Background: In March 2021, Sierra Leone introduced the COVID-19 vaccine to halt the spread of the virus. As of November 30, 2022, the vaccination coverage among the general population has reached 40%, which is below the WHO-recommended threshold (70%). This survey aimed to determine the COVID-19 vaccine coverage, and factors associated with vaccine hesitancy.

Methods: We conducted a community-based cross-sectional cluster survey among the general population from January to December 2021. We used multistage sampling to select 367 participants. Using a structured questionnaire, we collected data on demographics, vaccination status, and hesitancy including associated factors. We used Epi Info 7 to compute frequencies and proportions; calculated adjusted Odd Ratio (aOR), with a 95% Confidence Interval (CI) at p-value of <0.05 to identify risk factors.

Results: All 367 participants selected for the interview responded, with a median age of 35 years (Range: 18 – 91 years). Of the total respondents, 55% (200/367) were females. Thirty-seven percent (136/367) received at least one dose of the COVID-19 vaccine. Of those unvaccinated, 63% (146/231) reside in formal communities. Of the respondents, 97% (356/367) mentioned the availability of the COVID-19 vaccine. A total of 40% (147/367) of respondents were hesitant to take the COVID-19 vaccine. Forty-four percent (66/150) of the respondents among formal community dwellers and 38% (82/217) among individuals who live in informal settlements were hesitant to take the vaccines. Lack of trust in COVID-19 vaccine safety was independently associated with COVID-19 hesitancy (aOR: 0.4, 95% CI: 0.2 – 0.8, p-value = 0.007).

Conclusions: COVID-19 vaccine coverage was relatively low with high hesitancy, especially in formal communities. Lack of trust in COVID-19 vaccine safety was identified as the leading factor for vaccine hesitancy. We recommend the Ministry of Health heighten vaccination uptake by intensifying awareness campaigns through community stakeholders, media engagements and risk communication on COVID-19 vaccine safety.