COVID-19 vaccine hesitancy among health providers at Kenyatta National Teaching and Referral Hospital Nairobi-Kenya
Phelix Okello, Vallery Ogello, Nicholas Thuo, Stephen Gakuo, Paul Mwangi, Peter Mogere, Paul Mutua, Harrison Mwenda, Linnet Ongeri, John Kinuthia, Nelly Mugo, Kenneth Ngure
Corresponding author: Phelix Okello, Partners in Health Research and Development, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
Received: 21 Jul 2024 - Accepted: 27 Sep 2024 - Published: 10 Oct 2024
Domain: Sociology
Keywords: COVID-19 Vaccine, hesitancy, healthcare providers, Kenya
©Phelix Okello et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Phelix Okello et al. COVID-19 vaccine hesitancy among health providers at Kenyatta National Teaching and Referral Hospital Nairobi-Kenya. Pan African Medical Journal. 2024;49:31. [doi: 10.11604/pamj.2024.49.31.44719]
Available online at: https://www.panafrican-med-journal.com//content/article/49/31/full
Letter to the editors
COVID-19 vaccine hesitancy among health providers at Kenyatta National Teaching and Referral Hospital Nairobi-Kenya
COVID-19 vaccine hesitancy among health providers at Kenyatta National Teaching and Referral Hospital Nairobi-Kenya
Phelix Okello1,&, Vallery Ogello1, Nicholas Thuo1, Stephen Gakuo1, Paul Mwangi1, Peter Mogere1, Paul Mutua2, Harrison Mwenda2, Linnet Ongeri3, John Kinuthia2, Nelly Mugo3, Kenneth Ngure4
&Corresponding author
The evidence of COVID-19 vaccine efficacy for reducing the severe effects of COVID-19 infection, including hospitalization and death has been well established. 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. We sought to understand the reasons for health providers' COVID-19 vaccine hesitancy at Kenyatta National Teaching and Referral Hospital. From April to July 2021, we interviewed 60 health providers purposively sampled from the Infectious Disease Unit (IDU) (n=20) and other departments (n=40). Interviews were conducted remotely, audio recorded, transcribed, and translated verbatim to English. We analyzed data using inductive and deductive approaches to understand the reasons for COVID-19 vaccine hesitancy. The health providers had a median age of 37 years, (Interquartile range: [IQR 20.0-58.0]), 57% were female, and 30% nurses among other cadres. Most health providers cited low confidence in the vaccine such as mistrust in the healthcare system and government, vaccine safety and efficacy concerns. Constraints such as uncertainty about the second vaccine dose availability, and misinformation caused hesitancy. Further, few were reluctant to receive the vaccine because of perceived herd immunity from a recent COVID-19 infection, and the need for more information before deciding. The study highlights the need to address any misinformation about vaccine safety and efficacy and ensure accurate information is easily accessible to health providers which can translate to higher vaccine uptake.
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.
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.
All authors declare no competing interests.
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 authors read and reviewed the manuscript and approved the final version.
We thank all the participants who participated in this study and all study staff for their motivation and dedication.
Table 1: summary of findings using the 5C model
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