Presidents and vaccines: head of state inoculation as a tool for vaccine promotion.

Introduction: Vaccine hesitancy, an important threat to global health, has increased since the onset of the COVID-19 pandemic. The public vaccination of high-profile figures, such as heads of state, has been touted as a potential tool for increasing vaccine acceptance among the general population. However, systematic information on such role modelling is lacking and existing studies focus on a small number of high-income countries. We take advantage of the COVID-19 pandemic to fill this gap. Methods: Through a systematic search of internet sources, we first document that most global leaders supported the vaccination campaign and actively communicated their vaccination status to the public. We then turn to a case study to provide experimental evidence on vaccine role modelling for a country in Africa - the region that is most lagging behind in achieving universal immunization coverage. We rely on a randomized survey experiment with 600 citizens in the Democratic Republic of Congo and take advantage of the fact that the Congolese President publicly received a COVID-19 vaccine during the survey period. Results and discussion: Our findings demonstrate that the impact of political leader's role modelling is moderated by trust and depends on media outreach and access. When trust in leaders is lacking, or news on their actions is inaccessible, alternative ambassadors and effective communication methods become crucial in motivating and informing the public. This may be especially relevant in fragile states and remote regions.

Covid-19 vs. Ebola: Impact on households and small businesses in North Kivu, Democratic Republic of Congo.

In April 2020, the Eastern Democratic Republic of Congo was facing two major infectious disease outbreaks: Covid-19 and Ebola Virus Disease (EVD). We highlight large differences in the socioeconomic impact of these two outbreaks. The data come from a phone survey that we conducted in the period May-July 2020 with 637 households and 363 small firms from a megacity and two rural communes in the province of North Kivu. While 3,470 EVD cases and 2,287 EVD deaths were confirmed since August 2018, self-reported impacts of EVD on revenues, access to food and behavior were limited. In contrast, only 251 Covid-19 cases were reported as of July 22nd but respondents reported sizable effects on livelihoods, especially in the large urban hub, and in part driven by substantial job losses. 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.