Five Years Later: Did Institutional Trust Predict the Failure of Algeria's COVID-19 Vaccination Campaign? A Retrospective Validation of a 2021 Vaccine Hesitancy Survey

Abstract Background Algeria's COVID-19 vaccination campaign never came close to the World Health Organization's herd-immunity target. It plateaued at under one-fifth of the population fully vaccinated. A large cross-sectional survey conducted in Algeria in 2021 (N = 1,600) had found that only 11.4% of respondents intended to get vaccinated, and that this reluctance tracked institutional and vaccine-related trust much more closely than it tracked perceived disease severity. Objective Five years on, we revisit that survey to ask whether the stated intention actually anticipated what happened next. We also place the Algerian case within the wider literature on the intention-behaviour gap and within comparative evidence from across the Middle East and North Africa (MENA), to test whether a trust-centred account of hesitancy holds up better than a complacency-centred one. Methods We compare the previously published hesitancy indicators against national vaccination-coverage figures reported by the WHO African Region and Our World in Data at several points between 2021 and 2023, and set the Algerian trajectory alongside comparable data from Jordan, Tunisia, Egypt, and Kuwait. Results The stated acceptance rate (11.4%) and the level at which the campaign eventually plateaued (17.8% fully vaccinated) sit in the same low range - both around a quarter of the global target. Rather than climbing steadily toward international benchmarks, coverage rose early and then flattened, a shape that fits a persistent, trust-based barrier better than a fear-based one that should have eased once early recipients experienced no ill effects. The regional comparison reinforces this: countries with similarly low initial acceptance but more active trust-building measures, notably Jordan, ended up far ahead of Algeria. Conclusion Stated-intention surveys can carry real predictive weight in low-trust settings, and the durability of Algeria's coverage plateau lends retrospective support to trust, rather than risk perception, as the true driver of hesitancy there.