Perspectives on the COVID-19 vaccine uptake: a qualitative study of community members and health workers in Zambia

Objective Since introduction of the programme in April 2021, COVID--19 vaccine uptake has been low at less than 20%. This study explored community members' and health workers' perspectives on the COVID--19 vaccine uptake and its influencing factors in Zambia. Study design A qualitative study employing focus group discussions (FGDs) and in--depth interviews (IDIs). Study setting Sixteen primary healthcare facilities selected from Lusaka, Copperbelt, Central and Southern provinces. Participants A total of 32 FGDs comprising local community members and 30 IDIs including health workers, traditional, religious and civic leaders (n=272). FGDs were separated based on age (youth and adults), sex (male and female) and place of residence (urban and rural). Results Both FGD and IDI participants agreed that vaccine uptake was low. Limited knowledge, access to information, myths and misconceptions, negative attitude, low--risk perception and supply in remote areas affected vaccine uptake. Overall, FGD participants expressed limited knowledge about the COVID--19 vaccine compared with health workers. Further, FGD participants from urban sites were more aware about the vaccine than those from rural areas. Health workers perceived the vaccine to be beneficial; the benefits included prevention of infection and limiting the severity of the disease. Moreover, FGD participants from urban sites expressed a negative attitude towards the vaccine. They believed the vaccine conferred no benefits. By contrast, participants from rural communities had mixed views; they needed more information about the vaccine benefits. Participants' attitude seems to have been influenced by personal or family experience with the COVID--19 disease or vaccination; those who had experienced the disease had a more positive attitude. In contrast, most young people believed they were not at risk of the COVID--19 disease. Misinformation from social media influenced their attitude. Conclusion These results provide starting points for future policies and interventions for increasing COVID--19 vaccine uptake.