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Kobayashi T, Tokiya M, Matsumoto A, Nakano T, Hirota Y, Hara M. Predictive factors of coronavirus disease (COVID-19) vaccination series completion: a one-year longitudinal web-based observational study in Japan. Front Public Health 2024; 12:1348170. [PMID: 38487189 PMCID: PMC10937344 DOI: 10.3389/fpubh.2024.1348170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Addresing vaccine hesitancy is considered an important goal in management of the COVID-19 pandemic. We sought to understand what factors influenced people, especially those initially hesitant, to receive two or more vaccine doses within a year of the vaccine's release. Methods We conducted longitudinal Web-based observational studies of 3,870 individuals. The surveys were conducted at four different time points: January 2021, June 2021, September 2021, and December 2021. In the baseline survey (January 2021), we assessed vaccination intention (i.e., "strongly agree" or "agree" [acceptance], "neutral" [not sure], and "disagree" or "strongly disagree" [hesitance]), and assumptions about coronavirus disease (COVID-19), COVID-19 vaccine, COVID-19-related health preventive behavior, and COVID-19 vaccine reliability. In subsequent surveys (December 2021), we assessed vaccination completion (i.e., ≥2 vaccinations). To investigate the relationship between predictors of COVID-19 vaccination completion, a multivariable logistic regression model was applied. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated while adjusting for gender, age, marital status, presence of children, household income category, and presence of diseases under treatment. In a stratified analysis, predictors were determined based on vaccination intention. Results Approximately 96, 87, and 72% of those who demonstrated acceptance, were not sure, or hesitated had been vaccinated after 1 year, respectively. Overall, significant factors associated with COVID-19 vaccine compliance included the influence of others close to the index participant (social norms) (AOR, 1.80; 95% CI, 1.56-2.08; p < 0.001), vaccine confidence (AOR, 1.39; 95% CI, 1.18-1.64; p < 0.001) and structural constraints (no time, inconvenient location of medical institutions, and other related factors) (AOR, 0.80; 95% CI, 0.70-0.91; p = 0.001). In the group of individuals classified as hesitant, significant factors associated with COVID-19 vaccine compliance included social norms (AOR, 2.43; 95% CI, 1.83-3.22; p < 0.001), confidence (AOR, 1.44; 95% CI, 1.10-1.88; p = 0.008), and knowledge (AOR, 0.69; 95% CI, 0.53-0.88; p = 0.003). Discussion We found that dissemination of accurate information about vaccines and a reduction in structural barriers to the extent possible enhanced vaccination rates. Once the need for vaccination becomes widespread, it becomes a social norm, and further improvements in these rates can then be anticipated. Our findings may help enhance vaccine uptake in the future.
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Affiliation(s)
- Takaomi Kobayashi
- Department of Preventive Medicine, Faculty of Medicine, Saga University Nabeshima, Saga, Japan
| | - Mikiko Tokiya
- Department of Social and Environmental Medicine, Faculty of Medicine, Saga University Nabeshima, Saga, Japan
| | - Akiko Matsumoto
- Department of Social and Environmental Medicine, Faculty of Medicine, Saga University Nabeshima, Saga, Japan
| | - Takashi Nakano
- Department of Pediatrics, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshio Hirota
- Clinical Epidemiology Research Center, SOUSEIKAI Medical Group (Medical Co. LTA), Fukuoka, Japan
| | - Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University Nabeshima, Saga, Japan
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Gengiah TN, Naidoo DC, Maduma N, Govender S, Dhindayal S, Lewis L. COVID-19 vaccine hesitancy in KwaZulu-Natal, South Africa: A survey of unvaccinated adults. Health SA 2024; 29:2468. [PMID: 38445041 PMCID: PMC10913108 DOI: 10.4102/hsag.v29i0.2468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/29/2023] [Indexed: 03/07/2024] Open
Abstract
Background Concerns and misconceptions surrounding coronavirus disease 2019 (COVID-19) vaccines may account for vaccine hesitancy and low uptake. Aim To determine prevalence of COVID-19 vaccine hesitancy, vaccine-related misconceptions, and predictors of vaccine hesitancy among South Africans. Setting Community setting in five districts in KwaZulu- Natal province. Methods Between August 20, 2021, and September 27, 2021, we conducted a cross-sectional survey, interviewing 300 unvaccinated adults amid the national vaccination campaign. Predictors of hesitancy were identified through multivariable logistic regression analysis. Results Participants had a median age of 29 years (IQR: 23-39), 86.7% were Black African, 63.2% were male, 53.3% resided in rural communities, and 59.3% (95% CI: 53.8% - 64.9%) were classified as vaccine hesitant. The primary reason for not vaccinating was a lack of trust in the vaccine (62.1%). Factors associated with reduced vaccine hesitancy included age (participants aged 35-49 years: OR: 0.28, 95% CI: 0.18-0.64, p = 0.003; participants over 50 years: OR: 0.18, 95% CI: 0.07-0.47, p = 0.0004), previous COVID-19 infection (OR: 0.31, 95% CI: 0.11-0.87, p = 0.03), and receiving vaccine information from healthcare workers (OR: 0.32, 95% CI: 0.10-1.0, p = 0.05). Unemployed (OR: 2.14, 95% CI: 1.1-4.2, p = 0.03) and self-employed individuals (OR: 2.98, 95% CI: 1.27-7.02, p = 0.01) were more likely to be vaccine hesitant. Conclusion COVID-19 vaccine hesitancy rates are high in KwaZulu-Natal. Uptake could be enhanced by healthcare workers leading information campaigns with messages targeting younger individuals, the unemployed, and the self-employed. Contribution This survey provides evidence to improve COVID-19 vaccination uptake in South Africa.
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Affiliation(s)
- Tanuja N Gengiah
- Center for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Donavan C Naidoo
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Nomcebo Maduma
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saien Govender
- Center for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Sherishka Dhindayal
- Center for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Lara Lewis
- Center for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
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McKinley CJ, Limbu Y. Promoter or barrier? Assessing how social media predicts Covid-19 vaccine acceptance and hesitancy: A systematic review of primary series and booster vaccine investigations. Soc Sci Med 2024; 340:116378. [PMID: 38042027 DOI: 10.1016/j.socscimed.2023.116378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 12/04/2023]
Abstract
RATIONALE Prior research indicates that social media is primarily a negative contributor to Covid-19 vaccine outcomes. OBJECTIVE The current systematic review of Covid-19 primary series and booster vaccine investigations provides a more nuanced and comprehensive assessment of this association by exploring a) how distinct social media judgments and actions predict different vaccine-related outcomes - perceptions and intentions/uptake, b) both primary series and booster findings, c) types of social media, and d) comparisons across different populations. METHOD We conducted a systematic review of published research examining the link between social media and COVID-19 vaccine outcomes - judgments, intentions, and uptake. Overall, we identified 113 published articles. RESULTS The findings reveal complex associations between distinct social media predictors and these outcomes. The most consistent negative relationships emerge within studies looking at 'social media as an information source,' 'trust', and 'general social media use/passive exposure' as predictors of less favorable vaccine judgments and intentions/uptake. Conversely, studies focused on 'information seeking' indicate more mixed results. Among the few booster investigations, there are more positive than negative associations between social media predictors and Covid-19 vaccine intentions. Across different social media platforms and sample populations, social media was a less robust/consistent negative predictor of COVID-19 judgments and intentions. CONCLUSIONS While social media can contribute to more negative COVID-19 vaccine judgments and motivations, the consistency of this relationship may vary across populations, the platforms users access, and the nature of exposure. Overall, social media campaigns promoting COVID-19 vaccines should employ distinct strategies to target those individuals that value social media as an information resource.
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Affiliation(s)
| | - Yam Limbu
- School of Business at Montclair State University, USA
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Ndwandwe D, Ndlovu M, Mayeye A, Luphondo N, Muvhulawa N, Ntamo Y, Dludla PV, Wiysonge CS. Trends in Vaccine Completeness in Children Aged 0-23 Months in Cape Town, South Africa. Vaccines (Basel) 2023; 11:1782. [PMID: 38140186 PMCID: PMC10747087 DOI: 10.3390/vaccines11121782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND We have previously determined that the occurrence of missed vaccination opportunities in children in Cape Town, South Africa, is shaped by both individual and contextual factors. These factors present valuable openings for enhancing quality and implementing broader strategies to enhance the delivery of routine Immunisation services. METHODS Here, we are further reporting regional-level data on the coverage and factors influencing vaccination completion within a similar study population, based on extensive data analysis from the 2016 South African Demographic and Health Survey. RESULTS AND DISCUSSION The study reveals commendable vaccination coverage for most vaccines within recommended schedules, with high rates of initial vaccinations at birth and during the primary vaccination schedule. However, there are notable areas for improvement, particularly in ensuring complete coverage for the second measles vaccine and the 18-month vaccine. Socio-demographic factors also play a role, with maternal education and caregiver awareness campaigns showing the potential to positively influence vaccination completeness. This study emphasises the importance of timely vaccinations during the early months of life and underscores the need for interventions to maintain coverage as children age. Specific sub-districts, such as Tygerberg, may require targeted efforts to enhance vaccination completeness. Additionally, assessing caregiver knowledge about child vaccination is deemed vital, as it can impact vaccination decisions and adherence. CONCLUSIONS The findings provide valuable insights for public health interventions in Cape Town, aimed at reducing the burden of vaccine-preventable diseases and ensuring the health of the region's youngest population.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Musawenkosi Ndlovu
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Asanda Mayeye
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Nomahlubi Luphondo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Ndivhuwo Muvhulawa
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa
| | - Yonela Ntamo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Phiwayinkosi V. Dludla
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa, Empangeni 3886, South Africa
| | - Charles S. Wiysonge
- Vaccine Preventable Diseases Programme, Universal Health Coverage/Communicable and Non-Communicable Diseases Cluster, World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo;
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Eyal K, Njozela L, Köhler T, Ingle K, Brophy T, Buttenheim A, Maughan-Brown B. Correlates of COVID-19 vaccination intentions and opinions about mandates among four groups of adults in South Africa with distinct vaccine intentions: evidence from a large national survey. BMC Public Health 2023; 23:1767. [PMID: 37697314 PMCID: PMC10494356 DOI: 10.1186/s12889-023-16584-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/22/2023] [Indexed: 09/13/2023] Open
Abstract
INTRODUCTION Despite a high number of recorded COVID-19 infections and deaths in South Africa, COVID-19 vaccine coverage remained low in March 2022, ten months into the national vaccine roll-out. This study provides evidence on the correlates of vaccine intentions, attitudes towards vaccination and opinions about mandates. METHODS We used data from the second COVID-19 Vaccine Survey (CVACS), a telephone survey conducted February-March 2022 among 3,608 South African adults who self-reported not being vaccinated against COVID-19. The survey instrument was designed in consultation with government, policymakers, and civil society; and segmented the sample into four distinct groups with different vaccine intentions (synonymous with vaccine hesitancy levels). Kruskal-Wallis and Mann-Whitney tests were used to examine the sociodemographic characteristics, attitudes and behaviours associated with the different vaccination intentions groups. Thematic coding of responses to open-ended questions elicited insights on reasons for not being vaccinated and attitudes towards mandates. RESULTS Intentions to get vaccinated were greater among individuals with lower socio-economic status (Mann-Whitney Z = -11.3, p < 0.001); those believing the vaccine protects against death (Kruskal-Wallis Χ2 = 494, p < 0.001); and those who perceived themselves at risk of COVID-19-related illness (Χ2 = 126, p < 0.01). Vaccine intentions were lower among individuals who believed that the vaccine causes death (Χ2 = 163, p < 0.001); believed that the vaccine is unsafe for the babies of pregnant/breastfeeding mothers, or the chronically ill (Χ2 = 123, p < 0.01); those not trusting government health information about COVID-19 and the COVID-19 vaccine (Kendall's τ = -0.41, p < 0.01); and those in opposition to mandates (τ = 0.35, p < 0.001). Only 25% supported mandates, despite 48% thinking mandates would work well, with 54% citing individual rights as their main reason for mandate opposition. CONCLUSION The profile of individuals not vaccinated against COVID-19 as of March 2022 varied markedly by self-reported vaccination intentions, underscoring the importance of tailored demand-creation efforts. This paper highlights several factors which differ significantly across these groups. These findings could inform the design of future vaccination campaigns, potentially increasing their likelihood of success. This is an important policy objective given widespread vaccine hesitancy, and further work is required on this topic. Mandates remain an option to increase coverage but need to be carefully considered given extensive opposition.
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Affiliation(s)
- Katherine Eyal
- Southern Africa Labour and Development Research Unit, School of Economics, University of Cape Town, Cape Town, South Africa.
| | - Lindokuhle Njozela
- Southern Africa Labour and Development Research Unit, School of Economics, University of Cape Town, Cape Town, South Africa
| | - Timothy Köhler
- Development Policy Research Unit, University of Cape Town, Cape Town, South Africa
| | - Kim Ingle
- Southern Africa Labour and Development Research Unit, School of Economics, University of Cape Town, Cape Town, South Africa
| | - Timothy Brophy
- Southern Africa Labour and Development Research Unit, School of Economics, University of Cape Town, Cape Town, South Africa
| | - Alison Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 416 Fagin Hall, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Brendan Maughan-Brown
- Southern Africa Labour and Development Research Unit, School of Economics, University of Cape Town, Cape Town, South Africa
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Ashkir S, Abel T, Khaliq OP, Moodley J. COVID-19 vaccine hesitancy among pregnant women in an antenatal clinic in Durban, South Africa. S Afr J Infect Dis 2023; 38:516. [PMID: 37670934 PMCID: PMC10476234 DOI: 10.4102/sajid.v38i1.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/19/2023] [Indexed: 09/07/2023] Open
Abstract
Background Mass administration of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most efficient intervention against the coronavirus disease 2019 (COVID-19) pandemic. Recently, vaccinations were shown to be safe and effective during pregnancy. However, vaccination rates are low in low- and middle-income countries, and vaccine hesitancy is a major limiting factor. Objectives To investigate the rate of COVID-19 vaccine hesitancy among pregnant women. Method A cross-sectional questionnaire-based investigation of 313 unvaccinated pregnant women attending an antenatal clinic in Durban, South Africa (SA). The questionnaire included clinical and socio-demographic data, and reasons for vaccine hesitancy were recorded and evaluated. Results Of 313 women participating, 126 (40.3%) were vaccinated against COVID-19, 21/313 = 6.7%; for those unvaccinated, 21/187 (13.9%) were planning to be vaccinated. However, most unvaccinated women, 174 of 187 (93%), showed COVID-19 vaccine hesitancy. Conclusion The COVID-19 vaccination hesitancy among pregnant women in Durban, SA, is exceptionally high. This requires urgent attention by the relevant health authorities (both professional health organisations and the SA Department of Health) as many countries experience different waves of the variants of SARS-CoV-2 and herd immunity may not have been achieved. Contribution This study showed a high vaccine acceptance hesitancy rate among pregnant women in SA.
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Affiliation(s)
- Sahra Ashkir
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Tashlen Abel
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Olive P. Khaliq
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Jagidesa Moodley
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Piltch-Loeb R, Mazibuko L, Stanton E, Mngomezulu T, Gareta D, Nxumalo S, Kraemer JD, Herbst K, Siedner MJ, Harling G. COVID-19 vaccine uptake, confidence and hesitancy in rural KwaZulu-Natal, South Africa between April 2021 and April 2022: A continuous cross-sectional surveillance study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002033. [PMID: 37368864 DOI: 10.1371/journal.pgph.0002033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023]
Abstract
High COVID-19 vaccine hesitancy in South Africa limits protection against future epidemic waves. We evaluated how vaccine hesitancy and its correlates evolved April 2021-April 2022 in a well-characterized rural KwaZulu-Natal setting. All residents aged >15 in the Africa Health Research Institute's surveillance area were invited to complete a home-based, in-person interview. We described vaccine uptake and hesitancy trends, then evaluated associations with pre-existing personal factors, dynamic environmental context, and cues to action using ordinal logistic regression. Among 10,011 respondents, vaccine uptake rose as age-cohorts became vaccine-eligible before levelling off three months post-eligibility; younger age-groups had slower uptake and plateaued faster. Lifetime receipt of any COVID-19 vaccine rose from 3.0% in April-July 2021 to 32.9% in January-April 2022. Among 7,445 unvaccinated respondents, 47.7% said they would definitely take a free vaccine today in the first quarter of the study time period, falling to 32.0% in the last. By March/April 2022 only 48.0% of respondents were vaccinated or said they would definitely would take a vaccine. Predictors of lower vaccine hesitancy included being male (adjusted odds ratio [aOR]: 0.70, 95% confidence interval [CI]: 0.65-0.76), living with vaccinated household members (aOR:0.65, 95%CI: 0.59-0.71) and knowing someone who had had COVID-19 (aOR: 0.69, 95%CI: 0.59-0.80). Mistrust in government predicted greater hesitancy (aOR: 1.47, 95%CI: 1.42-1.53). Despite several COVID-19 waves, vaccine hesitancy was common in rural South Africa, rising over time and closely tied to mistrust in government. However, interpersonal experiences countered hesitancy and may be entry-points for interventions.
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Affiliation(s)
- Rachael Piltch-Loeb
- Emergency Preparedness Research Evaluation and Practice (EPREP) Program, Division of Policy Translation and Leadership Development, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Eva Stanton
- Emergency Preparedness Research Evaluation and Practice (EPREP) Program, Division of Policy Translation and Leadership Development, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - John D Kraemer
- Department of Health Management and Policy, Georgetown University School of Health, Washington, DC, United States of America
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- DSI-MRC South African Population Research Infrastructure Network (SAPRIN), Durban, South Africa
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
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Blahut R, Flint A, Orlando E, DesChatelets J, Khowaja A. A scoping review on the decision-making dynamics for accepting or refusing the COVID-19 vaccination among adolescent and youth populations. BMC Public Health 2023; 23:784. [PMID: 37118794 PMCID: PMC10141871 DOI: 10.1186/s12889-023-15717-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/20/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Global COVID-19 vaccinations rates among youth and adolescent populations prove that there is an opportunity to influence the acceptance for those who are unvaccinated and who are hesitant to receive additional doses. This study aimed to discover the acceptance and hesitancy reasons for choosing or refusing to be vaccinated against COVID-19. METHODS A scoping review was conducted, and articles from three online databases, PubMed, Wiley, and Cochrane Library, were extracted and screened based on exclusion and PICOs criteria. A total of 21 studies were included in this review. Data highlighting study attributes, characteristics, and decision-making dynamics were extracted from the 21 studies and put into table format. RESULTS The results showed that the primary drivers for accepting the COVID-19 vaccine include protecting oneself and close family/friends, fear of infection, professional recommendations, and employer obligations. Primary hesitancy factors include concerns about safety and side effects, effectiveness and efficacy, lack of trust in pharmaceuticals and government, conspiracies, and perceiving natural immunity as an alternative. CONCLUSIONS This scoping review recommends that further research should be conducted with adolescent and youth populations that focus on identifying health behaviors and how they relate to vaccine policies and programs.
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Affiliation(s)
- Roger Blahut
- Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, ON, L2S 3A1, St Catharines, Canada
| | - Amanda Flint
- Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, ON, L2S 3A1, St Catharines, Canada
| | | | - Joelle DesChatelets
- Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, ON, L2S 3A1, St Catharines, Canada
| | - Asif Khowaja
- Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, ON, L2S 3A1, St Catharines, Canada.
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Myburgh N, Mulaudzi M, Tshabalala G, Beta N, Gutu K, Vermaak S, Lau C, Hill C, Stanberry L, James W, Madhi S, Makadzange T, Dietrich JJ. A Qualitative Study Exploring Motivators and Barriers to COVID-19 Vaccine Uptake among Adults in South Africa and Zimbabwe. Vaccines (Basel) 2023; 11:vaccines11040729. [PMID: 37112641 PMCID: PMC10145404 DOI: 10.3390/vaccines11040729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
While vaccines are a well-established method of controlling the spread of infectious diseases, vaccine hesitancy jeopardizes curbing the spread of COVID-19. Through the Vaccine Information Network (VIN), this study explored barriers and motivators to COVID-19 vaccine uptake. We conducted 18 focus group discussions with male and female community members, stratified by country, age group, and—for Zimbabwe only—by HIV status. Participants’ median age across both countries was 40 years (interquartile range of 22–40), and most (65.9%) were female. We conceptualized the key themes within the World Health Organization’s Strategic Advisory Group of Experts on Immunization (SAGE) 3C (convenience, confidence, complacency) vaccine hesitancy model. Barriers to vaccine uptake—lack of convenience, low confidence, and high complacency—included inaccessibility of vaccines and vaccination sites, vaccine safety and development concerns, and disbelief in COVID-19’s existence. Motivators to vaccine uptake—convenience, confidence, and low complacency—included accessibility of vaccination sites, user-friendly registration processes, trust in governments and vaccines, fear of dying from COVID-19, and knowing someone who had died from or become infected with COVID-19. Overall, vaccine hesitancy in South Africa and Zimbabwe was influenced by inconvenience, a lack of confidence, and high complacency around COVID-19 vaccines.
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Affiliation(s)
- Nellie Myburgh
- Vaccines and Infectious Disease Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- African Social Sciences Unit of Research and Evaluation (ASSURE), Wits Health Consortium, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Mamakiri Mulaudzi
- African Social Sciences Unit of Research and Evaluation (ASSURE), Wits Health Consortium, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Gugulethu Tshabalala
- African Social Sciences Unit of Research and Evaluation (ASSURE), Wits Health Consortium, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Norest Beta
- Charles River Medical Group, Harare, Zimbabwe
| | - Kimberley Gutu
- Vaccines and Infectious Disease Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Stefanie Vermaak
- African Social Sciences Unit of Research and Evaluation (ASSURE), Wits Health Consortium, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Charles Lau
- GeoPoll, 3000 Lawrence Street, Suite 125, Denver, CO 80205, USA
| | - Catherine Hill
- Vaccines and Infectious Disease Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Lawrence Stanberry
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Wilmot James
- Institute for Social and Economic Research and Policy, Columbia University, New York, NY 10027, USA
| | - Shabir Madhi
- Vaccines and Infectious Disease Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | | | - Janan Janine Dietrich
- African Social Sciences Unit of Research and Evaluation (ASSURE), Wits Health Consortium, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Health Systems Research Unit, South African Medical Research Council, Bellville 7538, South Africa
- Correspondence: ; Tel.: +27-119899759
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10
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Abdelatif N, Naidoo I, Dunn S, Mazinu M, Essack Z, Groenewald C, Maharaj P, Msomi N, Reddy T, Roberts B, Zuma K. Heterogeneity in COVID-19 infection among older persons in South Africa: Evidence from national surveillance data. Front Public Health 2023; 11:1009309. [PMID: 37006523 PMCID: PMC10061133 DOI: 10.3389/fpubh.2023.1009309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundThe 2021 World Health Organization study on the impact of COVID-19 on older people (≥60 years) in the African region highlighted the difficulties they faced as the virus spread across borders and dominated the way of life. These difficulties included disruptions to both essential health care services and social support, as well as disconnections from family and friends. Among those who contracted COVID-19, the risks of severe illness, complications, and mortality were highest among near-old and older persons.ObjectiveRecognizing that older persons are a diverse group including younger- and older-aged individuals, a study was conducted to track the epidemic among near-old (50–59 years) and older persons (≥60 years) in South Africa covering the 2 years since the epidemic emerged.MethodsUsing a quantitative secondary research approach, data for near-old and older persons were extracted for comparative purposes. COVID-19 surveillance outcomes (confirmed cases, hospitalizations, and deaths) and vaccination data were compiled up to March 5th, 2022. COVID-19 surveillance outcomes were plotted by epidemiological week and epidemic waves to visualize the overall growth and trajectory of the epidemic. Means for each age-group and by COVID-19 waves, together with age-specific rates, were calculated.ResultsAverage numbers of new COVID-19 confirmed cases and hospitalizations were highest among people aged 50–59- and 60–69-years. However, average age-specific infection rates showed that people aged 50–59 years and ≥80 years were most vulnerable to contracting COVID-19. Age-specific hospitalization and death rates increased, with people aged ≥ 70 years most affected. The number of people vaccinated was slightly higher among people aged 50–59 years before Wave Three and during Wave Four, but higher among people aged ≥ 60 years during Wave Three. The findings suggest that uptake of vaccinations stagnated prior to and during Wave Four for both age groups.DiscussionHealth promotion messages and COVID-19 epidemiological surveillance and monitoring are still needed, particularly for older persons living in congregate residential and care facilities. Prompt health-seeking should be encouraged, including testing and diagnosis as well as taking up vaccines and boosters, particularly for high-risk older persons.
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Affiliation(s)
- Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Inbarani Naidoo
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Durban, South Africa
- *Correspondence: Inbarani Naidoo
| | - Shanaaz Dunn
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Mikateko Mazinu
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Zaynab Essack
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Pietermaritzburg, South Africa
- Honorary Research Fellow, School of Law, and Honorary Research Associate, Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Candice Groenewald
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Durban, South Africa
- Honorary Research Associate, Rhodes University, Grahamstown, South Africa
| | - Pranitha Maharaj
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Nokukhanya Msomi
- Discipline of Virology, University of KwaZulu-Natal and National Health Laboratory Services, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Benjamin Roberts
- Developmental, Capable and Ethical State Division, Human Sciences Research Council, Durban, South Africa
| | - Khangelani Zuma
- Human and Social Capabilities Division, Human Sciences Research Council, Pretoria, South Africa
- Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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11
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Viskupič F, Wiltse DL. Trust in physicians predicts COVID-19 booster uptake among older adults: Evidence from a panel survey. AGING AND HEALTH RESEARCH 2023; 3:100127. [PMID: 36817561 PMCID: PMC9922203 DOI: 10.1016/j.ahr.2023.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Affiliation(s)
- Filip Viskupič
- School of American and Global Studies, South Dakota State University, Box 510, Brookings, SD 57007, United States,Corresponding author
| | - David L. Wiltse
- School of American and Global Studies, South Dakota State University, United States
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12
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Kgatle M, Das R, Lawal I, Boshomane T, Mokoala K, Gaspar C, Mbokazi L, Nkambule N, Gow V, Ndlovu H, Mzizi Y, Chalwe J, Diphofa J, Mokobodi D, Gxekwa N, Zongo L, Maphosa T, Vorster M, Bassa S, Venkatesan A, Khanyile R, Munga Y, Ebenhan T, Zeevaart JR, Sathekge M. The SARS-COV-2 Seroprevalence among Oncology Patients. J Clin Med 2023; 12:jcm12020529. [PMID: 36675457 PMCID: PMC9865872 DOI: 10.3390/jcm12020529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Patients with cancer are presumed to be vulnerable to an increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe clinical outcomes due to the immunocompromised state mediated by their underlying malignancies and therapy. The aim of this study was to estimate the SARS-CoV-2 seroprevalence, following second to fourth waves in solid tumour patients attending the Steve Biko Academic Hospital (SBAH) for diagnosis and treatment of cancer. We used the single-prick COVID-19 IgG/IgM Rapid Test Cassettes to detect SARS-CoV-2 IgG/IgM antibodies in 760 patients with solid tumours who were asymptomatic and who had never tested positive for coronavirus disease 2019 (COVID-19). Out of the 760 patients, 277 were male (36.4%), 483 were female (63.6%), and the mean age was 55 years (range 18−92). The estimated total seroprevalence was 33.2%. The seroprevalence status of the COVID-19 IgG/IgM antibodies rose significantly from the second wave (11.3%) to the third (67.38%) and then the fourth (69.81%) waves with roughly similar counts. A significant number of the seropositive patients were asymptomatic to COVID-19 (96%). There was a higher rate of seropositivity in cancer patients with hypertension (p < 0.05). Patients with breast, gynaecologic, and prostate cancers exhibited increased SARS-CoV-2 seropositivity. Although oncology patients may be susceptible to SARS-CoV-2 infection, our data indicate that these patients remained asymptomatic throughout various waves with an overall COVID-19 IgG/IgM antibody seropositivity of 33.16%, suggesting no risk of severe or fatal cases of COVID-19.
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Affiliation(s)
- Mankgopo Kgatle
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Correspondence: (M.K.); (M.S.); Tel.: +27-12-354-1533 (M.K.); +27-12-354-1794 (M.S.)
| | - Rajesh Das
- Department of Bioinformatics, Pondicherry University, Kalapet, Puducherry 605014, India
| | - Ismaheel Lawal
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0001, South Africa
| | - Tebatso Boshomane
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria 0001, South Africa
- AXIM Nuclear & Oncology (Pty) Ltd., Laboratory & Scientific Division, 63 Old Pretoria Road, Midrand 1685, South Africa
| | - Kgomotso Mokoala
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0001, South Africa
| | - Cattleya Gaspar
- Radiation Oncology Outpatient Department, Ground Floor, Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Lydia Mbokazi
- Radiation Oncology Outpatient Department, Ground Floor, Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Nonhlanhla Nkambule
- Radiation Oncology Outpatient Department, Ground Floor, Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Veronique Gow
- Medical Oncology, Outpatient Department, Ground Floor, Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Honest Ndlovu
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Yonwaba Mzizi
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Joseph Chalwe
- AXIM Nuclear & Oncology (Pty) Ltd., Laboratory & Scientific Division, 63 Old Pretoria Road, Midrand 1685, South Africa
| | - Jeaneth Diphofa
- Medical Oncology, Outpatient Department, Ground Floor, Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Dinah Mokobodi
- Medical Oncology, Outpatient Department, Ground Floor, Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Nobuhle Gxekwa
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Faculty of Health Science, University of Pretoria, Pretoria 0001, South Africa
| | - Lusanda Zongo
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Faculty of Health Science, University of Pretoria, Pretoria 0001, South Africa
| | - Tinashe Maphosa
- Department of Dermatology, University of Pretoria & Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Dermatology Department, Ondangwa Private Hospital, Ondangwa Box 2775, Namibia
| | - Mariza Vorster
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Sheynaz Bassa
- Medical Oncology, Outpatient Department, Ground Floor, Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Amouda Venkatesan
- Department of Bioinformatics, Pondicherry University, Kalapet, Puducherry 605014, India
| | - Richard Khanyile
- Medical Oncology, Outpatient Department, Ground Floor, Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Yunus Munga
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Thomas Ebenhan
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0001, South Africa
- South African Nuclear Energy Corporation, Radiochemistry, Elias Motsoaledi Street, R104 Pelindaba, Brits 0240, South Africa
| | - Jan Rijn Zeevaart
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0001, South Africa
- South African Nuclear Energy Corporation, Radiochemistry, Elias Motsoaledi Street, R104 Pelindaba, Brits 0240, South Africa
| | - Mike Sathekge
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Department of Nuclear Medicine, University of Pretoria, Pretoria 0001, South Africa
- Correspondence: (M.K.); (M.S.); Tel.: +27-12-354-1533 (M.K.); +27-12-354-1794 (M.S.)
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13
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Njoga EO, Awoyomi OJ, Onwumere-Idolor OS, Awoyomi PO, Ugochukwu ICI, Ozioko SN. Persisting Vaccine Hesitancy in Africa: The Whys, Global Public Health Consequences and Ways-Out-COVID-19 Vaccination Acceptance Rates as Case-in-Point. Vaccines (Basel) 2022; 10:1934. [PMID: 36423029 PMCID: PMC9697713 DOI: 10.3390/vaccines10111934] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 08/29/2023] Open
Abstract
Vaccine hesitancy (VH) is the seventh among the WHO's top 10 threats to global public health, which has continued to perpetuate the transmission of vaccine preventable diseases (VPDs) in Africa. Consequently, this paper systematically reviewed COVID-19 vaccine acceptance rates (VARs)-including the vaccine uptake and vaccination intention-in Africa from 2020 to 2022, compared the rates within the five African regions and determined the context-specific causes of VH in Africa. Generally, COVID-19 VARs ranged from 21.0% to 97.9% and 8.2% to 92.0% with mean rates of 59.8 ± 3.8% and 58.0 ± 2.4% in 2021 and 2022, respectively. Southern and eastern African regions had the top two VARs of 83.5 ± 6.3% and 68.9 ± 6.6% in 2021, and 64.2 ± 4.6% and 61.2 ± 5.1% in 2022, respectively. Based on population types, healthcare workers had a marginal increase in their mean COVID-19 VARs from 55.5 ± 5.6% in 2021 to 60.8 ± 5.3% in 2022. In other populations, the mean VARs decreased from 62.7 ± 5.2% in 2021 to 54.5 ± 4% in 2022. As of 25 October 2022, Africa lags behind the world with only 24% full COVID-19 vaccinations compared to 84%, 79% and 63% reported, respectively, in the Australian continent, upper-middle-income countries and globally. Apart from the problems of confidence, complacency, convenience, communications and context, the context-specific factors driving COVID-19 VH in Africa are global COVID-19 vaccine inequality, lack of vaccine production/maintenance facilities, insecurity, high illiteracy level, endemic corruption, mistrust in some political leaders, the spreading of unconfirmed anti-vaccination rumors and political instability. With an overall mean COVID-19 acceptance rate of 58%, VH still subsists in Africa. The low VARs in Africa have detrimental global public health implications, as it could facilitate the emergence of immune invading SARS-CoV-2 variants of concern, which may spread globally. Consequently, there is a need to confront these challenges frontally and engage traditional and religious leaders in the fight against VH in Africa, to restore public trust in the safety and efficacy of vaccines generally. As the availability of COVID-19 vaccines improves, the vaccination of pets and zoo-animals from which reverse zoonotic transmission of SARS-CoV-2 have been reported is recommended, to limit the evolution and spread of new variants of concern and avert possible SARS-CoV-2 epizootic or panzootic diseases in susceptible animal species.
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Affiliation(s)
- Emmanuel O. Njoga
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Nigeria, Nsukka 410001, Nigeria
| | - Olajoju J. Awoyomi
- Department of Veterinary Public Health and Preventive Medicine, College of Veterinary Medicine, Federal University of Agriculture, Abeokuta PMB 2240, Nigeria
| | - Onyinye S. Onwumere-Idolor
- Department of Animal Production, Faculty of Agriculture, Delta State University of Science and Technology, Ozoro PMB 005, Nigeria
| | - Priscilla O. Awoyomi
- Department of Medicine and Surgery, College of Medicine, University of Ibadan, Ibadan 200005, Nigeria
| | - Iniobong C. I. Ugochukwu
- Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, University of Nigeria, Nsukka 410001, Nigeria
- Department of Veterinary Medicine, Faculty of Veterinary Medicine, Universita degli Studi di Bari, 70010 Valenzano, Italy
| | - Stella N. Ozioko
- Institute of Aquaculture, Faculty of Natural Sciences, University of Stirling, Stirling FK9 4LA, UK
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14
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Nicholls N, Yitbarek E. Trust in social media and COVID-19 beliefs and behaviours. PLoS One 2022; 17:e0275969. [PMID: 36227887 PMCID: PMC9560499 DOI: 10.1371/journal.pone.0275969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
The study investigates the relationship between trust in social media and beliefs and preventive behaviours in the context of the COVID-19 pandemic. We surveyed 1008 respondents in South Africa to study how trust in social media relative to other information sources predicts perceived risk and adoption of preventive behaviours. Although engagement with and trust in social media do not predict less adoption of preventive behaviours, trusting information from social media more than information from mass media or scientists is associated with less risk perception from COVID-19 and reduces the adoption of preventive behaviours (including vaccines).
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Affiliation(s)
- Nicky Nicholls
- Department of Economics, University of Pretoria, Gauteng, South Africa
- * E-mail:
| | - Eleni Yitbarek
- Department of Economics, University of Pretoria, Gauteng, South Africa
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15
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More Time, Carrot-and-Stick, or Piling Coffins? Estimating the Role of Factors Overcoming COVID-19 Vaccine Hesitancy in Poland and Lithuania in the Years 2021–2022. Vaccines (Basel) 2022; 10:vaccines10091523. [PMID: 36146603 PMCID: PMC9500938 DOI: 10.3390/vaccines10091523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/30/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
In this study, motivation for late (from 2021-W22, i.e., 24 July 2021) uptake of the first dose of the COVID-19 vaccine among adults in Poland and Lithuania is indirectly measured in order to avoid social-desirability bias or rationalisation in retrospect of prior decisions. Weekly vaccine uptake is modeled as if vaccine hesitant people were late adopters of a new product, with a fitted non-linear trend representing steadily decreasing interest. Before the analysed period, the vaccine uptake among Polish and Lithuanian adults was almost identical. Vaccination simply explainable by the trend was responsible for the vaccination of an additional 19.96% and 19.06% adults, respectively. The fear incurred by spikes in consecutive waves of infection motivated 3.20% and 3.89% more people, respectively, while the COVID-19 passport, introduced only in Lithuania, convinced an additional 13.98% of the overall population. The effect of the COVID passport was the biggest in the 18–24 age group, and the least visible among people aged 80 or more. In the latter group, other factors also had a limited impact, with merely 1.32% tempted by the one-time €100 payment offered to everybody aged 75 or more.
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16
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Ackah BBB, Woo M, Stallwood L, Fazal ZA, Okpani A, Ukah UV, Adu PA. COVID-19 vaccine hesitancy in Africa: a scoping review. Glob Health Res Policy 2022; 7:21. [PMID: 35850783 PMCID: PMC9294808 DOI: 10.1186/s41256-022-00255-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Vaccination against the novel coronavirus is one of the most effective strategies for combating the global Coronavirus disease (COVID-19) pandemic. However, vaccine hesitancy has emerged as a major obstacle in several regions of the world, including Africa. The objective of this rapid review was to summarize the literature on COVID-19 vaccine hesitancy in Africa.
Methods We searched Scopus, Web of Science, African Index Medicus, and OVID Medline for studies published from January 1, 2020, to March 8, 2022, examining acceptance or hesitancy towards the COVID-19 vaccine in Africa. Study characteristics and reasons for COVID-19 vaccine acceptance were extracted from the included articles.
Results A total of 71 articles met the eligibility criteria and were included in the review. Majority (n = 25, 35%) of the studies were conducted in Ethiopia. Studies conducted in Botswana, Cameroun, Cote D’Ivoire, DR Congo, Ghana, Kenya, Morocco, Mozambique, Nigeria, Somalia, South Africa, Sudan, Togo, Uganda, Zambia, Zimbabwe were also included in the review. The vaccine acceptance rate ranged from 6.9 to 97.9%. The major reasons for vaccine hesitancy were concerns with vaccine safety and side effects, lack of trust for pharmaceutical industries and misinformation or conflicting information from the media. Factors associated with positive attitudes towards the vaccine included being male, having a higher level of education, and fear of contracting the virus. Conclusions Our review demonstrated the contextualized and multifaceted reasons inhibiting or encouraging vaccine uptake in African countries. This evidence is key to operationalizing interventions based on facts as opposed to assumptions. Our paper provided important considerations for addressing the challenge of COVID-19 vaccine hesitancy and blunting the impact of the pandemic in Africa. Supplementary Information The online version contains supplementary material available at 10.1186/s41256-022-00255-1.
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Affiliation(s)
- Betty B B Ackah
- School of Communication, Simon Fraser University, Burnaby, BC, Canada
| | - Michael Woo
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Lisa Stallwood
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Zahra A Fazal
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Arnold Okpani
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Ugochinyere Vivian Ukah
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Prince A Adu
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada.
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17
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Factors Influencing Willingness to Be Vaccinated against COVID-19 in Nigeria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116816. [PMID: 35682398 PMCID: PMC9180792 DOI: 10.3390/ijerph19116816] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 02/04/2023]
Abstract
Vaccines have been historically used to address some pressing health problems in the world. COVID-19 presents no exception, although vaccine hesitancy remains a major bottleneck in some countries. This study analyzed the factors influencing willingness to be vaccinated against COVID-19 in Nigeria. The data are from the 10th wave of COVID-19 National Longitudinal Phone Survey (COVID-19 NLPS) that was conducted in 2021. The data were analyzed with Logit regression. The result showed that the national acceptance rate of COVID-19 vaccine was 85.29%. The North East had the highest acceptance rate (96.14%), while the South East (71.80%) had the lowest value. Rural areas had higher vaccine acceptance rates of 87.80% as compared against 81.41% for urban areas. Logit regression result showed that urban residents in the South East zone and the South South zone were not too worried about contracting COVID-19 or not worried at all about contracting COVID-19, saw COVID-19 as not much of a threat to household finance or COVID-19 as not a threat at all to households’ finances, which significantly reduced the log odds of residents’ willingness to be vaccinated against COVID-19 (p < 0.05). However, age, the COVID-19 preventive compliance index and needing medical services significantly increased the log odds of the willingness to be vaccinated against COVID-19 vaccines (p < 0.05). Addressing the COVID-19 pandemic in Nigeria through vaccination requires significant interventions for ensuring regional and sectoral balances in vaccine acceptability through interventions and programmes for promoting individuals’ perception of health risk and vulnerability.
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18
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Cascini F, Pantovic A, Al-Ajlouni YA, Failla G, Puleo V, Melnyk A, Lontano A, Ricciardi W. Social media and attitudes towards a COVID-19 vaccination: A systematic review of the literature. EClinicalMedicine 2022; 48:101454. [PMID: 35611343 PMCID: PMC9120591 DOI: 10.1016/j.eclinm.2022.101454] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Vaccine hesitancy continues to limit global efforts in combatting the COVID-19 pandemic. Emerging research demonstrates the role of social media in disseminating information and potentially influencing people's attitudes towards public health campaigns. This systematic review sought to synthesize the current evidence regarding the potential role of social media in shaping COVID-19 vaccination attitudes, and to explore its potential for shaping public health interventions to address the issue of vaccine hesitancy. METHODS We performed a systematic review of the studies published from inception to 13 of March2022 by searching PubMed, Web of Science, Embase, PsychNET, Scopus, CINAHL, and MEDLINE. Studies that reported outcomes related to coronavirus disease 2019 (COVID-19) vaccine (attitudes, opinion, etc.) gathered from the social media platforms, and those analyzing the relationship between social media use and COVID-19 hesitancy/acceptance were included. Studies that reported no outcome of interest or analyzed data from sources other than social media (websites, newspapers, etc.) will be excluded. The Newcastle Ottawa Scale (NOS) was used to assess the quality of all cross-sectional studies included in this review. This study is registered with PROSPERO (CRD42021283219). FINDINGS Of the 2539 records identified, a total of 156 articles fully met the inclusion criteria. Overall, the quality of the cross-sectional studies was moderate - 2 studies received 10 stars, 5 studies received 9 stars, 9 studies were evaluated with 8, 12 studies with 7,16 studies with 6, 11 studies with 5, and 6 studies with 4 stars. The included studies were categorized into four categories. Cross-sectional studies reporting the association between reliance on social media and vaccine intentions mainly observed a negative relationship. Studies that performed thematic analyses of extracted social media data, mainly observed a domination of vaccine hesitant topics. Studies that explored the degree of polarization of specific social media contents related to COVID-19 vaccines observed a similar degree of content for both positive and negative tone posted on different social media platforms. Finally, studies that explored the fluctuations of vaccination attitudes/opinions gathered from social media identified specific events as significant cofactors that affect and shape vaccination intentions of individuals. INTERPRETATION This thorough examination of the various roles social media can play in disseminating information to the public, as well as how individuals behave on social media in the context of public health events, articulates the potential of social media as a platform of public health intervention to address vaccine hesitancy. FUNDING None.
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Affiliation(s)
- Fidelia Cascini
- Department of Life Sciences and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, Rome 00168, Italy
- Corresponding author.
| | - Ana Pantovic
- Faculty of Biology, University of Belgrade, Belgrade, Serbia
| | | | - Giovanna Failla
- Department of Life Sciences and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, Rome 00168, Italy
| | - Valeria Puleo
- Department of Life Sciences and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, Rome 00168, Italy
| | - Andriy Melnyk
- Department of Life Sciences and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, Rome 00168, Italy
| | - Alberto Lontano
- Department of Life Sciences and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, Rome 00168, Italy
| | - Walter Ricciardi
- Department of Life Sciences and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, Rome 00168, Italy
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19
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Engelbrecht M, Heunis C, Kigozi G. COVID-19 Vaccine Hesitancy in South Africa: Lessons for Future Pandemics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116694. [PMID: 35682278 PMCID: PMC9180246 DOI: 10.3390/ijerph19116694] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 02/06/2023]
Abstract
Vaccine hesitancy, long considered a global health threat, poses a major barrier to effective roll-out of COVID-19 vaccination. With less than half (45%) of adult South Africans currently fully vaccinated, we identified factors affecting non-uptake of vaccination and vaccine hesitancy in order to identify key groups to be targeted when embarking upon COVID-19 vaccine promotion campaigns. A cross-sectional, anonymous online survey was undertaken among the South African adult population in September 2021. Our research identified race, interactive–critical vaccine literacy, trust in the government’s ability to roll out the COVID-19 vaccination programme, flu vaccination status and risk perception for COVID-19 infection as key factors influencing the uptake of COVID-19 vaccination. Respondents who did not trust in the government’s ability to roll out vaccination were almost 13 times more likely to be vaccine-hesitant compared to those respondents who did trust the government. Reliable, easy-to-understand information regarding the safety of COVID-19 vaccines is needed, but it is also important that vaccination promotion and communication strategies include broader trust-building measures to enhance South Africans’ trust in the government’s ability to roll out vaccination effectively and safely. This may also be the case in other countries where distrust in governments’ ability prevails.
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20
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Kahn K, Pettifor A, Mataboge P, Kelly NK, Mashinini DP, Nair H, Campbell H, Cohen C, Gómez-Olivé FX, Tollman S. COVID-19 vaccine hesitancy in rural South Africa: Deepening understanding to increase uptake and access. J Glob Health 2022; 12:05013. [PMID: 35567586 PMCID: PMC9107307 DOI: 10.7189/jogh.12.05013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background To date, COVID-19 vaccine coverage in the African region falls far too short of global goals. Increasing vaccination rates requires understanding barriers to vaccination so that effective interventions that sensitively and effectively address barriers to vaccination can be implemented. Methods To assess COVID-19 vaccination levels and identify major barriers to vaccine uptake we conducted a population-based, cross-sectional survey among 1662 adults 18 and older from August 25 to October 29 2021 in the Agincourt Health and Socio-Demographic Surveillance System (AHDSS) area, Mpumalanga, South Africa. Results Half of participants reported receiving a COVID-19 vaccine (50.4%) with 41.1% being fully vaccinated and 9.3% being partially vaccinated; 49.6% were unvaccinated. More women than men were vaccinated (55.5% vs 42.8%, P < 0.001), and older age groups were more likely to be vaccinated than younger age groups (P < 0.001). Among the unvaccinated, 69.0% planned to get vaccinated as soon as possible, while 14.7% reported definitely not wanting the vaccine. Major barriers to vaccination included lacking information on eligibility (12.3%) or where to get vaccinated (13.0%), concerns about side effects (12.5%), and inconvenient hours and locations for vaccination (11.0%). Confidence in the safety and efficacy of COVID-19 vaccines was higher among those vaccinated than unvaccinated (75.3% vs 51.2%, 75.8% vs 51.0%, both P < 0.001, respectively). Conclusions Increasing vaccination in South Africa beyond current levels will require a concerted effort to address concerns around vaccine safety and increase confidence in vaccine efficacy. Clarifying eligibility and ensuring access to vaccines at times and places that are convenient to younger populations, men, and other vulnerable groups is necessary.
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Affiliation(s)
- Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Palesa Mataboge
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole K Kelly
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Duduzile P Mashinini
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Harish Nair
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Harry Campbell
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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21
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Dennis A, Robin C, Jones LF, Carter H. Exploring vaccine hesitancy in care home employees in North West England: a qualitative study. BMJ Open 2022; 12:e055239. [PMID: 35501075 PMCID: PMC9062455 DOI: 10.1136/bmjopen-2021-055239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Care homes have experienced a high number of COVID-19 outbreaks, and it is therefore important for care home employees to receive the COVID-19 vaccine. However, there is high vaccine hesitancy among this group. We aimed to understand barriers and facilitators to getting the COVID-19 vaccine, as well as views on potential mandatory vaccination policies. DESIGN Semi-structured interviews. SETTING Care home employees in North West England. Interviews conducted in April 2021. PARTICIPANTS 10 care home employees (aged 25-61 years) in the North West, who had been invited to have, but not received the COVID-19 vaccine. RESULTS We analysed the interviews using a framework analysis. Our analysis identified eight themes: perceived risk of COVID-19, effectiveness of the vaccine, concerns about the vaccine, mistrust in authorities, facilitators to getting the vaccine, views on mandatory vaccinations, negative experiences of care work during the COVID-19 pandemic, and communication challenges. CONCLUSIONS Making COVID-19 vaccination a condition of deployment may not result in increased willingness to get the COVID-19 vaccination, with most care home employees in this study favouring leaving their job rather than getting vaccinated. At a time when many care workers already had negative experiences during the pandemic due to perceived negative judgement from others and a perceived lack of support facing care home employees, policies that require vaccination as a condition of deployment were not positively received.
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Affiliation(s)
- Amelia Dennis
- Behavioural Science and Insights Unit, Public Health England, London, UK
| | - Charlotte Robin
- Behavioural Science and Insights Unit, Public Health England, London, UK
| | - Leah Ffion Jones
- Behavioural Science and Insights Unit, Public Health England, London, UK
| | - Holly Carter
- Behavioural Science and Insights Unit, Public Health England, London, UK
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22
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Wiysonge CS, Alobwede SM, de Marie C Katoto P, Kidzeru EB, Lumngwena EN, Cooper S, Goliath R, Jackson A, Shey MS. COVID-19 vaccine acceptance and hesitancy among healthcare workers in South Africa. Expert Rev Vaccines 2022; 21:549-559. [PMID: 34990311 DOI: 10.1080/14760584.2022.2023355] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND We assessed willingness to accept vaccination against coronavirus disease 2019 (COVID-19) among healthcare workers(HCWs) at the start of South Africa's vaccination roll-out. RESEARCH DESIGN AND METHODS We conducted a cross-sectional survey among HCWs in Cape Town in March-May 2021 and assessed predictors of vaccination intentions. RESULTS We recruited 395 participants; 64% women, 49% nurses, and 13% physicians. Of these, 233(59.0%) would accept and 163 (41.0%) were vaccine hesitant i.e. would either refuse or were unsure whether they would accept COVID-19 vaccination. People who did not trust that COVID-19 vaccines are effective were the most hesitant (p = 0.038). Older participants and physicians were more likely to accept vaccination than younger participants (p < 0.01) and other HCWs (p = 0.042) respectively. Other predictors of vaccine acceptance were trust that vaccines are compatible with religion (p < 0.001), consideration of benefits and risks of vaccination (p < 0.001), willingness to be vaccinated to protect others (p < 0.001), and viewing vaccination as a collective action for COVID-19 control (p = 0.029). CONCLUSIONS COVID-19 vaccine hesitancy is high among HCWs in Cape Town. Reducing this would require trust-building interventions, including tailored education.
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Affiliation(s)
- Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Samuel M Alobwede
- Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Patrick de Marie C Katoto
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Francie van Zijl Drive, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Elvis B Kidzeru
- Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- The Medical Research Centre (CRM), Institute of Medical Research and Medicinal Plant Studies (Impm), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Evelyn N Lumngwena
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Cape Heart Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Centre for the Study of Emerging and Re-emerging Infections (CREMER), Institute of Medical Research and Medicinal Plant Studies (Impm), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rene Goliath
- Wellcome Centre for Infectious Disease Research in Africa (Cidri-africa), University of Cape Town, Cape Town, South Africa
| | - Amanda Jackson
- Wellcome Centre for Infectious Disease Research in Africa (Cidri-africa), University of Cape Town, Cape Town, South Africa
| | - Muki S Shey
- Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Disease Research in Africa (Cidri-africa), University of Cape Town, Cape Town, South Africa
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