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George G, Strauss M, Lansdell E, Nota P, Peters RPH, Brysiewicz P, Nadesan-Reddy N, Wassenaar D. Factors associated with COVID-19 vaccine uptake among South African health care workers. Vaccine 2024; 42:126181. [PMID: 39111155 DOI: 10.1016/j.vaccine.2024.126181] [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: 05/05/2023] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Identifying factors associated with vaccine uptake among health care workers (HCWs) remains crucial to generating evidence aimed at guiding national COVID-19 vaccination and future infectious disease outbreak strategies. This study aimed to elucidate these factors, focusing on the interplay between socio-demographic, health, knowledge, beliefs and attitudinal indicators. METHODS This was a cross-sectional online survey administered to HCWs across South Africa between August and October 2022. Bivariate and Multivariate logistic regressions identified associations between COVID-19 vaccine uptake and demographics, occupational characteristics, general knowledge of and attitudes towards vaccination, perceived COVID-19 risk and perceived importance of COVID-19 vaccine attributes. RESULTS Analysis revealed high vaccine uptake rates among the sample of 5564 HCWs, with 87.6% of the sample vaccinated at the time of the study. Demographic measures significantly associated with vaccine uptake were age (P-value = 0.001), race (P-value = 0.021), religion (P-value = 0.004), and having a chronic illness (P-value <0.001). Belief and attitude measures significantly associated with vaccine uptake included: need for vaccines (P-value <0.001), perceived risk of infection (P-value = 0.001), perceived patient risk (P-value <0.001), and perceived vaccine knowledge (P-value <0.001). Multivariate analysis revealed that HCWs who listed their religion as African Spirituality (OR = 0.4; 95% CI = 0.2-0.7; P-value = 0.002) and had any occupation other than nurse or doctor (OR = 0.6; 95% CI = 0.4-0.8; P-value <0.001), were less likely to vaccinate, while HCWs who had a chronic condition (OR = 1.5; 95% CI = 1.2-2.0; P-value <0.001) were more likely to have been vaccinated. CONCLUSION This study provides useful insights into the factors associated with and possibly driving COVID-19 vaccine uptake among HCWs in South Africa. These results add to a limited body of knowledge on contextual dynamics associated with vaccination programmes in Africa.
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Affiliation(s)
- Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban 4041, South Africa; Division of Social Medicine and Global Health, Lund University, 22363 Lund, Sweden.
| | - Michael Strauss
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban 4041, South Africa
| | - Emma Lansdell
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban 4041, South Africa
| | - Phiwe Nota
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban 4041, South Africa
| | - Remco P H Peters
- Research Unit, Foundation for Professional Development, East London 5241, South Africa
| | - Petra Brysiewicz
- School of Nursing & Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Nisha Nadesan-Reddy
- School of Nursing & Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Douglas Wassenaar
- South African Research Ethics Training Initiative, School of Applied Human Sciences, University of KwaZulu-Natal, Pietermaritzburg 3209, 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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de Figueiredo A, Temfack E, Tajudeen R, Larson HJ. Declining trends in vaccine confidence across sub-Saharan Africa: A large-scale cross-sectional modeling study. Hum Vaccin Immunother 2023:2213117. [PMID: 37290478 DOI: 10.1080/21645515.2023.2213117] [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: 12/29/2022] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Current WHO/UNICEF estimates of routine childhood immunization coverage reveal the largest sustained decline in uptake in three decades with pronounced setbacks across Africa. Although the COVID-19 pandemic has induced significant supply and delivery disruptions, the impact of the pandemic on vaccine is less understood. We here examine trends in vaccine confidence across eight sub-Saharan countries between 2020 and 2022 via a total of 17,187 individual interviews, conducted via a multi-stage probability sampling approach and cross-sectional design and evaluated using Bayesian methods. Multilevel regression combined with poststratification weighting using local demographic information yields national and sub-national estimates of vaccine confidence in 2020 and 2022 as well as its socio-demographic associations. We identify declines in perceptions toward the importance of vaccines for children across all eight countries, with mixed trends in perceptions toward vaccine safety and effectiveness. We find that COVID-19 vaccines are perceived to be less important and safe in 2022 than in 2020 in six of the eight countries, with the only increases in COVID-19 vaccine confidence detected in Ivory Coast. There are substantial declines in vaccine confidence in the Democratic Republic of Congo and South Africa, notably in Eastern Cape, KwaZulu-Natal, Limpopo, and Northern Cape (South Africa) and Bandundu, Maniema, Kasaï-Oriental, Kongo-Central, and Sud-Kivu (DRC). While over 60-year-olds in 2022 have higher vaccine confidence in vaccines generally than younger age groups, we do not detect other individual-level socio-demographic associations with vaccine confidence at the sample sizes studied, including sex, age, education, employment status, and religious affiliation. Understanding the role of the COVID-19 pandemic and associated policies on wider vaccine confidence can inform post-COVID vaccination strategies and help rebuild immunization system resilience.
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Affiliation(s)
- A de Figueiredo
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - E Temfack
- Africa Centers for Disease Control and Prevention, African Union Commission, Addis Ababa, Ethiopia
| | - R Tajudeen
- Africa Centers for Disease Control and Prevention, African Union Commission, Addis Ababa, Ethiopia
| | - H J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Health Metrics and Evaluation, University of Washington, Hans Rosling Center, Seattle, WA, USA
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George G, Nota PB, Strauss M, Lansdell E, Peters R, Brysiewicz P, Nadesan-Reddy N, Wassenaar D. Understanding COVID-19 Vaccine Hesitancy among Healthcare Workers in South Africa. Vaccines (Basel) 2023; 11:414. [PMID: 36851290 PMCID: PMC9966714 DOI: 10.3390/vaccines11020414] [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: 01/16/2023] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
Healthcare workers (HCWs) were the first population group offered coronavirus disease 2019 (COVID-19) vaccines in South Africa because they were considered to be at higher risk of infection and required protecting as they were a critical resource to the health system. In some contexts, vaccine uptake among HCWs has been slow, with several studies citing persistent concerns about vaccine safety and effectiveness. This study aimed to determine vaccine uptake among HCWs in South Africa whilst identifying what drives vaccine hesitancy among HCWs. We adopted a multimethod approach, utilising both a survey and in-depth interviews amongst a sample of HCWs in South Africa. In a sample of 7763 HCWS, 89% were vaccinated, with hesitancy highest among younger HCWs, males, and those working in the private sector. Among those who were hesitant, consistent with the literature, HCWs raised concerns about the safety and effectiveness of the vaccine. Examining this further, our data revealed that safety and effectiveness concerns were formed due to first-hand witnessing of patients presenting with side-effects, concern over perceived lack of scientific rigor in developing the vaccine, confidence in the body's immune system to stave off serious illness, and both a general lack of information and distrust in the available sources of information. This study, through discursive narratives, provides evidence elucidating what drives safety and effectiveness concerns raised by HCWs. These concerns will need to be addressed if HCWs are to effectively communicate and influence public behaviour. HCWs are key role players in the national COVID-19 vaccination programme, making it critical for this workforce to be well trained, knowledgeable, and confident if they are going to improve the uptake of vaccines among the general population in South Africa, which currently remains suboptimal.
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Affiliation(s)
- Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban 4041, South Africa
- Division of Social Medicine and Global Health, Lund University, 223 63 Lund, Sweden
| | - Phiwe Babalo Nota
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban 4041, South Africa
| | - Michael Strauss
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban 4041, South Africa
| | - Emma Lansdell
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban 4041, South Africa
| | - Remco Peters
- Research Unit, Foundation for Professional Development, East London 5241, South Africa
| | - Petra Brysiewicz
- School of Nursing & Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Nisha Nadesan-Reddy
- School of Nursing & Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Douglas Wassenaar
- South African Research Ethics Training Initiative, School of Applied Human Sciences, University of KwaZulu-Natal, Pietermaritzburg 3209, South Africa
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The Multidimensional Vaccine Hesitancy Scale: A Validation Study. Vaccines (Basel) 2022; 10:vaccines10101755. [PMID: 36298620 PMCID: PMC9608997 DOI: 10.3390/vaccines10101755] [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: 08/29/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Vaccination hesitancy (VH) is a phenomenon which increases the occurrence of vaccine-preventable diseases. The study tests the validity of the Multidimensional Vaccine Hesitancy Scale (MVHS) in the case of a sample of Romanian adults (n = 528; Meanage = 30.57). The latter filled in an online cross-sectional survey. The construct validity of MVHS was assessed by using confirmatory factor analysis (CFA), the reliability was calculated by using the internal consistency, and the convergent and discriminant validity was assessed by using the composite reliability (CR), and average variance extracted (AVE). The obtained model was invariant across gender. The structural equation model was designed for predictive validity by using the partial least square method (PLS-SEM) which analyses the relation between the MVHS dimensions and the vaccination willingness. The results show support for the 8-factor structure of the scale (χ2/df = 2.48; CFI = 0.95; RMSEA = 0.053). The Cronbach’s coefficients α > 0.70; McDonald’s ω > 0.70 and CR > 0.80 have very good values. The structural equation model shows that there are more dimensions of the scale which predict vaccination hesitancy in various types of vaccines—the main predictors remain the dimensions of health risk and healthy condition. The study’s conclusion led to the idea that the MVHS is suitable for medical practice and for research on the analysis of vaccination behaviours and intentions.
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