealth were associated with participants' willingness to register. A follow-up phone survey was consistent with the main results.

Discussion

Our study finds that endorsements appear to have little effect on people’s immediate willingness to register for vaccination. Our findings suggest messaging on its own may be insufficient to overcome widespread social and structural barriers to vaccine uptake.