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Introduction This study aimed to explore the factors contributing to COVID-19 vaccine hesitancy (VH) among healthcare workers (HCWs) who missed the first dose of the COVID-19 vaccine in Nigeria. Methods We conducted a qualitative study of the factors contributing to COVID-19 VH among HCWs at the University College Hospital, Ibadan using purposive sampling technique. Each interview session was held through telephone conversation. Qualitative data were analyzed using Colaizzi’s phenomenological method. Results The mean age of the 15 HCWs was 34.33±3.77 years, 10 (66.7%) were females, 6 (40.0%) were physiotherapists. Three themes were identified. The first theme, "Factors contributing to COVID-19 VH among healthcare workers” had five clusters: i) Lack of adequate information regarding the COVID-19 vaccine, ii) Challenges with immunization schedule, iii) Fear of side effects of the COVID-19 vaccine, iv) Lack of trust in the government, and v) Concerns about the safety of the COVID-19 vaccine. The second theme, "Healthcare workers’ perception on the solution to COVID-19” had three clusters: i) Adherence to non-pharmaceutical measures, ii) Vaccine production: key to submerging the COVID-19 pandemic, and iii) Healthcare workers’ perception of their roles in patient education on the COVID-19 vaccine. The third theme, "Recommendations to encourage COVID-19 vaccine acceptance among healthcare workers” had three clusters: i) Disclosure of extensive information on COVID-19 vaccine components, ii) Decentralization of COVID-19 vaccine collection points, and iii) Procurement of other brands of the COVID-19 vaccine.
The emergence of the novel coronavirus disease (COVID-19) was first confirmed in Wuhan city, Northern China during the fall of 2019.1 Between this period and 17th November 2021, there are 398,468 active COVID-19 cases globally of which 1,945 are in critically ill condition.2 Of this global total, there are 4,185 active COVID-19 cases in Nigeria out of which 11 are in critically ill conditions.2 Reported symptoms of COVID-19 among cases being investigated have included cough, fever, anosmia, loss of taste, and breathing difficulties.3 Person-to-person transmission of COVID-19 has been confirmed, thereby increasing the rate of transmission of COVID-19 and further threatening public health.4 To forestall a situation whereby COVID-19 completely paralyses the entire health system and public health, COVID-19 vaccines have been developed.4
COVID-19 vaccines have been recently rolled out for use across the globe.4 COVAX was launched by the World Health Organization, the European Union, and France as one of the three pillars of the Access to COVID-19 Tools (PACT).5 COVAX is focused on providing equitable access to COVID-19 diagnostics and vaccines.5 Many versions of the COVID-19 vaccine such as Pfizer, AstraZeneca, and Johnson & Johnson have been developed.5 The African Union has approved 41 million of these vaccines through the African Vaccine Acquisition Task Team portfolio between March and April, 2021.6 On 2nd March 2021, Nigeria received 3.94 million doses of the AstraZeneca vaccine.7
Due to the large population in Nigeria and the inadequate doses of procured COVID-19 vaccine, the Federal Government of Nigeria through the National Primary Healthcare Board prioritized all healthcare workers (HCWs) on the vaccine distribution strategy ahead of the general population.8 It is therefore expected that all HCWs, regardless of their cadre or health facility would have received the first dose of the COVID-19 vaccine before May 2021.8 By May 2021, the administration of the second dose is expected to commence for all HCWs who have received the first dose of the COVID-19 vaccine.8 Vaccine hesitancy (VH) has however been reported across the globe, and this has dissuaded many HCWs from receiving the first dose of the COVID-19 vaccine.3
Reports from the United States of America have revealed that nearly one-third of HCWs lacked confidence in the COVID-19 vaccine, and were therefore hesitant to receive the vaccine.9 Two studies conducted in Hong Kong and France before the COVID-19 pandemic reported 75% and 23.1% willingness to receive the COVID-19 vaccine among HCWs respectively.10,11 A study conducted in Israel found that 22% doctors, and 39% nurses were hesitant to receive the COVID-19 vaccine.12
The vaccination of HCWs not only results in fewer COVID-19 cases, but also strengthens the heath workforce for an adequate COVID-19 outbreak response. In addition, a high proportion of COVID-19 vaccine acceptance among HCWs is likely to influence high levels of vaccine acceptance among the general population when larger doses of the vaccine are available.12 Evidence from the National Primary Healthcare Development Agency revealed that only 68,748 (87%) of HCWs in Oyo State have received the first dose of the COVID-19 vaccine as of 18th May 2021.13 Given the promising success from the acceptance of the COVID-19 vaccine, an explorative study on the factors responsible for COVID-19 VH is timely. Knowledge gained from such a study will be essential to maximize the full benefits of COVID-19 vaccination on the journey towards normalcy. This study therefore aimed to explore the factors contributing to COVID-19 VH among HCWs who missed the first dose of the COVID-19 vaccine in Nigeria.
Research design
We conducted a qualitative study among HCWs in the University College Hospital (UCH), Ibadan, Southwest Nigeria. UCH, located in Ibadan, is a tertiary health facility that provides care to residents of Ibadan, Oyo State, and people from other parts of Nigeria and Africa.14 UCH has 850 bed spaces, with a good mix of HCWs, and a staff strength of over 5,000 HCWs.14 A qualitative study of all HCWs, regardless of cadre, was done to be able to document rich accounts regarding COVID-19 VH. As a result, we underpinned this study using the phenomenology method. All the authors: OSI, AAA, and OF interviewed the HCWs. To overcome gender bias and promote responsiveness especially from the female HCWs, the interviewers comprised of 2 females and 1 male. All the interviewers had been previously trained on qualitative research methods. The interviewers had been previously enrolled in the COVID-19 outbreak response and had previously participated in qualitative research among COVID-19 positive HCWs across some states in Nigeria.
Relationship with participants
All HCWs were approached, and they provided consent after the purpose of the study had been made known to them. The study participants were informed that the study aimed to report the existence of VH among HCWs in a bid to promote vaccine uptake among HCWs.
Participant selection
Purposive sampling was employed to study all the HCWs that were enrolled in the study. The inclusion criterion for participation was all HCWs who had missed the first dose of the COVID-19 vaccine. To obtain detailed information on VH across a range of HCWs, we included HCWs with direct and indirect involvement in patients’ care. We identified HCWs who missed out on the first dose of the COVID-19 vaccine through either of these two means: i) contact details obtained from the Heads of Departments; or ii) referral from close contacts. We adapted the interview method to ensure the privacy and confidentiality while exploring individuals’ perceptions and in-depth information. In addition, we used the interview method due to the sensitivity of the COVID-19 pandemic and the vaccine distribution. The interviewers were positioned at designated settings that assured privacy when each interview was held. We obtained informed consent through telephone conversation and shared informed consent forms through emails. Shortly afterwards, data collection commenced, and lasted for 8 days (26th April until 3rd May 2021). We continued to interview all HCWs that met the inclusion criterion until a saturation point, a point where no new information was obtained, was reached. Saturation has been described as a methodological principle in qualitative research where further data collection and/or analysis are unnecessary because new enrollees are not introducing new knowledge regarding the subject matter being investigated.15 After interviewing 15 HCWs (6 physiotherapists, 4 nurses, 2 doctors, 1 laboratory technician, 1 laboratory scientist, and 1 health attendant), we reached a saturation point for this study.
Setting
Each interview session lasted for 20-30 minutes. The telephone used to collect data from the HCWs was placed on speaker. No other person was present at the site of data collection apart from the three authors who shared roles as interviewer, recorder, and note-taker.
Data collection
Permission to record the interview was obtained from each healthcare worker. Sequel to data collection, each interview was transcribed verbatim by AAA and OF, and harmonized by OSI and AAA. The notes taken during the interview helped to ensure that the transcriptions fully matched respondents’ statements. To ensure further accuracy, each transcript was returned to each participant for additional comments and/or queries.
Interview guide
We developed an interview guide for the interview with the study participants. Sociodemographic characteristics included items such as age, sex, level of education, and length of experience. The questions included: "What contributes to COVID-19 vaccine hesitancy among healthcare workers?”, "Why did you not receive the first dose of the COVID-19 vaccine?”, "What do you consider as the solution to COVID-19 infection?”, and "What are the solutions to solve the problem of COVID-19 vaccine hesitancy among healthcare workers?” We piloted the questions on the interview guide among five doctors undergoing the residency training program at the University College Hospital, Ibadan, Oyo States. The doctors underwent regular posting exercises to different departments in the hospital and have contact with colleagues, consultants, and other HCWs. Each interview for the pilot spanned between 15-25 minutes. Fifteen percent of changes in the initial guide was generated by the pilot exercise. To enhance the depth of the discussion, prompts were introduced into the interview. This included the use of statements such as "Please explain further”, "Could you be more detailed about the subject matter”, and "Please clarify”.
Data analysis
We analyzed the qualitative data using Colaizzi’s phenomenological method. The method is based on narration of rich accounts of experiences through interviews, physical or virtual, and written narratives.16,17 To ensure that data are not lost accidentally, we followed the seven vital steps elucidated from the Colaizzi’s approach.16 Firstly, familiarization with the data was done, relevant and significant statements were coined, meanings were formulated, clusters were developed, relevant themes were described, structure was added, and verification of data from some HCWs was done. Manual transcription of each interview was done by AAA and OF, after which themes were identified by AAA and OSI. Three HCWs (1 doctor, 1 nurse, and 1 physiotherapist) were invited to ascertain whether the identified themes corresponded with their contributions in each instance.
Ethical review
Ethical approval for the study, in line with the Helsinki Declaration, was obtained from the Nigerian Institute of Medical Research (IRB/20/048). Verbal informed consent was obtained, and only willing participants were ultimately included in the study. The study did not expose respondents to any form of physical harm. Although the interview consumed a portion of participants’ time, discomfort was minimized by conducting the interview during the most preferred schedule of each participant. Scheduling interviews during respondents’ leisure period helps to minimize physical risks and optimize their involvement in the interview. The potential loss of participants’ confidentiality was prevented by ensuring that a detailed depiction of the socio-demographic features for each participant was excluded.
The mean age of the 15 HCWs was 34.33± .77 years. Among them, 6 (66.7%) were females. Overall, 6 (40.0%) were physiotherapists and 2 (13.3%) were doctors (Table 1). All 15 (100.0%) of the HCWs had not received the AstraZeneca COVID-19 vaccine. Among them, 3 (20.0%) were aware of other HCWs that had not been vaccinated against COVID-19.
Table 1. Sociodemographic characteristics of healthcare workers
Table 2 shows the summary of themes derived from the qualitative interview conducted among HCWs. Overall, there were 3 themes, with 5 clusters in theme one, and 3 clusters each in themes 2 and 3.
Theme one: Factors contributing to COVID-19 vaccine hesitancy among healthcare workers
Cluster one: Lack of adequate information regarding the COVID-19 vaccine (Figure 1)
VH has been reported during the administration of the first dose of the COVID-19 vaccine among many HCWs in Nigeria. VH among HCWs has been principally attributed to the lack of adequate information on the production of the vaccine.
Figure 1. Flowchart showing the summary of themes derived from the qualitative interview conducted among healthcare workers
"The lack of an indigenous COVID-19 could have contributed to the hesitancy regarding the COVID-19 vaccine among many healthcare workers. You know, foreign materials cannot be completely trusted to be safe” (Doctor 2).
"Apart from the fact that I am not completely certain of the information on the COVID-19 vaccine, I am afraid of the prick of the needle. Therefore, I hesitated to take the COVID-19 vaccine” (Nurse 2).
"Poor knowledge about the type of vaccine, how it works, and possible effects to expect has made me unwilling to take the vaccine” (Doctor 2).
"I have heard a lot of things from people that the COVID-19 vaccine is a sign of the beast. Some said you don’t know how effective the vaccine can be. They are not sure whether it is being kept in the normal temperature or that it will not affect their health at the end of the day. Even last week, I heard there was a man who took the vaccine and at the end of the day gave up the ghost. I’ve heard a lot of things and I think this information could have prevented other people from taking the vaccine” (Physiotherapist 3).
Cluster two: Challenges with immunization schedule
For some HCWs it was not opportune to receive the COVID-19 vaccine due to tight work schedule or absence during the scheduled period of vaccine distribution.
"I never had a chance because I was always at work. I was never able to get to the vaccine collection center early to be able to get the COVID-19 vaccine” (Physiotherapist 1).
"I was not around during the distribution of the vaccine. I wanted to be part of the last people to receive the COVID-19 vaccine” (Nurse 1).
"I was on leave while the vaccine was being administered. I participated in a study that required the collection of my blood sample. I wanted to ensure that my sample was collected before receiving the COVID-19 vaccine” (Nurse 3).
"I tested positive for COVID-19 during that period, so I could not take the vaccine” (Nurse 4).
Cluster three: Fear of side effects of the COVID-19 vaccine
A few others evaded the COVID-19 vaccine due to the fear of side effects as reported by colleagues who had previously received the vaccine.
"I was scared when others were complaining of pains on their hands and stomach after receiving the COVID-19 vaccine. I don’t want to experience these symptoms, so I have avoided taking the vaccine” (Health attendant).
"The fear of the side effects of the vaccine as seen in some people who have received the vaccine made me determine not to accept the vaccine” (Physiotherapist 4).
"I felt that there was no difference between myself and those who had received the COVID-19 vaccine. I experienced headache during the period of vaccine administration, and those who had gotten the vaccine also had headache” (Nurse 1).
"I was afraid to present with malarial-like symptoms such as headache and fever, reported by healthcare workers that had gotten the vaccine (Nurse 2).
The fear of unknown side effects also contributed to my hesitancy to take the vaccine” (Laboratory scientist).
"I didn’t take the COVID-19 vaccine because I’m plus size, and I’m worried about the thromboembolic phenomena. Some of my colleagues had side effects, and I asked myself whether I was ready to go through the stress in addition to the medical conditions I am managing. I’m wondering if the vaccine will worsen or improve the conditions. So, I’ll rather wait and see the outcome of the first dose since they will still roll out more doses” (Doctor 1).
Cluster four: Lack of trust in the government
Many HCWs doubted the high potency reported of the AstraZeneca COVID-19 being distributed in Nigeria. Many claimed that the speedy production of the COVID-19 vaccine introduces lots of questions to people’s minds. These questions doubt the reported potency of the vaccine, and the possibility that it is not a strategy for corruption from the government, even among HCWs.
"What I think is that the COVID-19 vaccine is new. Vaccines have been with us all these years. When we were younger, we took vaccines. Our children receive vaccines, but COVID-19 is new and when it came it was said to be a novel virus and much is not known about it. Within a short space of time coming up with the vaccine, people are wondering how safe the COVID-19 vaccine is” (Doctor 1).
"Absence of long-term studies on the effects and safety of the COVID-19 vaccine to other systems in the body” (Physiotherapist 5).
"I think the circumstances surrounding the production and distribution of the COVID-19 vaccine are suspicious. A number of conspiracy theories regarding the COVID-19 vaccine still need to be unraveled” (Physiotherapist 5).
"Members of the public, even healthcare workers are not completely aware of the stages the production of the COVID-19 vaccine went through (Physiotherapist 2).
"The potency of the COVID-19 vaccine is not as high as claimed” (Nurse 2).
"The fact that it has not been proven that one cannot contract COVID-19 after taking the vaccine” (Physiotherapist 6).
"The COVID-19 vaccine could be used against the human race in the future” (Physiotherapist 2).
A healthcare worker doubted the availability of the second dose of the COVID-19 vaccine in Nigeria. Due to the lack of assurance, they deliberately missed the first dose of the COVID-19 vaccine.
"I may not take the COVID-19 vaccine in the nearest future due to the fact that I’m not so sure if the second dose will be available at that point because there is this thing that goes on in our economy. It’s everywhere, right from the grassroots to the politicians. We might say that there is enough dose of the vaccine. However, we may later be told that the available doses cannot serve everyone. If this happens, there will always be preference for people at the top than those at the grassroot” (Physiotherapist 3).
Further, a few who were worried about the health condition that was being managed had controversies on the safety of the COVID-19 vaccine given their present health condition. Negative experiences during previous vaccinations made a healthcare worker to evade the COVID-19 vaccine.
"The side effects I had when I took the chickenpox vaccine did not prompt me to accept the COVID-19 vaccine. At that point, I experienced throbbing headache, malaise, fever, and body pain. I also had an unusual high-grade fever that lasted for 2 days.”
Another healthcare worker opined that receiving the COVID-19 vaccine was not self-sufficient to protect one from being infected with COVID-19. Adherence to the recommended safety measures were of key importance to keep safe from COVID-19.
"I deliberately evaded the COVID-19 vaccine due to the low efficacy level and the possible side effects. In addition, I have to still observe the preventive measures even after taking the vaccine (Doctor 2).
Cluster five: Concerns about the safety of the COVID-19 vaccine
Other concerns by HCWs included the safety of COVID-19 vaccine given some physiological conditions. Ethical issues surrounding the safety of the COVID-19 vaccine were also stated by the HCWs.
"Safety in pregnancy. I heard that pregnant women are not eligible for the COVID-19 vaccine” (Medical laboratory technician).
"Well, there is the issue of safety. If safety of the COVID-19 vaccine is doubted and if you really don’t know the constituents or components of the vaccine you are receiving, that could create a kind of reluctance or hesitancy. Partly also because of the resultant effect of receiving these vaccines, one could have side effects such as headache, flu-like symptoms body aches, and fever” (Doctor 2).
"My concerns and worry are on safety matters. How safe is the COVID-19 vaccine? The social media is not helping the situation” (Doctor 1).
"It is not only about the short-term effects of the COVID-19 vaccine. It is also about being sure of the long-term effect of what you are receiving. Some viruses have been previously linked to cancers. For instance, HPV has been linked to cervical cancer, Epstein Barr virus has been linked to Burkitt’s lymphoma, and cranio-pharyngeal lymphoma, and cranio-pharyngeal carcinomas. Therefore, one must be careful about taking the vaccine. One may even need to observe others and be a bit tardy before receiving the vaccine” (Doctor 2).
"Issues on the transmutation of genome of the COVID-19 vaccine are yet to be addressed” (Physiotherapist 2).
"We are not really sure of the duration of the immunity conferred by the COVID-19 vaccine. The vaccine may confer some form of immunity. If it’s a short-term immunity, you begin to weigh the risks to the benefit, and you keep wondering if this will protect me for just a year or two years, is it worth receiving it? But no one is able to really know the duration of the immunity conferred by the COVID-19 vaccine” (Doctor 2).
Theme Two: Healthcare workers’ perception on the solution to COVID-19
Cluster one: Adherence to non-pharmaceutical measures
Many HCWs explained the promising victory over the COVID-19 pandemic if adherence to the non-pharmaceutical interventions are enforced.
"I know when COVID-19 got into Nigeria people complied during the first wave. But now that the second wave is over, people are living their normal lives not wearing face masks and nobody is enforcing it. I live in Oyo State where enforcement is low. Most of my colleagues working in the Emergency Operations Centre, I tell them, you bring out good innovations, but nobody is enforcing mask wearing. It is not all about the COVID-19 vaccine but scaling up the practice of the non-pharmacological interventions” (Doctor 1).
"Non-pharmacological interventions such as handwashing and use of face masks need to be promoted” (Health attendant).
"Proper hygienic and infection prevention measures are presently lacking. If we scale up these two areas, the COVID-19 pandemic will be completely submerged” (Physiotherapist 4).
"Standard infection prevention and control practices are all that we need in Nigeria. The COVID-19 vaccines are not too important for us” (Physiotherapist 4).
"I may not know of any proven approach to overcome the COVID-19 pandemic. One thing I’m sure of is this: We have more serious public health problems for which solutions need to be sought” (Physiotherapist 6).
"Hygienic practices are cost-effective. I think that is all we need during the COVID-19 pandemic. The vaccines are not necessary in Nigeria. We have heard of the varying strains of SARS-CoV-2. So, let us just promote simple handwashing and other recommended measures” (Physiotherapist 2).
"To me, I think maintaining social distance and use of face masks is more effective than any other thing. We have heard of cases of re-infection among people who had taken the COVID-19 vaccine. So, social distancing, cough and sneezing etiquette should be looked into. I think these measures should be sufficient” (Physiotherapist 3).
Cluster two: Vaccine production: key to submerging the COVID-19 pandemic
Other HCWs opined that the COVID-19 vaccines are all it would require for public health to be assured amid the COVID-19 pandemic.
"Transparent, widely tried, and low side-effect COVID-19 vaccines are all it takes to suppress the COVID-19 pandemic” (Doctor 2).
"I believe the COVID-19 vaccines are very effective. Vaccines are principally all it requires to address public health threats” (Nurse 1).
"Vaccination is a proven tool to address COVID-19. I think the available vaccines are potent” (Nurse 3).
Cluster three: Healthcare workers’ perception of their roles in patient education on the COVID-19 vaccine
Among the HCWs, 13 (86.7%) had not encouraged patients to accept the COVID-19 vaccine when it becomes available for the public. Many among them considered it hypocritical, while others felt their own vaccination experience would be necessary to encourage others to accept the COVID-19 vaccine.
"I have encouraged my patients to accept the COVID-19 vaccine once it is available” (Nurse 1).
"Whether or not I have received the vaccine is not an issue, I just advise them to take the COVID-19 vaccine. The final decision is theirs to make”(Nurse 3).
"It is sheer hypocrisy. How would I encourage someone to take what I haven’t experienced?” (Doctor 2).
"My personal experience would help in sharing advice for patients to accept the COVID-19 vaccine. If I have not accepted the vaccine as a healthcare worker, I lack the right to advise others to accept it” (Nurse 1).
Theme three: Recommendations to encourage COVID-19 vaccine acceptance among HCWs
Cluster one: Disclosure of extensive information on COVID-19 vaccine components
To improve the acceptance of the COVID-19 vaccine among HCWs, suggestions on the extensive disclosure of the components of the COVID-19 vaccine, and assurance on the safety of the vaccine are needed.
"Number 1 for me is an extensive disclosure of the components of the vaccine. Don’t shroud it in secrecy. Don’t have certain components that nobody can talk about. Components that are controversial, you know there was a time that one of the vaccines had Luciferase as one of its components. You know, Luciferase is a religious name. So, full disclosure of all the components of the vaccine and ensuring that none of the vaccine components is controversial regardless of its country of origin” (Doctor 1).
"A guarantee needs to be given to healthcare workers that the government would bear the responsibility in case the unthinkable happens to anyone following the receipt of the vaccine”(Physiotherapist 6).
"I think allaying the fears of individuals regarding the misconceptions on the side effects of the COVID-19 vaccine will encourage vaccine acceptance among many” (Doctor 2).
"It is necessary to continue to persuade them that the COVID-19 vaccine is safe for the body” (Medical laboratory technician).
Cluster two: Decentralization of COVID-19 vaccine collection points
In addition, some HCWs suggested the decentralization of vaccine collection points to reduce waiting time, and vaccination distribution strategies in departmental levels for each institution.
"I’ve heard about some tertiary institutions where the COVID-19 vaccine is being distributed cadre y cadre, or on departmental basis. This has really made vaccine distribution effective, and I think if all institutions can adopt that process, more people will take the vaccine without hesitating. If it is cadre or in departmental levels, it means that not everybody will leave their duty posts at the same time. It will be well regulated so that work will continue, and at the same time people will benefit from the vaccine” (Physiotherapist 3).
"They need to extend the duration of vaccine administration or have a center where those who are still interested can get vaccinated” (Nurse 3).
Cluster three: Procurement of other brands of the COVID-19 vaccine
While some were unperturbed about the brand being distributed, some HCWs stated that the brand of COVID-19 vaccine mattered to some of their colleagues. They highlighted that the procurement of other brands of COVID-19 vaccine apart from AstraZeneca that was previously distributed could reduce VH.
"I think there is no reason why I shouldn’t take the AstraZeneca vaccine. I don’t think I’ve really thought about the variety of the vaccines, and I don’t think I have so much knowledge about each vaccine” (Physiotherapist 1).
"Another vaccine can be bought instead of AstraZeneca e.g., Pfizer” (Nurse 2).
"I am ready to accept another vaccine as long as it is AstraZeneca” (Physiotherapist 4).
"From my own research, if I had the choice, I’d rather go for Pfizer and that has to do with the studies that have been conducted. Pfizer has the highest threshold of potency compared to other COVID-19 vaccines” (Doctor 1).
"A colleague of mine said he’s waiting for the Johnson & Johnson vaccine. I am not particular about the brand. Once I have seen that people are doing fine after taking any of the vaccines, I don’t have any sentiment. My colleague did not give any reason for wanting Johnson & Johnson. He just mentioned it on a WhatsApp where people were encouraging one another to accept the available vaccine” (Doctor 1).
This study aimed to explore the factors contributing to COVID-19 VH among HCWs who missed the first dose of the COVID-19 vaccine in Nigeria. HCWs who had missed the first dose of the COVID-19 vaccine attributed it to the large workload and tight work schedule, which did not give them the opportunity to exit their unit of primary assignment. During the early phase of the COVID-19 pandemic, poor enrolment in COVID-19 testing exercise was attributed to the availability of testing centers in limited numbers.18 However, when decentralization was introduced following the creation of multiple testing sites, increased enrolment in COVID-19 testing was reported.19 Therefore, the decentralization of COVID-19 vaccination points to more healthcare facilities will reduce waiting time, and encourage HCWs’ enrolment in the vaccination exercise. In addition, the establishment of the COVID-19 Task Force across all healthcare facilities is needed. It is required that the head of each unit is enrolled as member of the COVID-19 Task Force. To improve vaccine acceptance among HCWs, vaccine collection schedules should be drafted. Such schedules would necessitate that one or two HCWs are excused during duty hours every day to visit the vaccine collection center to receive the COVID-19 vaccine. Thus, by the end of the scheduled period of vaccine distribution in Oyo State and elsewhere, more than 90% of HCWs would have received the COVID-19 vaccine.
The fear of side effects of the COVID-19 vaccine as reported from many individuals who have received the COVID-19 vaccine has discouraged other HCWs from receiving the COVID-19 vaccine. Reported side effects of the COVID-19 vaccine include headache, weakness, body pain, and thromboembolism.20 Reports from Nigeria and the United States have shown that the fear of side effects of the COVID-19 vaccine has caused VH among 45% of the population.21 In addition, 27% of the U.S. population lacked complete trust in the government. Issues of distrust on the government’s response to health events has been reported among many individuals in Nigeria.22 As a result, many individuals lack complete trust in the efficacy of the COVID-19 vaccine. Brewer and colleagues affirmed that unwillingness to receive vaccines is an outplay of individuals’ lack of confidence in the health authorities.23 Reinvigoration of public trust in local health authorities, namely the Ministry of Health and Centre for Disease Control should be promoted. In addition, national governments need to demonstrate competence in managing the COVID-19 situation in the country in a bid to promote public trust in them.
A large proportion of HCWs posited that the COVID-19 vaccines are not self-sufficient towards self-protection against COVID-19. Although COVID-19 vaccines proffer immunity against COVID-19, the duration of immunity conferred is unknown.24 Vaccination has been earlier described as a possible strategy towards achieving herd immunity against COVID-19 for any population.25 However, the journey towards complete vaccination of all members of the population may be farther away, thus necessitating the adoption of non-pharmaceutical measures that have been proven to be cost-effective. Therefore, it becomes pertinent to mount regulations guarding complete adherence to COVID-19 preventive measures such as social distancing and compulsory use of face masks especially in public places. Although COVID-19 preventive practices cannot be forced on people, statements such as "adherence to COVID-19 safety protocols connotes patriotism and high sense of responsibility” could be included into public awareness campaigns.
The vaccination of HCWs strengthens the heath workforce and reduces the risk of COVID-19 transmission among the population. This study identified that concerns relating to side effects, distrust, constitute factors that could contribute to COVID-19 VH among HCWs. Addressing COVID-19 VH among HCWs is necessary to improve the likelihood for COVID-19 vaccine acceptance among the general population. To improve vaccine acceptance, COVID-19 vaccine awareness programs should be organized to address COVID-19 vaccine-related concerns. To achieve this, a cost-benefit analysis needs to be communicated to HCWs via the risk communication channels in each state to educate them that the benefits of accepting the COVID-19 vaccine outweighs the risks in VH.
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