Low COVID-19 vaccination rates in Africa Cup of Nations host Cameroon and a fourth wave of the coronavirus across much of the continent could make for sparsely-attended matches when the soccer finals kick off on Sunday.

Cameroon announced last month that it would require spectators at Africa’s premiere soccer competition to be fully vaccinated and show a negative test result before entering stadiums.

That has encouraged some fans to get vaccinated, doctors and nurses say.

Cedric Franz Mbende a soccer fan who lives in Douala is one of them.

“I am a fan of the sport, and I play as well. I come for two reasons. Firstly, to protect myself by getting vaccinated and also to get to the stadium to take part in this special event for our country which is the Afcon,” he said after receiving his vaccination.

Doctors and nurses said they had seen an uptick in vaccinations since the government announced the stadium policy.

“At the moment, here at the center, we have people who wish to travel. We have the people who want to get vaccinated to reinforce their immune system and now, we have those who run to get vaccinated because it’s a condition to access the stadiums,” said Odette Felicite a nurse working at a Douala vaccination center.

But the overall vaccination numbers remain extremely low. Just 2.3% of Cameroon’s more than 26 million people are fully vaccinated, health ministry data shows, even though doses are now widely available.

Yannick Doutse, who was playing in a pick-up match in Douala one recent afternoon, said he had dreamed of going to see Cameroon’s Indomitable Lions play in the tournament but that the vaccination requirement was a deal-breaker.

“It will mean that a lot of people won’t make it to the stadium because there are not many people who want to be vaccinated so the stadiums will be a little empty. For such an Afcon, it’s true we can say it is the first Afcon for us because we are young, it will be very difficult. So, I’d prefer still to do a test to get to the stadium. But the vaccine, I am against it,” Doutse said.

Others like Moise Nyomo Ndikwa are still hesitating.

“Some people take the vaccines, others get headaches so I’d rather see how it looks before maybe before taking the vaccine. But, if it is an obligation, as I love football, I will most certainly get this vaccine to go to the stadium,” he said.

Low vaccination rates are common across many African countries, which initially struggled to secure doses and now face public scepticism as well as logistical challenges to get shots in arms.

Asked about the impact of the stadium policy on vaccination rates, Dr. Njoh Andreas Ateke, an official with the government’s vaccination agency, said simply: “People are getting vaccinated more and more.”

Infection rates from a fourth wave of COVID-19 driven by the Omicron and Delta variants are still rising in many African countries, while some are only just coming down from record peaks.

Tournament organisers did not respond to questions about how this would affect attendance at matches.