Determinants of COVID-19 vaccination acceptance based on the novel Omale INDEPT FORCIS Framework and recommendations for subsequent pandemics: a qualitative study among community members in Ebonyi state, Nigeria

Abstract

Background: The unprecedented COVID-19 pandemic has become an endemic disease of global public health importance. Mass COVID-19 vaccination has been an essential global control strategy amidst challenges of limited acceptance. Because of globalization, COVID-19/similar diseases vaccination acceptance and the determinants in any particular setting are important global public health issues. Using a novel and pragmatic framework, this study explored determinants of COVID-19 vaccination acceptance among community members during the pandemic in Ebonyi state, Nigeria, and made policy-relevant recommendations on how to increase vaccination acceptance in subsequent outbreaks/pandemics.

Methods: This qualitative study was based on the novel and pragmatic Individual Experiences and Perceptions and Complacency, Confidence, Convenience, and Compulsion (Four 'Cis') Determinants of Vaccination Acceptance Conceptual Framework - Omale INDEPT FORCIS Framework. On April 26 and 27, 2022, 20 semi-structured face-to-face focus group discussions were conducted in local language and pidgin English with 100 purposively selected consenting/assenting community members aged 15 years and above who had resided in the community for at least one year. Data was analysed using deductive (with some inductive) thematic analytic approach.

Results: The many, diverse, and significant determinants of COVID-19 vaccination acceptance found were factors that were individual-related (individual experiences and perceptions and knowledge about COVID-19, COVID-19 vaccine/vaccination, and the vaccination process/system, sociodemographic, individual's condition (e.g. pregnancy)); COVID-19-related (factuality, transmissibility, frequency, severity, fatality); COVID-19 vaccine/vaccination-related (safety/side-effects, effectiveness, speedy production); COVID-19 vaccination process/system-related (real availability/accessibility); family, group, and other individual-related (experiences and perceptions and actions); and broader local, national, international, and global (LONING) context-related (socio-political, economic, historic, health system factors). The broader LONING contextual factors included the unprecedented disinformation/conspiracy theories, non-sustained COVID-19 risk/behaviour change communication, enforcement and non-enforcement or termination of peculiar control policies/measures (lockdowns, social/physical distancing, use of face mask etc.), mandatory COVID-19 vaccination policies, provision of incentives, past experiences regarding the Ebola viral disease outbreak, (un)trustworthiness of the Nigerian health system and her international/global partners, and the (un)trustworthiness of the governments in Nigeria and bad/good governance, inclusive of the failure of the Ebonyi state government to distribute the COVID-19 palliatives to the people during the lockdowns.

Conclusion: The evidence illuminates complex and interrelated, specific underlying, and peculiar policy-relevant LONING determinants of COVID-19 vaccination acceptance and emphasizes the need for concerted and comprehensive LONING strategies (involving all the relevant LONING stakeholders/policy makers) in addressing these determinants to increase vaccination acceptance among community members in subsequent outbreaks/pandemics in Ebonyi state/Nigeria and similar settings.

Keywords: COVID-19; Community members; Determinants; International/global health; Nigeria; Omale INDEPT FORCIS Framework; Pandemics/outbreaks; Policy recommendations; Qualitative study; Vaccination acceptance (uptake hesitancy intention timeliness).

Fig. 1

Individual Experiences and Perceptions and Complacency, Confidence, Convenience, and Compulsion (Four ‘Cis’) – INDEPT FORCIS – Determinants of Vaccination Acceptance Conceptual Framework (Omale INDEPT FORCIS Framework). *Is about an individual, including a parent or primary caregiver of individual children (minors) and consists of primary factors (experiences, perceptions or expectations, knowledge, and cultural/religious beliefs) and secondary factors (information sources, sociodemographic, professional attributes, individual’s condition). ^Including the health workers giving and the govt providing the vaccination and source of the vaccine (country, company). ^ARegarding the disease and vaccine/vaccination, including information and communication being good or bad and its adequacy, consistency, and duration at the Local, National, International, and Global (LONING) levels. ^BThe enforcement and non-enforcement or termination of the policies/measures at the LONING levels (e.g. lockdowns, social/physical distancing, use of face mask, etc. and the policy that the vaccinated should still observe other preventive measures against the disease). ^CInclude mandatory and prohibitive vaccination policies, regulations like work-free vaccination days etc. by govt, community leaders, employers etc. at the LONING levels. ^DFinancial and non-financial incentives e.g. by govt, community leaders, employers etc. ¹Experiences regarding the disease and its attributes (e.g. about fear, cases, severe cases, deaths); perceptions about the disease and its attributes and perceived possibility of having the (severe) disease; and knowledge of the disease and its attributes. ²Experiences and perceptions or expectations and knowledge about the vaccine and vaccination attributes including level of trust in the health workers giving the vaccination, in the govt providing the vaccination, and in the source of the vaccine. ³Experiences and perceptions and knowledge about the vaccination process and system attributes (including, for e.g. local availability, stockouts or no stockouts, distance, waiting time, attitude of the health workers, cost (direct and or indirect), vaccination site(s) etc.). ⁴Gender, age, education, occupation, income, residence (rural vs. urban) etc. ⁵Type and nature of work, place of work, practising experience (in years) etc. ⁶Including pregnancy, breastfeeding a child, health status etc. and having contraindications to the vaccination. ⁷Experiences and perceptions or expectations and knowledge about the disease, vaccine/vaccination, and vaccination process/system (and their attributes) and the actions about the disease and the vaccination. ⁸Also include the request from members and heads of families/households. ⁹Include vaccination mandates and prohibitions by heads of families/households