Factors Associated with COVID-19 Vaccine Intentions in Eastern Zimbabwe: A Cross-Sectional Study

"Assessing vaccine intentions and identifying barriers and motivators of COVID-19 vaccine intentions can guide the targeting of evidence-based interventions to populations and areas most at risk."

Zimbabwe was one of the first African countries to receive COVID-19 vaccines, and a vaccine rollout plan was implemented in February 2021. A national online survey conducted when vaccines were not yet available reported on COVID-19 vaccine intentions among Zimbabweans, but the online survey consisted of a sample of primarily urban residents of Harare with internet access. This study builds on previous research by considering vaccine intentions after vaccines had been made available and focuses on a primarily rural province that has historically had lower vaccination coverage rates for childhood illnesses. Its purpose is to assess COVID-19 knowledge, attitudes, and behaviours and to identify factors associated with COVID-19 vaccine intentions among heads of households in Manicaland province, Zimbabwe.

In May 2021, when the survey was conducted, Manicaland province had the third-highest number of cumulative COVID-19 cases in the country, after Harare and Bulawayo provinces. The cross-sectional survey was administered to 551 randomly selected households. After obtaining written informed consent, interviewers read aloud each question to the participants and recorded responses on a mobile device programmed with SurveyToGo software. Data were collected on socio-demographic characteristics, and knowledge, attitudes, and behaviours regarding COVID-19 and the vaccines.

Of the 551 survey responses, 103 (18.7%) households had at least one member who had been vaccinated against COVID-19, 307 (55.7%) households intended to get vaccinated, and 141 (25.6%) did not intend to get vaccinated.

Knowledge of prevention measures (e.g., mask wearing, social distancing) and reported practice of these measures were consistently higher among respondents with vaccine intentions compared to those without. (Notably, only 51.7% respondents identified vaccination as a preventive measure despite the availability of COVID-19 vaccines in Zimbabwe since February 2021.) Although concerns about community spread of COVID-19 and acquiring infection were similar across households regardless of vaccination intentions, there were substantial differences in confidence in vaccine safety. About two-thirds (68.7%) of respondents with vaccination intentions were confident that COVID-19 vaccines were completely safe, compared to 8.5% of those with no intention of getting vaccinated.

The multivariate logistic regression results showed that the odds of intending to get vaccinated were most strongly associated with confidence in vaccine safety: Heads of households who were confident that COVID-19 vaccines were completely safe were 28 times more likely to intend to get vaccinated compared to those who lacked confidence in the safety of COVID-19 vaccines. Being male, having attended secondary school or higher, and knowing that vaccination and handwashing are prevention measures increased the likelihood of intending to get vaccinated. Other factors that were associated with increased odds of intending to get vaccinated included recommendations from the World Health Organization (WHO) and the availability of vaccines free of charge.

Country of vaccine manufacturer posed a barrier to vaccine intentions. As the researchers explain, when Zimbabwe received its first shipment of doses from China, there was speculation in the local media about the safety of Sinopharm and its efficacy against the beta variant. Furthermore, reported refusals to receive Chinese-made vaccines by healthcare workers and politicians received extensive attention in the media and may have influenced public trust in the safety of the vaccines. Health education focused on the safety and efficacy of the vaccine could impact vaccine intentions and eventual uptake, especially if messaging comes from trusted sources. (Also, given the high levels of trust in the Ministry of Health and WHO as sources of information in this population, it is likely that the approval of the Chinese vaccines for emergency use by the WHO will positively influence COVID-19 vaccine uptake in Zimbabwe.)

The researchers suggest that, "Given that vaccine intentions in the present study were suboptimal among the older, female, and less educated, health education and sensitization should target these populations. Misinformation about vaccines can quickly spread and these populations may be more vulnerable to believing and spreading misinformation about COVID-19 vaccines."

In conclusion: "As the COVID-19 vaccine roll-out in Zimbabwe continues, the findings from this study highlight several considerations in mounting evidence-based, tailored strategies to address vaccine hesitancy and improve vaccination coverage."