Exploring key informants' perceptions of Covid-19 vaccine hesitancy in a disadvantaged urban community in Ireland: Emergence of a '4Cs' model

Abstract

Aim: The aim of this study was to explore key informants' views on and experiences with Covid-19 vaccine hesitancy in a Dublin community with a high concentration of economic and social disadvantage and to identify feasible, community-centred solutions for improving vaccination acceptance and uptake.

Methods: Qualitative, semi-structured interviews were carried out at a local community-centre and a central hair salon. Twelve key informants from the target community were selected based on their professional experience with vulnerable population groups: the unemployed, adults in recovery from addiction, the elderly, and Irish Travellers. Inductive thematic framework analysis was conducted to identify emergent themes and sub-themes.

Results: Drivers of vaccine hesitancy identified by key informants largely fell under the WHO '3Cs' model of hesitancy: lack of confidence in the vaccine and its providers, complacency towards the health risks of Covid-19, and inconvenient access conditions. Covid-19 Communications emerged as a fourth 'C' whereby unclear and negative messages, confusing public health measures, and unmet expectations of the vaccine's effectiveness exacerbated anti-authority sentiments and vaccine scepticism during the pandemic. Community-specific solutions involve the provision of accurate and accessible information, collaborating with community-based organizations to build trust in the vaccine through relationship building and ongoing dialogue, and ensuring acceptable access conditions.

Conclusions: The proposed Confidence, Complacency, Convenience, Covid-19 Communications ('4Cs') model provides a tool for considering vaccine hesitancy in disadvantaged urban communities reacting to the rapid development and distribution of a novel vaccine. The model and in-depth key informants' perspectives can be used to compliment equitable vaccination efforts currently underway by public health agencies and non-governmental organizations.

Keywords: Covid-19; Hesitancy drivers; Low-SES community; Qualitative; Socioeconomic disadvantage; Vaccine hesitancy.

Fig. 1

Comparison of Pobal HP Deprivation Index 2016 rankings and Covid-19 Vaccination Rates by national decile as of March 2022 in Dublin, Ireland. Note: The target community is a cluster of eight ‘Disadvantaged’ Small Areas (SA) within a Local Electoral Area (LEA) in the lowest decile for national vaccination rates. In Ireland, Covid-19 vaccination rates are not publicly available in spatial units smaller than LEAs.

Fig. 2

Covid-19 vaccine topics included in the semi-structured interview guide. Note: key informants were asked about their own perceptions and experiences as well as those of the wider community.

Fig. 3

‘4Cs’ Model of Covid-19 Vaccine Hesitancy in a disadvantaged urban community: inductive analysis results from key informant interviews, Dublin, Ireland 2021. *From the WHO SAGE Working Group 3Cs model of Vaccine Hesitancy . Covid-19 Communications emerged through inductive analysis as a separate theme driving hesitancy.

Fig. 4

Drivers of vaccine resistance amongst adults in recovery from drug addiction as reported by community centre Guidance Counsellors (1) and (2): 19 November 2021, Dublin. *GP = General Practitioner. A&E = Accident and emergency department. HSE = Health Service Executive Ireland.