COVID-19 vaccine hesitancy among health providers at Kenyatta National Teaching and Referral Hospital Nairobi-Kenya

¹Partners in Health Research and Development, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya, ²Kenyatta National Hospital, Nairobi, Kenya, ³Kenya Medical Research Institute, Nairobi, Kenya, ⁴School of Public Health Department, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya

^&Corresponding author
Phelix Okello, Partners in Health Research and Development, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya

To the editors of the Pan African Medical Journal    

Health providers' delay of acceptance or refusal to receive the vaccine may slow down COVID-19 mass vaccination. Therefore, understanding health providers' COVID-19 vaccine concerns can provide critical insights to optimize the success of the vaccine rollout program as they are a trusted and important source of health information to patients and the general population [1]. We conducted a phenomenological study to understand the reasons for health providers' COVID-19 vaccine hesitancy at Kenyatta National Teaching and Referral Hospital, Kenya.

Between April to August 2021, we conducted in-depth interviews (IDIs) among providers at Kenyatta National Referral Hospital, Kenya. We employed stratified purposive sampling to enroll clinical care providers (medical officers, clinical officers, nurses), and pharmacy staff (pharmacists and pharmaceutical technologists). Eligible participants were those actively providing health care services at either the infectious disease unit (n=20) or non-infectious disease unit (n=40) at the Kenyatta National Hospital, willing and able to provide informed consent.

All interviews were conducted in English by experienced social scientists and transcribed verbatim. The social scientists developed a semi-structured interview guide to explore health providers' and colleagues' reasons for COVID-19 vaccine hesitancy, and suggestions to improve vaccine uptake among them and the general population. Experienced social scientists (PO, and VO), reviewed the interview transcripts to ensure consistency, clarity, and completeness, and subsequently coded supported by Dedoose software (version 8.3.35) ( (Sociocultural Research Consultants, LLC, Los Angeles, CA, USA), a web-based application for managing, analyzing, and presenting our qualitative data [2]. The two social scientists developed a thematic coding framework based on the topics covered in the interview guide. We used deductive and inductive content analytic approaches to identify emerging themes, and organized our findings within the 5c model of factors influencing vaccine hesitancy and acceptance including; confidence, convenience/constraints, complacency, calculation, and collective response [3], as in Table 1.

Low confidence in the COVID-19 vaccine including mistrust in the healthcare system and government, vaccine safety, and efficacy concerns were mentioned by health providers as reasons for vaccine hesitancy. They reported that they were hesitant to receive the vaccine as they perceived its development process was rushed and that the reports from the media highlighted the vaccine's potential and experienced side effects from people who got vaccinated. Additionally, constraints such as uncertainty about the second vaccine dose availability, misinformation, and inadequate vaccine knowledge were mentioned as reasons for poor vaccine uptake. Further, health providers were reluctant to receive the vaccine because of perceived herd immunity from a recent COVID-19 infection, religious and conspiracy theories, and seeking information before deciding to receive the vaccine. Health providers suggested the need to have well-planned strategies in place to ensure a reliable supply of the vaccine and that public sensitization of new vaccines should be prioritized before roll-out to improve uptake.

Our study findings underscore significant public health challenges regarding vaccine hesitancy among health providers, which can impact broader vaccination efforts. Safety concerns were mostly mentioned by health providers in this study as reasons for COVID-19 vaccine hesitancy. They attributed the vaccine's safety concerns to its perceived quick development compared to other vaccines and its potential side effects from media reports. Therefore, there is a need to ensure health providers' vaccine concerns and medicine adverse effects are considered before rollout programs. A review of evidence-based strategies to increase vaccination uptake highlighted that not all events occurring after vaccination can be attributed to the vaccine itself. The review emphasized the importance of ensuring access to medical advice when adverse events occur because this is crucial in building trust and addressing any concerns that may arise before it increase fear and escalates the overall negative experience [4].

Misinformation was also a key reason for vaccine hesitancy. Other studies have demonstrated that if misinformation remains unaddressed, it can affect individuals' perceptions and decision making leading to self-perpetuating negative news [5,6]. However, providing adequate and correct information to people with high levels of anxiety may not necessarily improve vaccine uptake therefore, alternative remedies need to be identified [7]. This reiterates the need to recognize that reasons for vaccine hesitancy are often complex and go beyond the scope of information alone. Therefore, the role of health providers, religious leaders, and public health officials in disseminating correct vaccine information is important but not adequate.

Conclusion     

Health providers are seen as trusted sources of information about vaccines. When they express hesitancy, it can erode public trust in vaccines in general, not just COVID-19 vaccines. This can lead to decreased uptake of routine vaccines among them, clients, and the general population. Therefore, there is a need to address individual, community, and religious concerns regarding any new vaccine before roll-out as this is likely to increase uptake among health providers, clients, and the general population.

Competing interests     

The authors declare no competing interests.

Authors contributions     

Study conceptualization and funding; Kenneth Ngure and Nelly Mugo. Project administration and tool development: Paul Mwangi, Nicholas Thuo, Kenneth Ngure, Nelly Mugo, Phelix Okello, Vallery Ogello, Stephen Gakuo, Linnet Ongeri, Harrison Mwenda, John Kinuthia, Paul Mutua and Peter Mogere. Data collection and analysis: Vallery Ogello and Phelix Okello. Phelix Okello wrote the first version of the paper. All the authors read, reviewed, and approved the final version of this manuscript.

Acknowledgments     

We thank all the participants who participated in this study and all study staff for their motivation and dedication.

Table     

Table 1: summary of findings using the 5C model

References