High SARS-CoV-2 Antibody Seroprevalence Amid COVID-19 Vaccine Hesitancy Among Unvaccinated Adults in Ghana.

COVID-19 vaccine uptake remains low in several parts of Ghana. Therefore, this study assessed prior exposure to SARS-CoV-2 by detecting immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies among unvaccinated adults in the Wassa Amenfi East District, and examined socio-demographic determinants of vaccine hesitancy and potential motivators for future vaccine acceptance. This cross-sectional study was conducted at Bethany Memorial Hospital, Wassa Akropong, Ghana, where unvaccinated adults aged ≥ 18 years were randomly selected. Blood samples were tested for SARS-CoV-2 IgG and IgM antibodies, and a structured questionnaire captured demographic characteristics, reasons for vaccine refusal, and factors influencing future acceptance. Data were analysed using descriptive statistics and Chi-square or Fisher's exact tests, with statistical significance set at p < 0.05. Seroprevalence rates for IgG, IgM, and combined IgG/IgM were 85% (142/166), 9.0% (15/166), and 7.8% (13/166), respectively. Antibody prevalence did not differ significantly by age, gender, or pregnancy status. Gender-specific patterns of hesitancy were observed: females more frequently reported fears of side effects, infertility, and pregnancy-related concerns, whereas males more commonly cited reduced productivity, impotence, and a perceived lack of need for vaccination (p < 0.05). Older adults were more likely to doubt vaccine efficacy, while younger adults reported fertility-related fears. Across all groups, credible evidence of vaccine safety and efficacy emerged as the strongest motivators for future acceptance. These findings indicate widespread prior exposure to SARS-CoV-2 among unvaccinated adults and highlight the need for gender-responsive, evidence-based community engagement to address vaccine hesitancy in low-coverage settings.