Sub-Saharan Africa remains the region with the highest under-five mortality rates. Vaccines and bed nets rank among the most cost-effective measures to reduce child mortality. Yet, although often available at low cost, their uptake is far from perfect. My work tries to understand what is holding back uptake and what can be done to stimulate demand.

One paper provides quantitative evidence to scrutinize ample ethnographic evidence that magico-religious beliefs affect the demand for preventive healthcare in Sub-Saharan Africa. We rely on the unique case of Benin, where Voodoo-adherence is freely reported, and varies greatly within villages and even within households, yet can be traced to historic events that are arguably exogenous to present-day healthcare behavior. We find that Voodoo adherence of the mother is associated with lower uptake of preventive healthcare measures and worse child health outcomes; results suggest a mediating role of traditional healers.

In another paper, we provide the first comprehensive attempt to quantify the role of institutional mistrust on child vaccination uptake in low- and middle-income countries. We matched information on child vaccination status from the Demographic Health Surveys with information on institutional trust from the Afrobarometer surveys for 166,953 children living in 22 African countries covering 216 subnational regions. We document that institutional mistrust is an important barrier in reaching universal child immunisation in Africa.

Child vaccination status based on DHS data. See here for detailed info.

Figures presenting information on world leaders’ vaccine role modelling behaviour during the COVID-19 pandemic. Paper forthcoming.

Building on the above findings, we explored whether public vaccination of political leaders can help promote vaccine acceptance. First, we systematically document that most global leaders supported the COVID-19 vaccination campaign and actively communicated their vaccination status to the public.

Focusing on DR Congo, we then leverage a survey experiment and take advantage of the fact that President Tshisekedi got publicly vaccinated against COVID-19 during our survey period. We find that the impact of political leader’s role modelling is moderated by trust and depends on media outreach and access. When trust in national leaders is lacking, or news on their actions is inaccessible, alternative ambassadors – such as village leaders or respected elderly community members – might be more effective in boosting vaccine acceptance.

As the world was trying to contain the COVID-19 outbreak, Eastern DR Congo faced the additional challenge of tackling Ebola. Relying on original survey data, we have highlighted the large differences in the socioeconomic impact of these two outbreaks. Our results show that different infectious disease outbreaks can have very different effects, largely unrelated to case numbers of the disease. Moderately lethal but highly transmissible viruses such as Covid-19 can trigger a steep economic downturn, especially in areas with high economic interconnectedness, reflecting both national and international policies to contain the pandemic.

Reported impact of COVID-19 and Ebola. See here for detailed info.

In other work, I have explored the relationship between psychological well-being and poverty in South-Africa, relying on five waves of the National Income Dynamics Study.

Related publications

“Presidents and vaccines. Head of state inoculation as a tool for vaccine promotion”. Frontiers in Public Health, 2024.
With L. Collart, E. Lunanga and M. Verpoorten link PDF replication media: The Conversation

“Institutional mistrust and child vaccination coverage in Africa”. BMJ Global Health, 2021.
With J.F. Maystadt and K. Hirvonen. link PDF replication 
media: The Conversation ; Le Soir ; IFPRI ; SciDev ; Communication Initiative Network ; Health Europa

“Covid-19 vs. Ebola: impact on households and small businesses in North Kivu, Democratic Republic of Congo”. World Development, 2021. 
With S. Desbureaux, A. Kaota, E. Lunanga and M. Verpoorten. link PDF replication media: blog

“Voodoo, vaccines and bed nets”. Economic Development and Cultural Change, 2019. 
With M. Verpoorten and K. Deconinck. link PDF media: policy brief

Science communication

“Are presidents good role models for vaccination uptake? DRC study shows only if they’re trusted, and people get to know about it.” The Conversation, 2024.
With L. Collart, E. Lunanga and M. Verpoorten link

“Low trust in authorities affects vaccine uptake: evidence from 22 African countries.” The Conversation, 2021. 
With J.F. Maystadt and K. Hirvonen link

“Covid-19 vs. Ebola: High stakes for Eastern DRC” IOB Blog, 2020.
With S. Desbureaux, A. Kaota, E. Lunanga, and M. Verpoorten. link French version

“Voodoo, vaccines and bed nets. Magicoreligious beliefs affect health behavior in Benin”. IOB Policy Brief 29, 2018. 
With M. Verpoorten. link

Working paper

“Exploring psychological well-being and poverty dynamics in South-Africa: evidence from NIDS waves 1-5”. NIDS Discussion Paper 2019/07, 2019. 
With M. Leibbrandt and R. Zizzamia. link