“My business challenges are far worse right now, I will go for Covid-19 vaccine later”: Post-pandemic lessons from the Covid-19 vaccine rollout in informal settlements in Harare, Kampala, Lilongwe and Nairobi

Working Paper 11

Kate Lines, Stanley Dzimadzi, Henrik Ernstson, Joseph Kimani, Michelle Koyaro, Zilire Luka, Tarisai Manyowa, George Masimba Nyama, Patience Mudimu, Sheila Muganyi, Paul Isolo Mukwaya, Viola Nuwahereza, Teurai Nyamangara, Junior Alves Sebbanja, Elvira Songoro, Hakimu Sseviiri, Alice Sverdlik, Jane Wairutu and Happiness Zidana

April 2024


This paper focuses on the immediate post-pandemic period (2021–23) to discuss how the Covid vaccination rollout offers insights into the pandemic’s longer-term socioeconomic, health and political consequences for marginalised residents of African cities. Our findings provide a snapshot of the local impact of global vaccine inequalities as these continued to play out in Harare, Lilongwe, Kampala and Nairobi. Structural barriers to vaccine deployment and access continued to be exacerbated by pre-pandemic inequities in infrastructure, basic services and local governance. Among low-income urban communities in the four cities, interest in getting vaccinated and vaccine accessibility have both declined despite improvements in global allocation and national availability. Drivers of hesitancy changed over time, as perceptions of risk shifted from the high potential harm of vaccination to the low severity of the Covid health threat, further influenced by limited availability of information from trusted sources. And Covid vaccination campaigns have largely been eclipsed by overlapping new crises, the effects of which have further compromised many people’s already slow recovery.


Covid-19 vaccines, informality, structural inequalities, health inequality, vaccine hesitancy, Harare, Nairobi, Lilongwe, Kampala, post-pandemic period