Exploring COVID-19 vaccine uptake among healthcare workers in Zimbabwe: A mixed methods study

medRxiv [Preprint]. 2023 Jul 23:2023.07.17.23292791. doi: 10.1101/2023.07.17.23292791.

Abstract

With COVID-19 no longer categorized as a public health emergency of international concern, vaccination strategies and priority groups for vaccination have evolved. Africa Centers for Diseases Prevention and Control proposed the '100-100-70%' strategy which aims to vaccinate all healthcare workers, all vulnerable groups, and 70% of the general population. Understanding whether healthcare workers were reached during previous vaccination campaigns and what can be done to address concerns, anxieties, and other influences on vaccine uptake, will be important to optimally plan how to achieve these ambitious targets. In this mixed-methods study, between June 2021 and July 2022 a quantitative survey was conducted with healthcare workers accessing a comprehensive health check in Zimbabwe to determine whether and, if so, when they had received a COVID-19 vaccine. Healthcare workers were categorized as those who had received the vaccine 'early' (before 30.06.2021) and those who had received it 'late' (after 30.06.2021). In addition, 17 in-depth interviews were conducted to understand perceptions and beliefs about COVID-19 vaccines. Of the 2905 healthcare workers employed at 37 facilities who participated in the study, 2818 (97%, 95% CI [92%-102%]) reported that they had received at least one vaccine dose. Geographical location, older age, higher educational attainment and having a chronic condition was associated with receiving the vaccine early. Qualitatively, (mis)information, infection risk perception, quasi-mandatory vaccination requirements, and legitimate concerns such as safety and efficacy influenced vaccine uptake. Meeting the proposed 100-100-70 target entails continued emphasis on strong communication while engaging meaningfully with healthcare workers' concerns. Mandatory vaccination may undermine trust and should not be a substitute for sustained engagement.

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Grants and funding

This work was supported by the Global Public Health strand of the Elizabeth Blackwell Institute for Health Research, funded under the University of Bristol’s QR GCRF strategy (ref:H100004-148) as well as support from Sheffield and Oxford QR-GCRF funds. It was supported by UK aid from the UK government (FCDO) (ref 668 303), and by funding from the government of Canada. The views expressed do not necessarily reflect the policies of the respective governments. RAF is funded by a Wellcome Trust Senior Fellowship (206316_Z_17_Z). IDO has received funding through the Wellcome Trust Clinical PhD Programme awarded to the London School of Hygiene & Tropical Medicine (grant number 203905/Z/16/Z). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.