Structural, Social, and Contextual factors influencing COVID-19 vaccine uptake: A qualitative methods study among Healthcare Workers and Older People in Uganda

Background The COVID-19 vaccine rollout program in Uganda was launched in March 2021 with Healthcare Workers (HCWs), older persons (≥50 years), and persons with chronic conditions as priority groups for vaccination. To inform the vaccine rollout efforts, we set out to explore the social and structural factors that influenced the uptake of COVID-19 vaccines among HCWs and older people in Uganda. Methods Between September and October 2021, we conducted 33 in-depth interviews with 25 HCWs aged 21–63 years from three hospitals from two districts in the central region of Uganda and eight older people from communities in Wakiso district. Selection was purposive based on sex, occupation, education, cadre of HCWs (doctors, nurses, laboratory technologist, hospital support staff, administrator) and vaccination status. We explored participants’ knowledge, beliefs, personal experiences, barriers, and facilitators to vaccine uptake and suggestions for future COVID-19 vaccine rollout. Interviews were audio-recorded, data was transcribed and translated from the local language, coded, and analysed by themes. Results Twenty-two of the 25 (88%) HCWs and 3 of the 8 (38%) older people had received at least one dose of the COVID-19 vaccine at the time of interview. The structural facilitating factors to vaccine uptake included access to correct information, fear of a risky work environment, and mandatory vaccination requirements especially for frontline HCWs. Old age, chronic health conditions, and the fear of death are contextual facilitating factors, while influence from leaders was the main social facilitating factor. Myths and misconceptions about COVID-19 vaccines and the fear of side effects were common social barriers to vaccine uptake among HCWs and older people. Long distances to vaccination centres, vaccine stock-outs, and long queues at the vaccination centres were specific barriers to vaccine uptake for older people. The prerequisite of signing a consent form was a specific structural barrier for the HCWs. Transport challenges linked to long distances to the vaccination centres, for older people, and having underlying chronic health conditions, for both older people and HCWs, were the reported contextual factors. Conclusion Future roll out of new vaccines should have a comprehensive information dissemination strategy about the vaccines. Improved access to vaccines through community outreaches, reliable vaccine supply and addressing vaccine misinformation, may enhance COVID-19 vaccine uptake in Uganda and other future mass vaccination campaigns. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was funded through the Makerere University-Uganda Virus Research Institute Centre of Excellence for Infection and Immunity Research and Training (MUII). MUII was supported through the DELTAS Africa Initiative (Grant no. DEL-15-004). The DELTAS Africa Initiative was an independent funding scheme of the African Academy of Sciences (AAS), Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust and the UK Government. The work was conducted at the MRC/UVRI and LSHTM Uganda Research Unit which is jointly funded by the UK Medical Research Council (MRC) part of UK Research and Innovation (UKRI) and the UK Foreign, Commonwealth and Development Office (FCDO) under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union. Alison Elliott is supported in part by the NIHR (NIHR134531) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the funders or the UK government. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Uganda Virus Research Institute Research Ethics Committee (UVRI REC GC/127/21/03/813), the Uganda National Council for Science and Technology (UNCST SS767ES), 27-04-2021, and the London School of Hygiene and Tropical Medicine Research Ethics Committee (25997). We obtained administrative clearance from all the collaborating hospitals to conduct the study. Written informed consent to participate in the interviews was obtained at enrolment time in the main study of acceptability and immunogenicity of COVID-19 vaccines. Before each interview, Research Assistants verbally checked to confirm that participants were still interested in taking part in the in-depth interview. All interviews were conducted in a safe and private place to ensure participants privacy and confidentiality. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Because of the characteristics of the data and the consent given by participants, with a guarantee of anonymity, we are unable to include all the original data. This precaution is necessary as certain details could potentially compromise the anonymity of the participants. Hence, the data forming the basis of this paper have been incorporated into the Supplementary information, ensuring that any mention of names, age, and specific job identifiers has been excluded.