Exploring the beliefs and experiences with regard to COVID-19 vaccine hesitancy and acceptance in a slum of Karachi, Pakistan

Abstract

Summary The COVID-19-related misinformation and vaccine hesitancy is a widespread global concern and a recognized public health problem in Pakistan. The current research sought to explore the beliefs and experiences with regard to COVID-19, including vaccine hesitancy and acceptance, in a slum of Karachi, Pakistan. This study used an interpretivist epistemological approach for data collection and employed in-depth interviews (IDIs) and focus group discussions (FGDs) to explore the themes of interest. IDIs and FDGs were conducted in the local language (Pashtu) and Urdu, using semi-structured interview guides. A hybrid thematic analysis approach (use of both inductive and deductive coding) was used to analyze the data. We identified two key themes: the first related to vaccine hesitancy and refusal and included the role of personal belief systems, vaccine mistrust and public perceptions in hesitancy; the second related to vaccine acceptance and included knowledge and awareness about the vaccine and trusted sources of information. Religious beliefs and cultural norms influenced attitudes toward COVID-19 and vaccination. This study also found that awareness about the COVID-19 vaccine in this sample was influenced by sex, educational status and socioeconomic status. Participants with good health literacy and those from healthcare backgrounds were more likely to share views that indicated vaccine acceptance. The findings of this study are being used to co-design a comprehensive intervention to dispel COVID-19 misinformation and vaccine hesitancy across a range of stakeholders such as youths, community leaders, family members, faith leaders, schools and community-based local organizations in Pakistan.

COVID-19 Vaccine Acceptance, Attitude and Perception among Slum and Underserved Communities: A Systematic Review and Meta-Analysis

“…On further screening, 42 articles remained for eligibility assessment after excluding those which were not original studies and not done in slum/underserved communities. The final assessment yielded 24 articles for further analysis [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ].…”

“…Older age was a strong predictor reported in nine studies, with some reporting a positive association with acceptance and uptake [ 28 , 30 , 35 , 38 , 41 , 42 , 47 ] and a negative association in others [ 27 , 29 ]. High education level and good health literacy were also positive correlates of vaccine acceptance and uptake [ 25 , 29 , 37 , 39 , 42 ], though some studies reported a negative association [ 32 , 38 ]. Male gender had a positive association with vaccine acceptance in five studies [ 25 , 29 , 33 , 35 , 38 ].…”

“…Ethnicity/tribe was also a strong predictor in Uganda [ 41 ]. Being employed and having higher SES had a positive association with acceptance and uptake [ 29 , 39 ], while occupation had a varying effect on vaccination [ 29 , 37 , 38 , 42 ]. Good knowledge and awareness of the vaccines as well as reliable information sources, were strong positive associates of vaccine acceptance and uptake [ 28 , 34 , 37 , 41 ].…”

“…Being employed and having higher SES had a positive association with acceptance and uptake [ 29 , 39 ], while occupation had a varying effect on vaccination [ 29 , 37 , 38 , 42 ]. Good knowledge and awareness of the vaccines as well as reliable information sources, were strong positive associates of vaccine acceptance and uptake [ 28 , 34 , 37 , 41 ]. Perceived benefit of vaccination, high perceived susceptibility and severity of COVID-19, and self-efficacy to receive vaccination were also strong positive predictors of vaccine acceptance and uptake [ 27 , 30 , 34 , 39 , 41 , 48 ], same as cues to action in the forms of text messages and reminders for people to get vaccinated [ 41 , 48 ].…”

“…Perceived benefit of vaccination, high perceived susceptibility and severity of COVID-19, and self-efficacy to receive vaccination were also strong positive predictors of vaccine acceptance and uptake [ 27 , 30 , 34 , 39 , 41 , 48 ], same as cues to action in the forms of text messages and reminders for people to get vaccinated [ 41 , 48 ]. However, perceived barriers such as serious side effects and safety concerns of the vaccines and long distances to vaccination centres were associated with higher vaccine hesitancy, same as negative attitudes, beliefs and perceptions about the vaccine, for example, anti-vaccine attitudes and religious beliefs against vaccination [ 28 , 33 , 34 , 37 , 39 , 41 , 48 ]. Trust and confidence in the vaccine, healthcare workers and the government were also reported in several studies as strong positive predictors [ 33 , 34 , 42 , 47 , 48 ].…”