Background The development of vaccines for SARS-CoV-2 had a major impact on the COVID-19 pandemic, protecting and vulnerable and dramatically reducing mortality and severe morbidity due to SARS-CoV-2 infection in countries where vaccine coverage was high. African countries faced various challenges in rolling out SARS-CoV-2 vaccination campaigns, with poorer access to vaccines, vaccine hesitancy and the logistical challenges of reaching communities in rural areas. Rural communities might have differential access to information that results in different levels of vaccine hesitancy compared with urban populations. The aim of this study was to compare the knowledge, attitudes and practices of urban and rural communities regarding immunisation.

Methods We used a mixed-methods design combining individual surveys with focus group discussions. The 240 participants included healthcare workers and lay members of the community (patient carers & relatives), recruited through participating health centres in both rural and urban locations in each country.

Results Preliminary findings suggest that in urban areas, participants were overwhelmed by the multiplicity and contradiction of information sources. In rural areas, there was less access to information, and participants questioned the rationale for vaccination, less so because of anti-vaxx hysteria, but more because of a rational perception that they were at lower risk of COVID-19 due to to the lower population density. The majority of diagnoses were confirmed in urban settings, but this is deceptive, because that is where the greatest diagnostic capacity is.

Conclusion There are disparities in knowledge, attitudes and perceptions between communities living in urban areas compared to those in villages. An in-depth analysis across all 4 participating countries will be presented. We will demonstrate how EDCTP networks of excellence can be used to implement impactful student-led multi-site research studies at low cost.