Determinants of COVID-19 Vaccine Uptake and Hesitancy among Healthcare Workers in Tanzania: A Mixed-Methods Study

Abstract

The novel Coronavirus disease 2019 (COVID-19) presents a major threat to public health but can be prevented by safe and effective COVID-19 vaccines. Vaccine acceptance among healthcare workers (HCWs) is essential to promote uptake. This study, aimed to determine the COVID-19 vaccination uptake and hesitancy and its associated factors among HCWs in Tanzania. We employed a convergent-parallel mixed-methods design among 1368 HCWs across health facilities in seven geographical zones in Tanzania in 2021. We collected quantitative data by using an interviewer-administered questionnaire and qualitative data, using in-depth interviews and focus group discussions. Participants in the quantitative aspect were conveniently selected whereas those in the qualitative aspect were purposively selected based on their role in patient care, management, and vaccine provision. Stata software version 16.1 was used in the analysis of quantitative data and thematic analysis for the qualitative data. Multiple logistic regression was used to assess the determinants of COVID-19 vaccine uptake. The median age of 1368 HCWs was 33, and the interquartile range was 28–43 years; 65.6% were aged 30+ years, and 60.1% were females. Over half (53.4%) of all HCWs received the COVID-19 vaccine, 33.6% completely refused, and 13% chose to wait. HCWs aged 40+ years, from lower-level facilities (district hospitals and health centers), who worked 6+ years, and with perceived high/very high risk of COVID-19 infection had significantly higher odds of vaccine uptake. The qualitative data revealed misinformation and inadequate knowledge about COVID-19 vaccine safety and efficacy as the key barriers to uptake. Nearly half of all HCWs in Tanzania are still unvaccinated against COVID-19. The predominance of contextual influence on COVID-19 vaccine uptake calls for interventions to focus on addressing contextual determinants, focusing on younger HCWs’ population, short working duration, those working at different facility levels, and providing adequate vaccine knowledge.

The Social Ecological Model: A Framework for Understanding COVID-19 Vaccine Uptake among Healthcare Workers—A Scoping Review

“…Subsequent studies reported HCWs’ acceptance towards the COVID-19 vaccines [ 43 , 57 , 65 , 68 , 74 , 75 , 78 , 86 , 87 , 89 , 90 , 93 , 95 ]. Among these ten studies, over half of the participants were vaccinated with at least one dose (see Figure 2 ).…”

“…The following factors associated with VA were gender [ 23 , 46 , 56 , 65 , 67 , 72 , 74 , 76 , 77 , 79 , 80 , 87 ], age [ 43 , 46 , 48 , 54 , 56 , 57 , 65 , 74 , 87 , 94 ], education level [ 43 , 46 , 50 , 52 , 67 , 75 , 78 ], belonging to religion [ 48 , 74 ], marital status [ 43 , 72 , 76 , 77 , 78 ], being a parent [ 95 ], absence of pregnancy [ 43 ], presence of chronic illness [ 43 , 56 , 59 , 77 ], living area [ 65 , 67 , 77 , 79 ], cadre [ 23 , 43 , 48 , 49 , 51 , 53 ,…”

“…Within the theme of COVID-19 vaccines, ten sub-themes were identified, all acting as barriers to vaccine uptake. The most prominent sub-theme was safety concerns, which was reported as the primary barrier [ 23 , 25 , 43 , 47 , 50 , 51 , 55 , 56 , 57 , 60 , 61 , 65 , 66 , 67 , 68 , 69 , 70 , 72 , 74 , 75 , 76 , 77 , 78 , 81 , 82 , 83 , 84 , 85 , 86 , 88 , 90 , 91 , 92 , 95 ]. However, only three studies mentioned confidence in the COVID-19 vaccines, facilitating uptake [ 47 , 52 , 88 ].…”

“…At the institutional level, there are significant challenges in the environmental structures. One identified barrier is the lack of trust in stakeholders, such as government and pharmaceutical companies [ 25 , 43 , 56 , 57 , 68 , 81 , 90 ]. Furthermore, a study [ 66 ] found that some HCWs would refuse the vaccine because government officials themselves did not accept it.…”

“…However, specific barriers to vaccine uptake were also identified. Several studies [ 23 , 25 , 57 , 61 , 63 , 67 , 70 , 78 ] observed that limited access to reliable information hindered the willingness of HCWs to receive the vaccine. Social media emerged as a significant influencer, with seven studies [ 57 , 60 , 63 , 68 , 70 , 72 , 90 ] reporting that HCWs subscribed to misinformation or conspiracy theories.…”