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

  1. A Tariro Makadzange
  2. Charles Lau
  3. Janan Dietrich
  4. Admire Hlupeni
  5. Nellie Myburgh
  6. Patricia Gundidza
  7. Nyasha Elose
  8. Shabir Mahdi
  9. Wilmot James
  10. Larry Stanberry
  11. Chiratidzo Ndhlovu

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Abstract

Background

The 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.

Methods

Between 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.

Results

1016 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.

Conclusion

Improving 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.

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    SciScore for 10.1101/2022.04.20.22274081: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: All individuals receiving their first COVID-19 vaccine were eligible to participate except those who had obvious cognitive impairments or were unable to provide informed consent.
    IRB: Ethics Approvals: The protocol, consent forms and recruitment materials were reviewed and approved by the Medical Research Council of Zimbabwe, Joint Research Ethics Committee (JREC) of Parirenyatwa Hospital, the University of Zimbabwe, and Harare City Health Departments prior to initiation of the study.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    An important limitation is that our survey was not designed to evaluate complacency or hesitancy in-depth. We observed that as many as 16.4% of participants indicated that they ‘Do not see need for vaccine’. Complacency has been described as a major barrier in Africa and may become increasingly important as milder variants of SARS-CoV-2 emerge and seroprevalence from natural infection increases(33). We also did not specifically survey healthcare workers who in some settings may be key drivers of vaccine hesitancy. In sharing this data with healthcare workers many indicated that their own personal knowledge about vaccines was limited, and they would have appreciated further training and vaccine knowledge reinforcement. The impact of healthcare worker hesitancy on program success is critical and needs to be studied and addressed(34, 35). The study data highlights the need for consistent and targeted information that is gender and age specific and targeted to subpopulations such as PLWH. Information must be delivered by trusted sources such as the Ministry of Health via traditional media platforms such as radio and television that are heavily accessed and can be used to address misinformation delivered on social media. The vaccination encounter should equip friends and family with accurate information on specific vaccines and side effects so they can act as informed social influencers for their family and friends. These individuals can be key ambassadors for vaccination within t...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2022.04.20.22274081v1 on medRxiv