Investigating Attitudes, Motivations and Key Influencers for vaccine uptake among late adopters of COVID-19 vaccination in Africa

Abstract

BackgroundThe rapid development of vaccines in response to the COVID-19 pandemic has provided an effective tool for the management of COVID-19. However, in Africa there has been a poor uptake of COVID-19 vaccines with only 15% vaccine coverage compared to the WHO global target of 70%. One of the important drivers has been vaccine hesitancy, understanding late adopters of vaccination can provide insights into the attitudes, motivations and influences that can enhance vaccine uptake.MethodsBetween January 4 – February 11, 2022, we conducted a survey among adults presenting for their first dose of a COVID-19 vaccine almost 12-months after the vaccination program began. Vaccines were free and provided at clinics and outreach centers in Harare, Zimbabwe. The questionnaire assessed environmental and individual factors (attitudes, barriers, motivations, key influencers, and information sources) that influenced the decision to present for vaccination. Baseline socio-demographic data and responses to survey questions were summarized using descriptive statistics. Binary logistic regression models were developed to understand factors associated with vaccine confidence.Results1016 adults were enrolled into the study, 508 (50%) were female, 126 (12.4%) had HIV co-infection. The median age was 30 years (IQR 22 – 39). Women were more likely to have negative views about the COVID-19 vaccine compared to men (OR 1.51 (95%CI 1.16, 1.97, p=0.002). Women compared to men and older adults (≥ 40 years) compared with youth (18-25 years) were more likely to have ‘major concerns’ about vaccines. Most concerns were about safety with 602 (59.3%) concerned about immediate and 520 (51.2%) about long-term health effects of vaccines. People living with HIV (PLWH) were more likely to perceive vaccines as safe (OR 1.71 (95%CI: 1.07, 2.74, p=0.025), effective (1.68 (95%CI: 1.07, 2.64, p=0.026) and to trust regulatory systems for approving vaccines (OR 1.79 (95% CI: 1.11, 2.89, p=0.017) compared to those without HIV. Internet users were less likely to perceive vaccines as safe (OR 0.72 (95% CI: 0.55, 0.95, p=0.021), effective (OR 0.61 (95% CI: 0.47, 0.80, p<0.001) or trust regulatory processes for approving vaccines (OR 0.64 (95% CI: 0.48, 0.85, p=0.002) compared to non-internet users. Social influence was a key factor in the decision to be vaccinated with family members being the primary key influencers for 560 (55.2%) participants. The most important reason for receiving the COVID-19 vaccine today for 715 (70.4%) participants was the protection of individual health. The most trusted source of information regarding the vaccine was the Ministry of Health (79.7%) and the radio, television and social media were the preferred sources for obtaining this information. Social media was a more likely source for youth and those with higher levels of education.ConclusionImproving vaccine coverage will need targeted communication strategies that address negative perceptions of vaccines and associated safety and effectiveness concerns. Leveraging normative behavior as a social motivator for vaccination will be important as close social networks are key influences of vaccination. Traditional media remains important for health communication in Africa and should be strengthened to counter social media-based misinformation that drives concerns about safety and effectiveness particularly among internet users.

Attitudes to Vaccine Mandates among Late Adopters of COVID-19 Vaccines in Zimbabwe

“…We enrolled 1016 adults presenting for vaccination approximately one year after the initiation of the vaccination program as described [ 20 ]. Half of the cohort was female; the median age was 30 years (IQR: 22–39 years) ( Table 2 ).…”

“…All participants were vaccinated with the Sinopharm vaccine, except for three participants who received the Sinovac vaccine. Perceptions of vaccine safety, effectiveness, and trust in regulatory processes were high ( Table 2 ) [ 20 ].…”

“…Attitudes to vaccine mandates for school attendance were slightly more favorable, with almost 80% of the study population agreeing with COVID-19 vaccine mandates for schools and over 70% indicating that they would be extremely or very likely to vaccinate their children. The greatest concerns regarding vaccines for children were around short- and long-term side effects and were similar to trends in concerns about COVID-19 vaccines for adults [ 20 ]. Approval of vaccine mandates for children was also associated with low economic status, and confidence in vaccine safety, effectiveness, and trust in regulatory processes.…”

“…Between 4 January and 11 February 2022, we conducted a quantitative survey to evaluate attitudes, barriers, motivations, key influencers, and information sources for vaccination among individuals presenting for COVID-19 vaccines in public vaccination centers in Harare [ 20 ].…”

“…A comprehensive questionnaire was prepared as previously described [ 20 ]. The questionnaire was administered in the language preferred by the participant, either English or Shona.…”