The global COVID-19 vaccine rollout faced significant challenges, with religion emerging as a key factor influencing vaccine hesitancy and health choices. While research exists on this topic, the multifaceted religious landscapes of Africa and the Asia Pacific remain relatively under-researched. This study aims to address this gap by examining the relationship between religious beliefs, perceptions of vaccine-religion compatibility, and COVID-19 vaccine acceptance across these two regions. The unequal access to vaccines between the regions (with higher rates in Asia-Pacific compared to Africa) further highlights the need to investigate factors beyond availability that influence vaccine uptake. Previous studies have demonstrated a correlation between religiosity and reduced vaccine support, often attributed to conflicts between religious teachings and vaccination practices, or the spread of misinformation within religious communities. However, many studies focus on specific countries, lacking comparative analysis across diverse religions within and between regions. This study bridges this gap by leveraging data from two survey waves conducted in 15 countries across Africa and the Asia Pacific, providing a unique opportunity to analyze the diverse religious contexts and their influence on vaccine attitudes over time.

Existing literature extensively documents the association between religiosity and decreased vaccine support. Studies have highlighted potential conflicts between religious beliefs and vaccination procedures, such as concerns about the use of porcine products in some vaccines. Furthermore, misinformation regarding vaccines frequently circulates within religious communities, fostering doubt about vaccine safety and efficacy. However, much of the research focuses on specific countries, neglecting comparisons across multiple religions within a single region or between diverse regions. Africa, predominantly Christian and Muslim, contrasts with the Asia Pacific's heterogeneity of religious beliefs, including Buddhism, Hinduism, Christianity, and Islam. This study addresses this research gap by analyzing data from a large, geographically diverse sample.

This cross-sectional study utilized data from two waves of surveys conducted by the Vaccine Confidence Project between mid-2021 and 2022. The surveys covered 15 countries in Africa and the Asia Pacific, with approximately 1000 adult participants per country in each wave. Data collection methods included telephone, face-to-face, and online interviews. The study focused on religions with over 50 believers among respondents, including Christianity and Islam in both regions, and Animism, Atheism, Buddhism, and Hinduism in the Asia Pacific. Respondents were grouped by religious affiliation and region, resulting in eight distinct religious groups. Individuals with incomplete demographic information or who did not respond to the question regarding vaccine-religion compatibility were excluded. Vaccine attitudes were measured through two aspects: perceived compatibility of vaccines with religious beliefs and acceptance of COVID-19 vaccines. Multivariate logistic regression models were used to quantify the influence of religion, controlling for education, gender, and age. Interaction terms were incorporated to account for variations in the effects of religion across subpopulations and time points. Three main logistic regression models were used: (a) Compatibility: modeling religious compatibility with time, religion, education, gender, and age; (b) Acceptance: modeling vaccine acceptance with the same variables as in (a); and (c) Acceptance with compatibility: including perceived compatibility as a predictor of vaccine acceptance alongside other factors. Sensitivity analyses were performed to test the robustness of the findings. All analyses were conducted using R, accounting for sample weights.

The study revealed significant variations in vaccine attitudes across religious groups and regions. Atheists and Buddhists in Asia Pacific demonstrated the lowest agreement on vaccine-religion compatibility, consistently below 60% in both survey waves. Vaccine acceptance was considerably higher in Asia Pacific than in Africa, with the disparity widening in the second wave. The impact of education on vaccine perceptions varied considerably among the different religious groups. Those perceiving religious compatibility with vaccines were more likely to accept the COVID-19 vaccine. Significant temporal changes were observed. In the second survey wave, all religious groups except Atheists and Muslims exhibited increased vaccine acceptance. Specifically, African Muslims showed a slight decrease in vaccine acceptance from Wave 1 to Wave 2. In Asia Pacific, there was a significant increase in the acceptance rates among Buddhists and Christians in comparison to African Christians. The increase in vaccine acceptance within groups was driven mostly by those who had at most secondary school education. Individuals over 45 years old were more likely to believe that vaccination was compatible with their faith than younger people. The impact of education was also dependent on religious affiliation. Post-secondary education increased support for compatibility among Muslims in Asia Pacific but decreased this support for Buddhists in Asia Pacific. The role of perceived religious compatibility in vaccine acceptance was substantial, particularly during the first survey wave, but this impact weakened somewhat in the second wave, indicating shifts in overall vaccine acceptance over time.

This study's findings highlight the complex and context-specific nature of the relationship between religious beliefs and vaccine attitudes. The lower levels of vaccine acceptance and perceived compatibility among Atheists and Buddhists in Asia Pacific, and particularly low acceptance rates in Africa, underscore the need for targeted interventions tailored to specific religious and regional contexts. The variation in the impact of education across religious groups demonstrates the importance of understanding the interplay of individual beliefs and societal factors. The increased acceptance of vaccines in Wave 2 suggests temporal shifts, possibly due to increased vaccine availability, changing perceptions of risk, and evolving social dynamics. The study acknowledges that the strong association between faith and vaccine acceptance varied significantly based on time and location; this highlights the importance of continuing to monitor vaccine confidence and tailor interventions to specific subgroups.

This study demonstrates the complex interplay between religious beliefs, socio-demographic factors, and COVID-19 vaccine acceptance in Africa and the Asia Pacific. The findings highlight the need for tailored interventions that address concerns specific to particular religious groups and regional contexts. Future research should focus on longitudinal studies to understand the dynamic interplay of these factors over time, helping to develop more effective strategies to increase vaccine uptake and improve public health outcomes.

The study's cross-sectional design limits the ability to establish causal relationships. The timing discrepancies between survey waves in Africa and Asia Pacific might have influenced the observed differences in vaccine acceptance rates. The high acceptance rates in certain religious groups during Wave 2, particularly Animists and Hindus in Asia Pacific, created class imbalance and posed challenges in accurately assessing covariate effects. The exclusion of factors like socioeconomic status and employment may have influenced the results. Further research incorporating longitudinal data and a broader range of factors would strengthen the understanding of the complex relationships between religious beliefs and vaccination.