This study used a ‘vaccine anxieties’ framework to consider the socially-embedded reasons why people want or do not want Covid-19 vaccines, and how this intersects with the dynamics of vaccine supply, access and distribution in rapidly-unfolding epidemic situations. Whereas discourses of vaccine hesitancy misrepresent African publics as ignorant or confused, the authors argue that Covid-19 vaccine anxieties make sense given disease, social and political experiences. While growing familiarity with Covid-19 vaccines have eroded some concerns, vaccine preparedness must nevertheless address health system structures and politics.