Despite misinformation, low trust, and conflict in Somalia, high demand for vaccines and a negative endorsement effect of non-state authorities

Abstract

Expanding vaccination coverage in conflict regions is crucial to the prevention of further mutations and outbreaks of COVID-19, as well as of future pandemics, worldwide. However, scholars’ suppositions that low levels of trust and control over the flow of misinformation in these regions may necessitate tailored solutions—in particular, that health advice come from trusted non-state authorities—remain largely untested. To better understand the levels and drivers of COVID-19 vaccine receptivity in conflict regions, we partnered with the United Nations and the Somali Ministry of Justice to field a three-wave panel survey (N1 = 1672; N2 = 880; N3 = 908) and vaccine endorsement experiment in South Central Somalia. We observe high overall demand for vaccines (between 90 and 94%), particularly among those who have experienced violence and illness, who perceive high economic disruption due to the pandemic, and who report more favorable views of and exposure to the West and Western-affiliated organizations. The high overall demand is particularly striking given respondents’ low interpersonal trust and considerable exposure to vaccine disinformation. Contrary to scholars’ and policymakers’ expectations, we find that whereas endorsements from government health authorities increase vaccine receptivity, endorsements from non-state customary authorities and extremist militant group Al-Shabaab decrease support for vaccination (− 8 and − 16% points, respectively). Our findings caution against presupposing a need for different approaches to increasing vaccination coverage in conflict regions, and suggest that at least in the short-term, constraints on vaccine supply and access are more likely to bind than those on demand.