Acceptability of the Ebola vaccine in the sub-Saharan African population: A systematic review and meta-analysis

Abstract

Ebola virus disease is a very serious disease, with a case-fatality rate of around 50%, and a high epidemic potential. Vaccination is a vital intervention to stop the spread of disease and prevent future epidemics. The aim of this study was to carry out a systematic review and meta-analysis to determine the level of acceptability of the Ebola vaccine among the population of sub-Saharan Africa. We conducted an exhaustive systematic search to identify relevant studies. we included observational or cross-sectional studies. we conducted an extensive search of electronic libraries (Pubmed/medline, Google scholar and Index Medicus Africa) covering the period January 2014 to December 2024. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to assess the quality of the included studies. Data were analyzed using a random-effects model. Q test Cochran and I² index were used to assess heterogeneity. Subgroup analyses were performed according to year, country, gender, and sample size. Publication bias was assessed graphically by a funnel plot and statistically by Egger test. A total of 11 studies involving 14,826 participants were included. The meta-analysis found that the level of acceptability of the Ebola vaccine was 74.0% (95% CI: 65.0–82.0). Heterogeneity between studies was highly significant (I²=99.16%, P < 0.001). The level of acceptability being slightly higher in male-dominated studies (75.6%; 95% CI:71.4% − 79.6%) and in studies conducted after 2020 (78.4%; 95% CI: 63.1% − 90.4%). Across countries, the highest level of acceptability was recorded in Nigeria, (79.9%; 95% CI: 76.5% − 83.1%). The main reasons for vaccine hesitancy included fear of adverse effects, distrust of health authorities, and misinformation. Ebola vaccine acceptability in sub-Saharan Africa remains moderate. Although this level indicates encouraging progress since 2020, it may still be insufficient to ensure optimal population coverage during outbreaks. Targeted community engagement, trust-building, and proactive management of misinformation are essential to enhance vaccine acceptance and achieve coverage goals.