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Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base

  • August 2023
DOI:10.61473/001c.75321
Authors:
Gavin George at University of KwaZulu-Natal
Gavin George
Phiwe Babalo Nota at University of KwaZulu-Natal
Phiwe Babalo Nota
Michael Strauss at University of KwaZulu-Natal
Michael Strauss
Emma Lansdell
Emma Lansdell
Emma Lansdell
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Abstract

Background Studies have shown that healthcare workers (HCWs) are considered trusted sources of coronavirus disease 2019 (COVID-19) information in their communities, ideally placing them as effective vaccine advocates. However, limited data exist on the role of HCWs in the promotion of vaccines, and whether they feel adequately equipped to fulfil this role. This study therefore aimed to determine the willingness of HCWs in promoting COVID-19 vaccines, how this correlated with their own vaccination behaviour and attitudes to alternative therapies, and whether they felt they had adequate knowledge and skills to communicate effectively with patients. Methods A mixed-methods design was adopted, involving an online web-based survey and in-depth interviews (IDIs). HCWs were recruited for the online survey from an integrated health system database in South Africa using voluntary response sampling, with follow-up qualitative interviews conducted with HCWs who indicated interest in participating in an interview. Univariate and multivariate logistical regression models were used to understand how demographic characteristics, HCW roles, vaccination status, attitudes and practices around alternative medications, and information on COVID-19 vaccines were related to the willingness of HCWs to recommend vaccination to their patients. Results Most of the survey sample were vaccinated (90.7%) and indicated that they would recommend vaccination (81.7%). However, a significant proportion of the sample (58.6%) felt that they did not have enough information on COVID-19 vaccines, while 59.8% felt that they required additional guidance on how to educate their patients on COVID-19 vaccines. Vaccinated HCWs were more likely to recommend vaccination (OR=10.63 [95% CI: 6.53-17.31]) than their unvaccinated counterparts. The qualitative results provide further insights into why HCWs were willing or unwilling to administer and promote vaccines, with three themes emerging: (i) HCWs’ belief in the value of vaccines and their promotion strategies; (ii) challenges facing HCWs in fulfilling their mandate of administering and promoting COVID-19 vaccination; and (iii) the rationale for HCWs discouraging vaccination and promoting alternative medicines for COVID-19 prevention and treatment. Conclusions This study posits that if HCWs are key to the success of national vaccination programmes, then they will need to be provided with clear, contextual, up-to-date information in order to enhance patient communication and vaccine uptake.
Available via license: CC BY-NC 4.0
Content may be subject to copyright.
*:H:6G8=
Examining healthcare worker
willingness to promote COVID-19
vaccines in South Africa: the importance
of a clear evidence base
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Background
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Methods
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Conclusions
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Introduction
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8>C:L=>A:DI=:G;68IDGH >C8AJ9>C< EG:;:G:C8: ;DG E=NH
>DAD<>86A >BBJC>IN I=GDJ<= C6IJG6A >C;:8I>DC 9>HIGJHI >C
<DK:GCB:CI6C9E=6GB68:JI>86A8DBE6C>:H6C96C:B
E=6H>H DC 6JIDCDBN 6C9 E:GHDC6A ;G::9DB B6N 6W:8I
7DI=I=:>G DLC K688>C6I>DC 8=D>8:H 6C9 I=:G:8DBB:C
96I>DCH I=:N B6@: ID E6I>:CIH 99>I>DC6AAN =:H>
I6C8N6C9G:AJ8I6C8:ID EGDBDI:K688>C6I>DCIDE6I>:CIH
B6N6AHD7:;J:AA:9 7N68DB7>C6I>DCD;><CDG6C8:B>H
>C;DGB6I>DC 8DCHE>G68N I=:DG>:H 9DJ7I 67DJI H8>:CI>X8
:K>9:C8:8DC8:GCHG:A6I>C<IDB:9>86A=>HIDG>:H6C98JA
IJG6AG:A><>DJH6C9E=>ADHDE=>86A7:A>:;H
!C I=: +DJI= ;G>86C 8DCI:MI I=:G: 6G: G:EDGIH I=6I
HDB: /H>C8AJ9>C<9D8IDGH=6K:68I>K:AN9>H8DJG6<:9
E6I>:CIH;GDB<:II>C<'.!K688>C6I>DCH/=>A:I=>H
:K>9:C8: >H A6G<:AN 6C:89DI6A >I G:B6>CH 86JH: ;DG 8DC
8:GC 6C9 8DJA9 7: 6 ;68IDG >C I=: 8DJCIGNSH HIJ77DGCAN
HADLK688>C:6C97DDHI:GJEI6@:G6I:H 6H:9 DC I=>H
EG:B>H: I=: EG:H:CI HIJ9N6>B:9 ID:MEADG: / L>AA
>C<C:HHIDEGDBDI:'.!K688>C:HID;6B>AN;G>:C9H
6C9 E6I>:CIH 6C9 =DL I=>H 8DGG:A6I:9 L>I= H:A:8I:9 9:
BD<G6E=>8 8=6G68I:G>HI>8H I=:>G DLC K688>C6I>DC DG 6A
I:GC6I>K: I=:G6E:JI>8 7:=6K>DJG 6C9 L=:I=:G I=:N =69
HJZ8>:CI>C;DGB6I>DC6C969:FJ6I:H@>AAHL>I=L=>8= ID
:C<6<:E6I>:CIHDC'.!K688>C:H,=:HIJ9N;JGI=:G
FJ6A>I6I>K:AN :MEADG:9 7DI= I=: 8DCI:CI 6C9 C6IJG: D;
I=:H: >CI:G68I>DCH :ME6C9>C< DC L=6I L:G: A>B>I:9 >C
H><=IH >CID / >CI:G68I>DCH L>I= E6I>:CIH 6GDJC9
'.!EG:K:CI>K:6C9IG:6IB:CIDEI>DCH,=:XC9>C<H
6G:G:A:K6CICDIDCAN>CI=:8DCI:MID;I=:'.!K68
8>C6I>DC EGD<G6BB: >C +DJI= ;G>86 L=>8= =6H A6G<:AN
7::CH86A:9768@6II>B:D;LG>I>C<7JI;DGK688>C6I>DC
EGD<G6BB:H BDG: 7GD69AN >C L=>8= I=: GDA:D; /H
L>AA8DCI>CJ:IDG:B6>C7DI=8:CIG6A6C98G>I>86AID6C:;
;:8I>K:EJ7A>8=:6AI=G:HEDCH:
Methods
,=>HHIJ9NL6HE6GID;6A6G<:GB>M:9B:I=D9HHIJ9N8DC
9J8I:9 7:IL::C I=: I= D; "JAN 6C9 I=: I= D; '8ID
7:GI=6I6>B:9ID>CK:HI><6I:G:6HDCH;DG /K68
8>C:688:EI6C8:6C9=:H>I6C8N>C+DJI=;G>86:I6>AHD;
I=:A6G<:GHIJ9N 6G: 6K6>A67A: :AH:L=:G:6I6;DGI=>H
HIJ9N L:G: 9G6LC ;GDB 6 L:776H:9 FJ6CI>I6I>K: HJG
K:NL=>8=:MEADG:9 /7:A>:;H6C96II>IJ9:H67DJIK68
8>C:H E:GHE:8I>K:H DC E6I>:CIH 7:>C< K688>C6I:9 K>:LH
6C9JH: D;8DBEA:B:CI6GN6C96AI:GC6I>K: B:9>8>C:;DG
'.! 6C9 E6I>:CII6G<:I:9 8DBBJC>86I>DC ,=:H:
96I6 L:G: 6J<B:CI:9 7N FJ6A>I6I>K: 96I6 8DAA:8I:9
I=GDJ<= 6 H:G>:H D; K>GIJ6A DCA>C: >C9:EI= >CI:GK>:LH
!!H L>I= E6GI>8>E6CIH L=D 8DBEA:I:9 I=: HJGK:N 6C9
>C9>86I:9 L>AA>C<C:HH ID E6GI>8>E6I: ,=: DJC96I>DC ;DG
(GD;:HH>DC6A:K:ADEB:CISH ( 96I676H:L6HJH:9ID
G:8GJ>I /H ,=: ( >H6 EG>K6I: =><=:G:9J86I>DC>C
Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base
4:9-+7.(&3*&19-*;.*<
HI>IJI>DC I=6I EGDK>9:H IG6>C>C< ID /H 6C9 L>I= E:G
B>HH>DCG:8DG9HI=:>G9:I6>AH>CI=:96I676H: AA /H
L=DL:G:E6GID;I=:(96I676H:L:G:>CK>I:9I=GDJ<=
:B6>A 6C9 HD8>6A B:9>6 EA6I;DGBH ID E6GI>8>E6I: >C I=:
HJGK:N6C9 6AAI=:HIJ9NE6GI>8>E6CIH L:G: H:A;9:8A6G:9
/H IDI6AD; /HE6GI>8>E6I:9>CI=: ;JAAHJG
K:N'CANHIJ9NE6GI>8>E6CIHG6C9DB>H:9ID6CHL:GI=:
ILDH:8I>DCH+:8I>DCH 6C9  8DCI6>C>C< FJ:HI>DCH DC
/ L>AA>C<C:HH ID EGDBDI: K688>C:H ID E6I>:CIH 6C9
E6GI>8>E6CIH L=D L:G: >C 9>G:8I 8DCI68I L>I= E6I>:CIH
L:G:>C8AJ9:9>CI=:XC6A6C6ANH>HL=>8=>C8AJ9:96IDI6A
D;E6GI>8>E6CIH
,=: HJGK:N L6H 9>K>9:9 >CID ILD E6GIH ,=: XGHI E6GI
>C8AJ9:99:BD<G6E=>8>C;DGB6I>DC6C996I6DCK688>C6
I>DC 7:=6K>DJG 6C9 L6H 8DBEA:I:9 7N 6AA E6GI>8>E6CIH
,=: H:8DC9 E6GI L6H 9>K>9:9 >CID XK: H:8I>DCH (6GI>8>
E6CIH L:G: G6C9DBAN 6HH><C:9 ID 8DBEA:I: DC: D; I=:
XK:H:8I>DCH ID9:8G:6H:I=: I>B:>ILDJA9 I6@:I=:BID
8DBEA:I:I=:HJGK:N6C9 ID :CHJG: =><= G:HEDCH: G6I:H
6C97:II:G96I6FJ6A>IN,=:;JAAHIJ9N9:H><C6ADC<L>I=
G:8GJ>IB:CI 6C9 96I68DAA:8I>DC 9:I6>AH =6H 7::C 9:
H8G>7:9:AH:L=:G:,=>H 8=6EI:G EG:H:CIH 6C6ANH:H JH
>C<K6G>67A:H;GDBILDD;I=:H:H:8I>DCH;D8JH>C<DC /
L>AA>C<C:HHIDEGDBDI:K688>C:HID;G>:C9H;6B>AN6C9E6
I>:CIH
+:8I>DC :MEADG:9;68IDGH>CYJ:C8>C< K688>C6I>DC9:
8>H>DC6C9<:C:G6A6II>IJ9:HIDL6G9HK688>C6I>DC+:8I>DC
 8DK:G:9 E:G8:>K:9 '.! K688>C: 7:C:XIH 7DI=
HE:8>X86C9<:C:G6A+:8I>DC>C8AJ9:9FJ:HI>DCHDCE:G
8:>K:9 K688>C: H6;:IN :Z868N 6C9 E:G8:>K:9 G>H@ ,=:
EG:H:CI8=6EI:GG:EDGIHDC /L>AA>C<C:HHIDEGDBDI:
K688>C:HID;G>:C9H;6B>AN6C9E6I>:CIHL=>8=L6HDCAN
6H@:9>C+:8I>DCH6C999>I>DC6AAN+:8I>DC>C8AJ9:9
FJ:HI>DCH DC '.! K688>C: >C;DGB6I>DC 6BDC<
/H 6C9 H@>AAH ID :C67A: :C<6<:B:CI L>I= E6I>:CIH
+:8I>DC >C8AJ9:9 FJ:HI>DCHDCJH>C<6C9 G:8DBB:C9
>C< 6AI:GC6I>K: B:9>8>C:H ;DG EG:K:CI>DC 6C9DG IG:6I
B:CID;'.! >C8AJ9>C< T 6K:NDJJH:96AI:GC6I>K:
B:9>8>C:H ;DG EG:K:CI>DC 6C9DG IG:6IB:CI D;
'.!U 6C9 T 6K: NDJ G:8DBB:C9:9 6AI:GC6I>K:
B:9>8>C:H ;DG EG:K:CI>DC 6C9DG IG:6IB:CI D;
'.!U
,=:EG>B6GNDJI8DB:B:6HJG:L6H67>C6GNK6G>67A:
;DG L=:I=:G DG CDI E6GI>8>E6CIH LDJA9 G:8DBB:C9 K68
8>C6I>DC,LD HJGK:N>I:BHL:G:JH:9 ID8G:6I:I=:DJI
8DB:K6G>67A:,=: XGHI >I:BL6H;GDB+:8I>DC  (6G
I>8>E6CIHL:G:6H@:9ID>C9>86I:I=:9:<G::IDL=>8=I=:N
6<G::9 L>I= I=: ;DAADL>C< HI6I:B:CI T! LDJA9 CDI G:8
DBB:C9 I=: '.! K688>C: ID BN E6I>:CIH ;6B>AN
6C9;G>:C9H7:86JH:!6B8DC8:GC:9 67DJII=:H6;:IND;
I=:K688>C:U*:HEDCH:HL:G:<>K:CDC6;DJGED>CI$>@:GI
H86A:RHIGDC<AN 9>H6<G::S R9>H6<G::SR6<G::S6C9RHIGDC<AN
6<G::SR+IGDC<AN9>H6<G::S6C9R9>H6<G::SL:G:8DB7>C:9
6H RG:8DBB:C9S L=>A: R6<G::S 6C9 RHIGDC<AN 6<G::S L:G:
8DB7>C:9 6H RCDI G:8DBB:C9S ,=: H:8DC9 >I:B L6H
;GDB +:8I>DC  D; I=: HJGK:N (6GI>8>E6CIH L:G: 6H@:9
T/DJA9NDJG:8DBB:C9'.!K688>C6I>DCID:A><>7A:
E6I>:CIHU ,=>H L6H 86EIJG:9 6H RCDS RN:HS 6C9 RJCHJG:S
*:HEDCH:H<>K:C6H RCDS 6C9 RJCHJG:S L:G: 8DB7>C:9 6H
RCDIG:8DBB:C9SL=>A:RN:HSL6HRG:8DBB:C9S
7>C6GNK6G>67A:L6H8G:6I:9;DG8DBEDH>I:'.!
K688>C:@CDLA:9<: (6GI>8>E6CIHL:G:6H@:9XK:FJ:H
I>DCH67DJII=:>G'.! K688>C: @CDLA:9<: TD NDJ
=6K::CDJ<= >C;DGB6I>DC 67DJI=DL'.! K688>C:H
LDG@UTDNDJ=6K::CDJ<= >C;DGB6I>DC67DJI=DL:;
;:8I>K:'.!K688>C:H6G:UTDNDJ=6K::CDJ<=>C
;DGB6I>DC67DJI=DLH6;:'.! K688>C:H 6G:U TD
NDJ=6K::CDJ<= >C;DGB6I>DC 67DJI '.! K688>C:HS
H>9::W:8IHU 6C9 TD NDJ =6K: :CDJ<= >C;DGB6I>DC
67DJI=DLIDJH:'.!K688>C:HUAAFJ:HI>DCHL:G:
86EIJG:96HRCDSRN:HSDGRJCHJG:S*:HEDCH:H<>K:C6HRCDS
6C9RJCHJG:SL:G:8DB7>C:96HRCDI:CDJ<=>C;DGB6I>DCS
L=>A:RN:HS L6H 86EIJG:9 6H R:CDJ<= >C;DGB6I>DCS,=:H:
XK: FJ:HI>DCH L:G: 8DB7>C:9 ID ;DGB 6C >C9:E:C9:CI
K6G>67A:L=>8=L6H8D9:9JH>C<67>C6GN6EEGD68=
,=G:: JC>K6G>6I: AD<>HI>86A G:<G:HH>DC BD9:AH L:G:
JH:9IDG:<G:HH9>W:G:CIB:6HJG:H6<6>CHII=:H6B:DJI
8DB: K6G>67A: !C I=: XGHI BD9:A I=: DJI8DB: K6G>67A:
L6H G:<G:HH:9 6<6>CHI 9:BD<G6E=>8 8=6G68I:G>HI>8H !C
I=:H:8DC9BD9:AI=:DJI8DB:K6G>67A:L6H G:<G:HH:9
6<6>CHIK688>C6I>DC HI6IJH6C96<6>CHIJH>C<6C9G:8DB
B:C9>C< 6AI:GC6I>K: B:9>8>C:H ;DG EG:K:CI>DC 6C9DG
IG:6IB:CID;'.!!CI=:I=>G9BD9:AI=: DJI8DB:
K6G>67A: L6H G:<G:HH:9 6<6>CHI K688>C6I>DC HI6IJH 6C9
'.!K688>C:@CDLA:9<:6C9E:GHE:8I>K:H!C:K:GN
BD9:AI=: 6>BL6HID 9:I:GB>C:=DLH><C>X86CIAN:68=
B:6HJG: >CYJ:C8:9 L=:I=:G 6 E6GI>8>E6CI G:8DB
B:C9:9K688>C6I>DCDGCDI
!C 699>I>DC DC: BJAI>K6G>6I: AD<>HI>86A G:<G:HH>DC
BD9:AG:<G:HH:9 I=:DJI8DB:K6G>67A:6<6>CHII=: B:6
HJG:H I=6I :B:G<:9 6H H><C>X86CI >C I=: I=>G9 BD9:A
C6B:ANK688>C6I>DCHI6IJH6C9'.! K688>C: @CDLA
:9<: DCIGDA K6G>67A:H >C I=: BD9:A L:G: 6<: <:C9:G
G68:G:A><>DCC6I>DC6A>IN8=GDC>88DC9>I>DCHD88JE6I>DC
=:6AI=H:8IDG;68>A>IN6C9N:6GHLDG@:9
)J6A>I6I>K: 96I6 L:G: 8DAA:8I:9 ID ;JGI=:G :AJ8>96I:
E:GHE:8I>K:HDC /'.!K688>C:7:=6K>DJGH6C9
E6I>:CI >CI:G68I>DC H E6GI D; I=: HJGK:N E6GI>8>E6CIH
=69 I=: DEI>DC ID >C9>86I: I=:>G L>AA>C<C:HH ID 7: 8DC
I68I:9 ;DG 6 ;DAADLJE >CI:GK>:L *6C9DB H:A:8I>DC L6H
9DC:6BDC<I=DH:L=D>C9>86I:9HJ8=L>AA>C<C:HHJH>C<
I=:RG6C97:IL::CS;DGBJA6 >C %>8GDHD;I M8:A;DG!!H7N
K688>C6I>DCHI6IJH (6GI>8>E6CIHL:G:I=:C8DCI68I:9G:
8GJ>I:9 6C9 >CI:GK>:LH L:G: 9DC: L>I=  K688>C6I:9
6C9 JCK688>C6I:9 >CI:GK>:L::H !CI:GK>:LHL:G:8DC
9J8I:97N ILD 6JI=DGH(&6C9 7DI=:ME:G>:C8:9
G:H:6G8=:GHL>I=6768@<GDJC9 >C8DC9J8I>C< FJ6A>I6I>K:
G:H:6G8= 6C9 JH>C< >CI:GK>:L <J>9:H ,LD >CI:GK>:L
<J>9:HL:G: 9:K:ADE:9DC:;DGK688>C6I:96C96CDI=:G
;DGJCK688>C6I:9 /HL>I=DE:C:C9:9FJ:HI>DCH6C9
EGD7:HDCI=:;DAADL>C<>K688>C6I>DC7:=6K>DJG>>:M
E:G>:C8:H L>I= 69B>C>HI:G>C< K688>C:H >>> E:GHE:8I>K:H
DCI=:C6I>DC6AK688>C:EGD<G6BB:>KI=:K688>C:H6C9
=DL /H<6I=:G6C96EEG6>H:>C;DGB6I>DCHDJG8:H6C9
K E:GHE:8I>K:H DC :9J86I>DC6A G:HDJG8:H I=6I 86C 7:
JH:9IDHJEEDGI /H ,=: K>GIJ6A !!H L:G: 8DC9J8I:9
DC2DDB6C9L:G:B>CJI:H>C9JG6I>DC,=:2DDB
Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base
4:9-+7.(&3*&19-*;.*<
IG6CH8G>7>C< HD;IL6G: L6H JH:9 ID IG6CH8G>7: I=:
G:8DG9:9>CI:GK>:LH,=:IG6CH8G>EIH L:G: G:K>:L:9 6C9
:9>I:97N ILD G:H:6G8=>CI:GCH6C9 DC: 6JI=DG(&ID
:A>B>C6I: INED<G6E=>86A :GGDGH 6C9 H6K:9 DC %>8GDHD;I
/DG9K:GH>DC)J6A>I6I>K:96I6L:G:6C6ANH:9I=:
B6I>86AAN JH>C< 6C >C9J8I>K: 6EEGD68= 6H EG:H8G>7:9 7N
G6JC 6C9 A6G@: ,=: FJ6A>I6I>K: 96I6 L:G: I=:C IG>
6C<JA6I:9 L>I= I=: FJ6CI>I6I>K: 96I6 ID <6>C 9::E:G >C
H><=I>CID /:ME:G>:C8:HL>I= '.!K688>C:H6C9
E6I>:CI:C<6<:B:CI
Results
,67A: H=DLH I=: 9:BD<G6E=>8 8=6G68I:G>HI>8H D; I=:
H6BEA:H:K>9:CI>CI=:I67A:BDHID;I=: H6BEA:L6H
NDJC<:GI=6C N:6GH DA9  6C9  N:6GH DA9
%DG:I=6C=6A;I=: H6BEA: L6H ;:B6A: 
>9:CI>X:96H7A68@6C9+DJI=;G>86C,=:
B6?DG>IND; I=: H6BEA:9>9CDI=6K: 6 8=GDC>88DC9>I>DC
 ,=: B6>C D88JE6I>DC >C I=: H6BEA: L6H CJGH:
 L>I= 9D8IDGH 8DBEG>H>C<  D; I=: H6BEA:
(6GI>8>E6CIHL:G:BDHIANLDG@>C<>CI=:EJ7A>8DG
EG>K6I:  =:6AI= H:8IDGH 6C9 >C =DHE>I6AH 
6C98A>C>8H  %DHI D; I=: H6BEA:=69 LDG@:9 ;DG
DG BDG:N:6GH %DHID;I=: H6BEA:L:G:K68
8>C6I:9  6C9 LDJA9 G:8DBB:C9 K688>C6I>DC

,67A: EG:H:CIH I=: HIJ9NSH '.! K688>C: B:6
HJG:H D; >CI:G:HI H H::C >C I=: I67A:  D; E6GI>8
>E6CIH =69 JH:9 6AI:GC6I>K: B:9>86I>DC L>I= 6 H>B>A6G
EGDEDGI>DC  G:8DBB:C9>C< 6AI:GC6I>K: B:9>86
I>DCIDE6I>:CIH.>I6B>CH6C99>:I6GNHJEEA:B:CIHL:G:
I=:B6>C6AI:GC6I>K:IG:6IB:CIHJH:96C9G:8DB
B:C9:9%DHID;I=:H6BEA:>C9>86I:9I=6II=:N
LDJA9:C8DJG6<:EG:<C6CILDB:C6C98=>A9G:C
DK:GI=:6<:D;N:6GH ID<:IK688>C6I:9%DG:
I=6C=6A;I=:H6BEA:  ;:AI I=6I I=:N 9>9 CDI=6K:
:CDJ<=>C;DGB6I>DCDC'.!K688>C:H6C9G:
EDGI:9 C::9>C< <J>96C8: DC =DL ID :9J86I: I=:>G E6
I>:CIH67DJI'.!6C9I=:6K6>A67A:K688>C:H
,67A: EG:H:CIH I=: JC>K6G>6I: 6C6ANH>H D; I=: H6B
EA:SH 9:BD<G6E=>8 8=6G68I:G>HI>8H H G:Y:8I:9 L=>I:
/H L:G: A:HH A>@:AN ID G:8DBB:C9 K688>C6I>DC I=6C
7A68@ /H'* 3 !   4!C 699>I>DC
6AADI=:G /HHJ8=6HE=6GB68>HIH6AA>:9=:6AI=EGD;:H
H>DC6AHE:GHDC6AH:GK>8:LDG@:GHE6G6B:9>8H6C9DI=:G
=:6AI=EGD;:HH>DC6AH L:G:A:HHA>@:ANID G:8DBB:C9K68
8>C6I>DCI=6CCJGH: /H'*3!4
'I=:G ;68>A>I>:H >C8AJ9>C< <:C:G6A EG68I>I>DC:G EG68I>8:H
L:G:A:HHA>@:ANIDG:8DBB:C9K688>C6I>DCI=6C=DHE>I6AH
'*3!Q4
,67A:EG:H:CIHI=:JC>K6G>6I:6C6ANH>HD;K688>C6I>DC
HI6IJH6C9I=: JH: D; 6C9DG G:8DBB:C96I>DC D; 6AI:G
C6I>K: B:9>8>C:H H G:Y:8I:9 >C I=: I67A: K688>C6I:9
/H L:G: BDG: A>@:AN I=6C I=:>G JCK688>C6I:9 8DJC
I:GE6GIH ID G:8DBB:C9 K688>C6I>DC '* 3 !
4 /HL=D=69I=:BH:AK:HJH:96AI:GC6I>K:
B:9>8>C:H;DGEG:K:CI>DC6C9DGIG:6IB:CID;'.!
L:G: A:HH A>@:AN ID G:8DBB:C9 K688>C6I>DC I=6C I=DH:
L=D=69CDI9DC:HD'*3!4 /H
L=D =69 G:8DBB:C9:9 6AI:GC6I>K: B:9>8>C:H ;DG EG:
K:CI>DC6C9DGIG:6IB:CID;'.!L:G:A:HHA>@:ANID
G:8DBB:C9 K688>C6I>DC I=6C I=DH: L=D =69 CDI B69:
HJ8=G:8DBB:C96I>DCH'*3!4
,67A:EG:H:CIHI=:JC>K6G>6I:6C9BJAI>K6G>6I:6C6AN
H>H DC K688>C6I>DC HI6IJH '.! @CDLA:9<: 6C9
'.! E:GHE:8I>K:H H G:Y:8I:9 >C I=: I67A: K688>
C6I:9 /H L:G: BDG: A>@:AN I=6C I=:>G JCK688>C6I:9
8DJCI:GE6GIH ID G:8DBB:C9 K688>C6I>DC '* 3
! 4 /H L=D ;:AII=:N =69 :CDJ<=>C;DG
B6I>DCDC'.!K688>C:HL:G:BDG:A>@:ANIDG:8DB
B:C9 K688>C6I>DC I=6C /H L=D;:AI >CHJZ8>:CIAN >C
;DGB:9'*3!4
Qualitative results
,=:FJ6A>I6I>K:G:HJAIHEGDK>9:;JGI=:G>CH><=IH>CIDL=N
BDHI /H L>AA>C<AN 69B>C>HI:G:9 6C9 EGDBDI:9 K68
8>C:HL=>A:DI=:GH9>9 HDJC9:G9JG:HHDG;DJC9 >I8=6A
A:C<>C< 6H I=:N ;:AI >C69:FJ6I:AN HJEEDGI:9 ID 699G:HH
8DC8:GCHG6>H:97NE6I>:CIHJGI=:GI=:G:HJAIH9G6L6I
I:CI>DCIDI=:JH:6C9EGDBDI>DCD;6AI:GC6I>K:G:B:9>:H
6BDC<HDB: /H / C6GG6I>K:H >AAJHIG6I: =DLE:G
HDC6A7:A>:;H6II>IJ9:H 6C9 E:G8:EI>DCH >CYJ:C8:9I=:>G
:C<6<:B:CI L>I= E6I>:CIH DC I=: HJ7?:8I D; K688>C:H
,=G::I=:B:H:B:G<:9 ;GDB I=: 96I6 > / 7:A>:;>C
I=:K6AJ: D; K688>C:H6C9I=:>GEGDBDI>DC HIG6I:<>:H >>
8=6AA:C<:H;68>C< /H>C69B>C>HI:G>C< 6C9EGDBDI>C<
'.!K688>C6I>DC6C9>>>I=:G6I>DC6A:;DG /H9>H
8DJG6<>C< K688>C6I>DC 6C9 EGDBDI>C< 6AI:GC6I>K: B:9>
8>C:
HCW belief in the value of vaccines and
their promotion strategies
H 8DCXGB:9 >C I=: FJ6CI>I6I>K: 96I6 I=: B6?DG>IN D;
/H L:G: L>AA>C< IDG:8DBB:C9 K688>C6I>DCID ;6B>AN
B:B7:GH 6C9 E6I>:CIH 6C9 ;:AI 8DB;DGI67A: 699G:HH>C<
6CN8DC8:GCH G6>H:9I=>HL6HI=: 86H:6BDC<7DI=K68
8>C6I:96C9JCK688>C6I:9 /H /HL:G:6II=:8D6A
;68:D;I=>HE6C9:B>8D7H:GK>C<=><=BDG7>9>IN6C9BDG
I6A>ING6I:H+DB:E:G8:>K:9I=:6K6>A67>A>IND;K688>C:H6H
=6K>C<7GDJ<=I67DJI6H:68=6C<:QI=:ND7H:GK:96G:
9J8I>DC >C I=: CJB7:G D; 86H:H G:9J8:9 H:K:G>IN D; >AA
C:HH>C K688>C6I:9 E6I>:CIH >C G:A6I>DC ID I=DH:L=D G:
B6>C:9JCK688>C6I:96C9G:9J8:9BDGI6A>IN
#-&9 -&;**=5*7.*3(*) &3)-&;*8**3&3:2'*74+
5*451*9-&9<* -&;*;&((.3&9*)9-.309-*;&((.3*-&8
,.;*3:8.22:3.9><4:1)8&>.9-&87*&11>.2574;*).3
9*7284+ 5*451* ,*99.3, .3+*(9*)<.9-" !-* 3:2
'*74+5*451*<-4&7*;&((.3&9*)9-*>3*;*7*=5*7.*3(*
.9&,&.3;*3.+2&>'*>4:(4:1).9<&8/:89.39*7284+
&2.1) F:C 9-.309-*;&((.3* .87*&11>*D*(9.;* (
&JGH:;:B6A:K688>C6I:9
/H EG:H:CI:9 E:GHDC6A 688DJCIHD;I=: E:G8:>K:9
7:C:XIHD;I=:K688>C:
>-:8'&3)<&88.(0':98&.)94-.2&+9*7-*-&)7*
(4;*7*)>4: <4:1) -&;* '**32:(-<478* >4: 574'
Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base
4:9-+7.(&3*&19-*;.*<
,67A: :BD<G6E=>88=6G68I:G>HI>8HD;I=:HIJ9NH6BEA:
Measures n %
<:C 1DJC<:GI=6CN:6GHDA9  
N:6GHDA9  
N:6GHDA9DGDA9:G  
:C9:GC %6A:  
:B6A:  
*68:C A68@  
DADJG:9  
!C9>6C  
/=>I:  
*:A><>DCC =G>HI>6C  
%JHA>B  
J99=>HIDG >C9J  
;G>86C+E>G>IJ6A>IN  
'I=:G  
&6I>DC6A>INC +DJI=;G>86C  
&DC+DJI=;G>86C  
=GDC>88DC9>I>DCH6C &D  
1:H  
'88JE6I>DCC &JGH:  
D8IDG  
AADI=:G7  
:6AI=H:8IDGC (J7A>8  
(G>K6I:  
&'  
(J7A>86C9(G>K6I:  
'I=:G  
68>A>INC DHE>I6A  
A>C>8  
*:H>9:CI>6A6<:9DG9>H67>A>IN86G:  
'I=:G  
1:6GHLDG@:9C $:HHI=6C  
ID  
DGBDG:  
.688>C6I:9C &D  
1:H  
/DJA9G:8DBB:C9K688>C6I>DCC &D  
1:H  
6=GDC>88DC9>I>DCHL:G:9:XC:96HDC:DGBDG:D;I=:;DAADL>C<9>67:I:H=NE:GI:CH>DCG:HE>G6IDGN9>H:6H: !.DGDI=:G8=GDC>89>H:6H:H
7,=>H86I:<DGN>C8AJ9:9E=6GB68>HIH6AA>:9=:6AI=EGD;:HH>DC6AHE:GHDC6AH:GK>8:LDG@:GHE6G6B:9>8HDI=:G=:6AI=EGD;:HH>DC6AH6C9DI=:G
&'1><4:1)-&;**3)*):5'*.3,43&;*39.1&9473>;NDJ
=69CDI7::CK688>C6I:94'*(&:8*-* *3)*):5-&;
.3,'743(-.9.8 &3) 8&.)94-.2 A>4:7 '743(-.9.8.87*
1&9*)94143,9*72"B3)-*34<:3)*789&3)8&(
9:&11> 9-* '*3*E98 4+ -&;.3, 9-* ;&((.3* ( &JGH:
;:B6A:JCK688>C6I:9
Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base
4:9-+7.(&3*&19-*;.*<
,67A: '.!K688>C:B:6HJG:HD;>CI:G:HI
Measures n %
6HJH:96AI:GC6I>K:B:9>8>C:H;DGEG:K:CI>DC6C9DGIG:6IB:CID;
'.!C
&D  
1:H  
AI:GC6I>K:B:9>8>C:HJH:9C ;G>86CIG69>I>DC6A  
.>I6B>CH9>:I6GN
HJEEA:B:CIH
 
'I=:G6  
6HG:8DBB:C9:96AI:GC6I>K:B:9>8>C:H;DGEG:K:CI>DC6C9DGIG:6IB:CI
'.!C
&D  
1:H  
AI:GC6I>K:B:9>8>C:HG:8DBB:C9:9C ;G>86CIG69>I>DC6A  
.>I6B>CH9>:I6GN
HJEEA:B:CIH
 
'I=:G7  
/DJA9:C8DJG6<:EG:<C6CILDB:CID<:IK688>C6I:9C &D  
1:H  
/DJA9:C8DJG6<:8=>A9G:CDK:GI=:6<:D;N:6GHID<:IK688>C6I:9
C
&D  
1:H  
6H:CDJ<=>C;DGB6I>DC67DJI'.!K688>C:H8C &D  
1:H  
&::9H<J>96C8:DC=DLID:9J86I:E6I>:CIH67DJI'.!6C9I=:
6K6>A67A:K688>C:HC
&D  
1:H  
6,=>H86I:<DGN>C8AJ9:9=>C:H:=:G76AB:9>8>C:/:HI:GC=:G76AB:9>8>C:!K:GB:8I>C=ADGDFJ>C:6C9DI=:G
7,=>H86I:<DGN>C8AJ9:9=>C:H:=:G76AB:9>8>C:/:HI:GC=:G76AB:9>8>C:!K:GB:8I>C=ADGDFJ>C:6C9DI=:G
8,=:L6NI=>HHJBB6GNK6G>67A:L6H<:C:G6I:9>H9:H8G>7:9>CI=:%:I=D9HH:8I>DC
/HIGJHI:96AADE6I=>8B:9>8>C:6C97:A>:K:9>CI=:
7:C:XIHD;I=:6K6>A67A:K688>C:H
9@8&3 *;.)*3(*'&8*) E*1) 4+2*).(.3*:89 1.0* 2*).
(.3*.98*1+84>*8$4:034<9-**;.)*3(*.89-*7* $4:
3**) 9-* ;&((.3* ( 'I=:G / ;:B6A: K688>
C6I:9
/H =6K: =>HIDG>86AAN H::CI=: K6AJ:D; K688>C6I>DC
6C9 6EEA>:9 I=: H6B: EG>C8>EA:H ID I=: 6K6>A67A:
'.!K688>C:H
*7843&11>9-.30.9.8.25479&399-.309-&9&,&.3@2
&'*1.*;*7 84 -&;*9&0*3 9-* F:;&((.3*&33:&11> V 
&(9:&11>).)574249*9-*3'.!4;&((.3*&3)6:.9*
&(9.;*1>('I=:G /;:B6A:K688>C6I:9
/H >CI:G68I L>I= E6I>:CIH6C96G: I6H@:9 L>I=69
9G:HH>C<E6I>:CIFJ:G>:H /HG:EDGI:9=6K>C<ID6AA6N
E6I>:CI 8DC8:GCH G:A6I:9 ID I=: H6;:AN D; '.! K68
8>C:H /H L:AAK:GH:9 L>I= I=:EDI:CI>6A G>H@H D; I=:
K688>C:L:G:67A:ID:W:8I>K:AN8DBBJC>86I:I=::MI:CI
D;I=:G>H@9G6L>C<DCI=:>G8A>C>86AIG6>C>C<
3*4+9-*+*2&1*83H6>94A@2,4.3,94,*9&'144)(149
@29&0.3,-47243* 7*51&(*2*39 9-*7&5>B 4  <4:1)
7*8543)V<*11&243-47243*7*51&(*2*399-*7&5>
&3)-*7* &7* 9-* 89&98>4:@11-&;* & ,7*&9*7 (-&3(*4+
-&;.3,&9-742'48.837ADD98ADI4+7429-*-47243*7*
51&(*2*39.98*1+ &845548*)94 &;&((.3*( 'I=:G
/;:B6A:K688>C6I:9
.688>C6I:9 /H L:G: 6AHD 67A: ID H=6G: I=:>G E:G
HDC6A:ME:G>:C8:H6H6HIG6I:<NID6AA:K>6I:E6I>:CI;:6GH
)43@9<&39948:,&7 (4&9 &3>9-.3, 47 8*11 5*451* 1.*8
49*11 9-*2 2> *=5*7.*3(* 4+ 9-* ;&((.3*9-&940&>
<-*3 -&) 9-* ;&((.3*  431> -&) &-*&)&(-* &3) .9
1&89*)+479-7**)&>8V!-&9@8<-&9-&55*3*)942*84
*85*(.&11><.9-+&2.1>2*2'*78,499-*294;&((.3&9*
('I=:G /;:B6A:K688>C6I:9
+DB: /H 9>9CSI ;::AI=:K688>C: L6H C:8:HH6GN;DG
:K:GNDC:6C9G6I=:G;D8JH:9I=:>G:C:G<NDC8DCK>C8>C<
E6I>:CIH 6C9 ;6B>AN B:B7:GH 8DCH>9:G:9 ID 7: 6I =><=
G>H@ID<:IK688>C6I:9
)43493**)94'*;&((.3&9*)':9)4&,7**9-&99-48*
<-4 &7* &9 7.80 8-4:1) '* ;&((.3&9*) 9-* 5*451* <.9-
(4247'.).9.*8 C 1.0* 2> -:8'&3) .8 ->5*79*38.;* 84 
*3(4:7&,*) -.2 94 '* ;&((.3&9*) 3) 9-* *1)*71> 1.0*
2>249-*78-*@8&184'**3;&((.3&9*)'*(&:8*8-*-&)
" .3 9-* '*,.33.3, 4+   9-.30 9-48* &7* 9-*
5*451*<-4<4:1)8**&85*451*<-4&7*-.,-7.80&3)
<-4 3**) 94 '* ;&((.3&9*) ( &JGH: ;:B6A: JC
K688>C6I:9
Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base
4:9-+7.(&3*&19-*;.*<
,67A: -C>K6G>6I:6C6ANH>HDCI=:9:BD<G6E=>88=6G68I:G>HI>8HD;I=:HIJ9NH6BEA:
Measures Recommend n (%) Odds ratio [95% CI]a
<: 1DJC<:GI=6CN:6GHDA9  
N:6GHDA9  34
N:6GHDA9DGDA9:G  34
:C9:G %6A:  
:B6A:  34
*68: A68@  
DADJG:9  34
!C9>6C  34
/=>I:  34
*:A><>DC =G>HI>6C  
%JHA>B  34
J99=>HIDG >C9J  34
;G>86C+E>G>IJ6A>IN  34
'I=:G  34
&6I>DC6A>IN +DJI=;G>86C  
&DC+DJI=;G>86C  34
=GDC>88DC9>I>DCH7 &D  
1:H  34
'88JE6I>DC &JGH:  
D8IDG  34
AADI=:G8  34
:6AI=H:8IDG (J7A>8  
(G>K6I:  34
&'  34
(J7A>86C9(G>K6I:  34
'I=:G  34
68>A>IN DHE>I6A  
A>C>8  3Q4
*:H>9:CI>6A6<:9DG9>H67>A>IN86G:  3Q4
'I=:G  3Q4
1:6GHLDG@:9 $:HHI=6C  
  34
DGBDG:  34
6-C>K6G>6I:6C6ANH>H7>C6GNAD<>HI>86AG:<G:HH>DC
7=GDC>88DC9>I>DCHL:G:9:XC:96HDC:DGBDG:D;I=:;DAADL>C<9>67:I:H=NE:GI:CH>DCG:HE>G6IDGN9>H:6H: !.DGDI=:G8=GDC>89>H:6H:H
8,=>H86I:<DGN>C8AJ9:9E=6GB68>HIH6AA>:9=:6AI=EGD;:HH>DC6AHE:GHDC6AH:GK>8:LDG@:GHE6G6B:9>8HDI=:G=:6AI=EGD;:HH>DC6AH6C9DI=:G
Challenges facing HCWs in administering
and promoting COVID-19 vaccination
+DB: /H;:AI8DCY>8I:967DJI68I>K:ANEGDBDI>C<K68
8>C6I>DC7:86JH:>IL6H>C8DC<GJ:CIL>I= I=:>G E:GHDC6A
7:A>:;H
@2(43F.(9*)':9):9>'4:3) 42>5*7843&145.3.43
&'4:9 9-* 8:'/*(9 2&99*7  3472&11> 8-4;* &8.)*  )4
3498-&7*<.9-5&9.*398)43@9<&3994'*1&'*11*)9-&9
&22.81*&).3,9-*5:'1.()43@9)49-&9#-&9*;*7@;*
8-&7*)<.9- >4:)43@98-&7*<.9- 9-*5:'1.(*(&:8*
'*.3,.39-*548.9.439-&9&2.32&>E3).9574'1*2
&9.(&3)2&>'*(&11*).3946:*89.43&3)2&>'*7*
,&7)*)&82.81*&).3,9-*5:'1.((&JGH:B6A:JC
K688>C6I:9
Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base
4:9-+7.(&3*&19-*;.*<
,67A: -C>K6G>6I:6C6ANH>HDCG:8DBB:C9>C<K688>C6I>DC688DG9>C<I=:HIJ9NSH
'.!K688>C:B:6HJG:HD;>CI:G:HI
Measures Recommend
n (%)
Odds ratio
[95% CI]a
.688>C6I:9+:8I>DCDCAN &D  
1:H  3
4
6HJH:96AI:GC6I>K:B:9>8>C:H;DGEG:K:CI>DC6C9DGIG:6IB:CID;
'.!
&D  
1:H  34
6HG:8DBB:C9:96AI:GC6I>K:B:9>8>C:H;DGEG:K:CI>DC6C9DG
IG:6IB:CID;'.!
&D  
1:H  34
6-C>K6G>6I:6C6ANH>H7>C6GNAD<>HI>86AG:<G:HH>DC
,67A: -C>K6G>6I:6C9BJAI>K6G>6I:6C6ANH>HDC /K688>C6I>DCHI6IJH6C9'.!
K688>C:B:6HJG:HD;>CI:G:HI
Measures Recommend
n (%)
Odds ratio
[95% CI]a
Odds ratio
[95% CI]b
.688>C6I:9+:8I>DCDCAN &D   
1:H  3
4
3
4
6H:CDJ<=>C;DGB6I>DC67DJI'.!K688>C:H8 &D   
1:H  3
4
3
4
&::9H<J>96C8:DC=DLID:9J86I:E6I>:CIH67DJI
'.!6C9I=:6K6>A67A:K688>C:H
&D   
1:H  3
4

6-C>K6G>6I:6C6ANH>H7>C6GNAD<>HI>86AG:<G:HH>DC
7%JAI>K6G>6I:6C6ANH>H7>C6GNAD<>HI>86AG:<G:HH>DC
8,=:L6NI=>HHJBB6GNK6G>67A:L6H<:C:G6I:9>H9:H8G>7:9>CI=:%:I=D9H:8I>DC
(6GI>8>E6CIH G6>H:9 8DC8:GCH 67DJI CDI =6K>C< HJZ
8>:CI>C;DGB6I>DCDGI=:67>A>INIDG:HEDC969:FJ6I:ANID
I=:FJ:HI>DCHEDH:9 7N E6I>:CIH +:K:G6A /H;:AII=6I
I=:>GDLC@CDLA:9<: 9:X8>I G:HJAI:9 >C I=:B HIGJ<<A>C<
ID C6K><6I: I=GDJ<= 8DCK:GH6I>DCH L>I= E6I>:CIH 67DJI
I=:'.!K688>C:H
2*&39-*7*@8&119-*8*3*<;&((.3*8&,&.3&3)9&10.3,
&'4:9(4;*7.3,9-*).D*7*39;&7.&398)43@9*;*3034<
.+3**)&349-*7'4489*78-49V.+)43@9034<.9+472>
8*1+9-*7*@834 <&>(&39*&(-.9 94&5&9.*39$*&-*8
5*(.&11><.9-9-*3*<*7:5)&9*8)*E3.9*1>)4349034<
*34:,- 94 '* &'1* 94 &)*6:&9*1> *):(&9* 5&9.*398 7*
,&7).3,9-.8(D8IDGB6A:K688>C6I:9
+:K:G6A E6GI>8>E6CIH :MEG:HH:9 ;GJHIG6I>DC G:<6G9>C<
I=:>GA68@D;688:HH>7A:>C;DGB6I>DCID699G:HHFJ:HI>DCH
G6>H:97NE6I>:CIH
!-*41)&,*-42*57*88:7.8*)*;*7>'4)>3IDK688>C6I:4
&3) & 149 4+ 5*451* ).)3@9 &80 '*+47*-&3) 9-*> (&2*
'&(0 1&9*7 &3) 8&.) A#-&9@8 -&55*3.3, 94 2*BV 4
9-*7*<&8& 149 4+ +7:897&9.43 &74:3) 9-.8 <-41*9-.3,
<-*7* 9-*> 8&.) A#-> 8-4:1)  ;&((.3&9* .+  8.9 .3 2>
4G(*&3)&2349.3(439&(9<.9-2&3>5*451*/:89'*
(&:8*.9@8541.(>B 4 >*8 .9<&8).G(:1994 ,.;* 5745*7
&38<*78'*(&:8*.9).)3@92&0* 8*38* 94 2* *.9-*7C 
(&3@91.*!-.8.8<-4&2(&3@99*115*451*&8947>9-&9
(&3@98(.*39.E(&11>6:&1.+>(D8IDG;:B6A:JCK68
8>C6I:9
+:K:G6A /H6AHD9:H8G>7:9=DLI=:ND;I:C=69H>B
>A6G FJ:HI>DCH 6C9 8DC8:GCH 6H I=: EJ7A>8 67DJI I=:
'.!K688>C:H
C844';.4:81>'*(&:8*@2<470.3,+479-*(425&3> 
&1843**)94249.;&9*5*451*94)4;&((.3&9.43 42489
4+4:75&9.*398<-*3)49-*(&119-*>&80.+9-*;&((.3*
.8&557457.&9*&184-&;*9-48*6:*89.438('I=:G
/;:B6A:JCK688>C6I:9
Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base
4:9-+7.(&3*&19-*;.*<
Rationale for HCWs discouraging
vaccination and promoting alternative
medicine
+DB: /H 9>H8DJG6<:9 E6I>:CIH ;GDB <:II>C< K688>
C6I:9 76H:9 DC E:G8:>K:9 8A>C>86A 6C9 6C:89DI6A :K>
9:C8:HJ<<:HI>C<=6GB;JA:W:8IHD;I=:K688>C:
4-&;*3@99&0*3.9&3)@29*11.3,*;*7>5&9.*39(42.3,
.3-*7*9-*> 8-4:1) 349 9&0* .9&3)9-*3 8-4< 9-*2
&112>(&8*8-4<2&3>89740*89-*7*<*7*)*&9-89-*7*
<*7* &11 9-* 8.)**D*(98 &3) @2 8:7* 9-*> &7* (43
;.3(*) 9*11 9-*2478-4< 9-*2 @;*,49842*&79.(1*8
&3)*;*3842*1.991*$4:!:'*(1.58/:8989&9.3,9-*4';.
4:8&3)8-4<9-*2&112>89&9.89.(8
Interviewer: 4 >4: )43@9 7*(422*3) 94 5&9.*398 47
&3>43*94,*9;&((.3&9*)
*;*7 3 9-* '*,.33.3,  <&8 -*8.9&39 -*8.9&9.3, '*
(&:8*<&83@98:7*<-*9-*79-*;&((.3*<&8247*'*3*
E(.&19-&3-&72+:1':9&89.2*574,7*88*)(&3(1*&71>
8**<.9-2>4<3*>*8&3)7*&)+742&114;*79-*<471)
9-*;&((.3*.8 349-*15+:1&3).9@8349'*3*E(.&1!-*7*@8
34'*3*E9 .9@8247*-&72+:19-&3'*3*E(.&1 (D8
IDGB6A:JCK688>C6I:9
B>CDG>IND; /H69KD86I:9;DG6AI:GC6I>K:EG:K:C
I>DC6C9IG:6IB:CIH+DB: /H A:6C:9 IDL6G9H IG:6I
B:CIG6I=:GI=6CEG:K:CI>DC6C9 7:A>:K:9 I=6I B:9>86
I>DC6AG:69N:M>HI:9I=6ILDJA97:7:C:X8>6A;DG>C;:8I:9
E6I>:CIHDGI=6I8DJA97:JH:96HEGDE=NA6M>H
89&79*)5*451*.22*).&9*1>43;.9&2.3&3)?.3(&3)
9-48*'&8.(8:9@;*8**3&(9:&11>2&3>2&3>8.)**+
+*(98 /:89 <.9- ;.9&2.3  '*(&:8* .9@8 84 94=.( 43 >4:7
,&897.(1.3.3,V 49-&9<&8&'.94+&<477>%.3(<4708
<.9-&3> ;.7&1).8*&8*?.3( <47089)*E3.9*1> 2&0*8&
).D*7*3(*!-*5*451*<-4<*7*247*&97.805:943
.;*72*(9.3 &3) .9 2&)* &3 .3(7*).'1* ).D*7*3(*3)
8.3(*.;*72*(9.3 ,49 9-*4'*17.?*  9-.30.3 47
 +47 '*.3, 8:(- & 8&+* 2*).(.3* &+9*7 -4< 2&3>
2.11.43)48&,*89@8&<43)*7+:1&39.5&7&8.9.(&8<*11'>
9-*<&>@2&(9:&11>;*7>8&)9-&99-*>89455*).9(
D8IDG;:B6A:JCK688>C6I:9
+DB: /H;:AIHIGDC<AN67DJII=:JH:D;>K:GB:8I>C
6L>9:ANJH:96CI>E6G6H>I>8B:9>8>C:L>I=@CDLC6CI>K>G6A
6C9 6CI>>CY6BB6IDGN EGDE:GI>:H ID IG:6I '.!
,=:N :MEG:HH:9 6 8A:6G HI6C8: I=6I I=: <DK:GCB:CI
H=DJA9CDI=6K:EGD=>7>I:9 /H;GDBEG:H8G>7>C<>I
!-* 4:9-+7.(&3,4;*732*39)4*8349<&39:894:8*
.;*72*(9.3(7&?>!-&9)7:,-&8&4'*17.?*&99&(-*)
94.9.9@8'**3:8*)8&+*1>V9-*>)43@9<&39:894:8*.9
9-*><&39 :8 94:8*;*7> *=5*38.;*)7:,8( D8IDG
B6A:JCK688>C6I:9
Discussion
,=>HHIJ9NJC9:GIDD@6C6I>DC6A8GDHHH:8I>DC6AHJGK:ND;
+DJI=;G>86C /L>AA>C<C:HHIDG:8DBB:C9'.!
K688>C6I>DCID E6I>:CIH >C G:A6I>DCID I=:>G DLCK688>C6
I>DC7:=6K>DG JH:D;6AI:GC6I>K:B:9>8>C:6C96K6>A67>A
>IND;>C;DGB6I>DC-H>C<FJ6A>I6I>K:96I66C:M6B>C6I>DC
L6H 9DC: D; / K>:LH DC K688>C:H INE:H D; :C<6<:
B:CIHL>I=E6I>:CIH6C9 I=:E:G8:>K:9K6AJ:D;6AI:GC6
I>K:G:B:9>:H
,=:G:HJAIHH=DL:9I=6I6=><=EGDEDGI>DCD;I=:
/H>CI=>HHIJ9N=697::CK688>C6I:9,=>H8DGG:A6I:9
L>I=I=:B6?DG>INL=D>C9>86I:9I=6II=:NL:G:L>AA
>C< ID G:8DBB:C9 K688>C6I>DC ID E6I>:CIH ;6B>AN 6C9
;G>:C9H ,=: 96I6 HJ<<:HI I=6I I=:G: L6H 6 ADL:G EGD
EDGI>DCD; /HL>AA>C<IDG:8DBB:C9K688>C:HIDEG:<
C6CI LDB:C  6C9 8=>A9G:C  ,=:H: XC9>C<H
6ZGB G:HJAIH ;GDB 6C !I6A>6C HIJ9N DC L=:I=:G /H
LDJA9G:8DBB:C9K688>C6I>DCIDI=:>GE6I>:CIH(6E>C>
:I6A;DJC9I=6IDCAN6HB6AAE:G8:CI6<:D;E6GI>8>E6CIH
 LDJA9 CDI G:8DBB:C9 I=: '.! K688>C: ID
I=:>GG:A6I>K:H6C9:K:C;:L:GE6GI>8>E6CIHLDJA9
CDI G:8DBB:C9 >I ID I=:>G E6I>:CIH H >C I=: !I6A>6C
HIJ9N I=: EG:H:CI HIJ9N ;DJC9 8DCH>HI:C8N 7:IL::C
/HSE:GHDC6AK688>C:7:=6K>DJG 6C9 I=:>G L>AA>C<C:HH
IDEGDBDI:K688>C6I>DCD;I=:H6BEA:L:G: JCK688>
C6I:96C9DCANL:G:CDIEG:E6G:9IDG:8DBB:C9
I=:K688>C: =><=:GEGDEDGI>DCD; JCK688>C6I:9 /H
8DBE6G:9L>I= I=:>GK688>C6I:98DAA:6<J:H L:G:JCL>AA
>C< ID EGDBDI: K688>C:H DL:K:G L>I=>C I=: JCK688>
C6I:9<GDJE HDB: HI>AA H6L I=:7:C:XI D; DG;:AI 9JIN
7DJC9IDG:8DBB:C9K688>C:HL>I=I=:FJ6A>I6I>K:96I6
G:K:6A>C< I=6I HDB: /H ;DJC9 K688>C:H E6GI>8JA6GAN
7:C:X8>6A ;DG E6I>:CIH >C =><=G>H@ <GDJEH ,=: G:HJAIH
D; I=: EG:H:CI HIJ9N 6ZGB 96I6 ;GDB DC: D; I=: ;:L
HIJ9>:H9DC:DC /:C<6<:B:CIL>I=E6I>:CIH6GDJC9
'.!K688>C:H L=>8=8DC8AJ9:9I=6I K688>C:=:H
>I6CI /H L:G: G:AJ8I6CI ID EGDBDI: K688>C:H 8>I>C<
;:6GD;>C9J8>C<E6I>:CI6CM>:I>:HDG8DBEA6>CIH
/>I= DCAN  D; I=: +DJI= ;G>86C 69JAI EDEJA6I>DC
K688>C6I:9 7N I=: :C9 D; "6CJ6GN  6C9 L>I= G:
H:6G8=HJ<<:HI>C<I=6I /HG:B6>C6IGJHI:9HDJG8:D;
>C;DGB6I>DC>C I=:>G 8DBBJC>I>:H‑ >I >H:K>9:CI I=6I
/H =6K: CDI 7::C69:FJ6I:AN :9J86I:9 6C9JI>A>H:9
>CI=:EGDBDI>DCD;K688>C6I>DC,=:A>I:G6IJG:=><=A><=IH
/HSE:GK6H>K: HJ7DEI>B6A @CDLA:9<: 6C98DBBJC>
86I>DC H@>AAH 6GDJC9 '.! K688>C6I>DC L=>8= =6H
C:<6I>K:AN>BE68I:9>CI:G68I>DCHL>I=E6I>:CIH6C9EDH
H>7AN 6W:8I:9 K688>C: JEI6@:/=>A: /H E6GI>8>E6I>C<
>CI=>HHIJ9N6EE:6G:9E:GHE>868>DJH6CJCB:I6EE:I>I:
;DG699>I>DC6AJEID96I:>C;DGB6I>DCG:B6>CH:HE:8>6AAN
<>K:C I=6I I=>H >H 6 G:A6I>K:AN CDK:A K>GJH G:HJAI>C< >C 6C
:KDAK>C<H:FJ:C8: D; K6G>6CIH6C9JC9:GHI6C9>C<H D; >IH
:W:8IH6C9:W:8I>K:6K6>A67A:IG:6IB:CI6C9EG:K:CI>DC
DEI>DCH,=:FJ6CI>I6I>K:G:HJAIHD;I=:EG:H:CIHIJ9NG:
K:6A:9 I=6I I=: B6?DG>IN D; E6GI>8>E6CIH  ;:AI I=6I
I=:N 9>9 CDI =6K: HJZ8>:CI @CDLA:9<: D; I=: 6K6>A67A:
'.! K688>C:H 6C9 6 H>B>A6G EGDEDGI>DC  G:
FJ>G:9 699>I>DC6A <J>96C8: DC =DL ID :9J86I: E6I>:CIH
67DJI '.! 6C9 I=: 6K6>A67A: K688>C:H JGI=:G
6C6ANH>H >C9>86I:H I=6I I=:H: ;68IDGH C:<6I>K:AN 6W:8I:9
/L>AA>C<C:HHIDEGDBDI:K688>C6I>DCIDE6I>:CIHK:C
;DG I=DH: /H L>AA>C< IDEGDBDI: K688>C6I>DC I=: G:
EDGI:9AN>C69:FJ6I:>C;DGB6I>DC6I I=:>G 9>HEDH6A B69:
I=:>GI6H@BDG:8=6AA:C<>C<,=>H>HCDIJC>FJ:L>I=DI=:G
HIJ9>:HG:EDGI>C<I=6I /H;DJC9>I 9>Z8JAI ID 9>H8JHH
Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base
4:9-+7.(&3*&19-*;.*<
K688>C:H@CDLA:9<:67ANL>I=E::GH6C9E6I>:CIH)J6A
>I6I>K:6C6ANH>H>CI=:EG:H:CIHIJ9NG:K:6A:9I=:7:C:XIH
D; =6K>C< /HL:AA K:GH:9 >CI=: G>H@ 6C97:C:XIH D;
K688>C:HG:HJAI>C<>C7:II:G8DBBJC>86I>DC6C967>A>INID
69:FJ6I:AN699G:HHE6I>:CIHSFJ:HI>DCH6C9;:6GH
,=>HHIJ9N;JGI=:GG:K:6A:9I=6I /HL=DE:GHDC6AAN
JH:9 6AI:GC6I>K: B:9>86I>DC ID IG:6I DG EG:K:CI
'.!L:G:A:HH>C8A>C:9IDEGDBDI:K688>C6I>DCJG
I=:GI=DH:G:8DBB:C9>C< 6AI:GC6I>K: 6EEGD68=:H L:G:
A:HHA>@:ANIDG:8DBB:C9K688>C:HHJ<<:HI>C<I=6I /H
6G:CDIC:8:HH6G>ANEGDBDI>C<6AI:GC6I>K: B:9>86I>DC ID
HJEEA:B:CI K688>C:H 7JI >C HDB: 86H:H I=:N 6G: EGD
BDI>C<>I6H6HJ7HI>IJI:,=>HHIJ9N96I6HJEEDGIHI=>H6H
H:GI>DCL>I=HDB: /H6G<J>C<;DGI=:7:C:XIHD;6AI:G
C6I>K:6EEGD68=:HHJ8=6HIG69>I>DC6A;G>86CB:9>86I>DC
K>I6B>CH6C9I=:G6E:JI>8HHJ8=6H>K:GB:8I>C,=:G:6G:
A>B>I:9HIJ9>:HDC /EG:H8G>EI>DC6C9EGDBDI>DCD;6A
I:GC6I>K: B:9>8>C: !C =>C6 H8>:CI>HIH 6C9 9D8IDGH >C>
I>6AAN G:8DBB:C9:9 JH>C< ,G69>I>DC6A =>C:H: %:9>8>C:
,% 6H 6 8JG: ;DG '.! JG>C< I=: +*+ :E>
9:B>8 ,% =69 G:EDGI:9AN 7::C :W:8I>K: >C I=: IG:6I
B:CI D; >C;:8I:9 E:DEA: 6C9 I=: =>C:H: DK:GCB:CI
DG9:G:9 I=: JH: D; ,% ID IG:6I '.! E6I>:CIH !I
L6H G:EDGI:9 I=6I 67DJI  D; '.! E6I>:CIH >C
=>C6G:8:>K:98DB7>C:9IG:6IB:CIL>I=,%6C9G:<J
A6GB:9>86I>DC,=>HHI6C8:>HCDIE6GD8=>6A6HI=:/DGA9
:6AI= 'G<6C>O6I>DC / 'L:A8DB:H >CCDK6I>DCH HJ8=
6HIG69>I>DC6AB:9>8>C:G:EJGEDH:99GJ<H6C99:K:ADE
B:CI D; C:L I=:G6E>:H ;G>86 6C9 HDB: E6GIH D; H>6
=6K:6ADC<=>HIDGND;JH>C<IG69>I>DC6AB:9>8>C:6C9I=:
/ ' G:8D<C>H:H I=:B6CN 7:C:XIH D; IG69>I>DC6A B:9
>8>C:H !C 699>I>DC I=: :B:G<:C8: D; 8DCY>8I>C< EJ7
A>H=:9 G:HJAIH DC HDB: EGDEDH:9 I=:G6E:JI>8 6AI:GC6
I>K:H >C8AJ9>C< >K:GB:8I>C =6H 699:9 ID 8DC;JH>DC
HJGGDJC9>C<K>67A:I=:G6E:JI>86AI:GC6I>K:H,=>HA:9
IDHJEEDGI;DGI=:9GJ<68GDHHHD8>6AB:9>66C97NHDB:
DG<6C>H6I>DCH ,=>H L6H E>8@:9 JE 7N /H 6C9 I=:
EJ7A>8>C8AJ9>C< >C +DJI=;G>86L>I=HDB: 6CI>K6MM:GH
:MIDAA>C<I=:7:C:XIHD;>K:GB:8I>CHIJ9N>C!C9>6:M
EADG:9@CDLA:9<:6C9EG68I>8:H 6GDJC9 >K:GB:8I>C 6H 6
EDI:CI>6A EG::MEDHJG: EGDE=NA6M>H (G( ,=:N ;DJC9
I=6I I=: B6?DG>IN  D; I=: H6BEA: D; /H 7:
A>:K:9 I=6I >K:GB:8I>C L6H EGDI:8I>K: 6<6>CHI '.!
L=>A:BDG:I=6C=6A;D;I=:H6BEA:JH:9DGG:8
DBB:C9:9 I=: 9GJ< /=>A: 69KD868N ;DG >K:GB:8I>C
6C9 DI=:G 6AI:GC6I>K: B:9>8>C: 6BDC< I=>H H6BEA: L6H
HB6AA>IHJ<<:HIH6A68@D;8A:6GB:HH6<>C<6ZGB>C<I=:
C::9ID>BEGDK:>CHI>IJI>DC6A8DBBJC>86I>DC699G:HH:9
ID /H ID :C=6C8: I=:>G GDA: 6H K688>C6I>DC ;68>A>I6
IDGH
DG /H IDEGDBDI:K688>C:H:W:8I>K:ANIDI=:EJ7
A>8I=:NC::97DI=8JGG:CIH8>:CI>X8@CDLA:9<:6C98DB
BJC>86I>DCH@>AAH,=>HL6H6C98DCI>CJ:HID7:8=6AA:C<
>C<L>I=>C6C:B:G<:C8N8DCI:MI6C98DCI>CJ:HID:KDAK:
6H9>W:G:CIK6G>6CIHD;I=:K>GJH:B:G<:6C9BDG::Z86
8>DJHK688>C:H6C9I=:G6E:JI>8H7:8DB:6K6>A67A:,=:G:
G:B6>CCJB:GDJHHDJG8:HD;>C;DGB6I>DC6AAB69:BDG:
:6H>AN 688:HH>7A: I=GDJ<= >C8G:6H:9 JH: D; I=: >CI:GC:I
6C9 HD8>6A B:9>6 Q B6CN D; I=:H: HDJG8:H EGDK>9: >C
;DGB6I>K:6C9K6AJ67A:>C;DGB6I>DC7JIHDB:EGDE6<6I:
B>H>C;DGB6I>DC HDB:I>B:H E:GHJ6H>K:AN /H G:FJ>G:
IGJHI:9HDJG8:H D; >C;DGB6I>DCI=6I9:A>K:GJE96I:9 :K>
9:C8:76H:9B:HH6<:H I=6I6G::6H>ANJC9:GHIDD97N 6AA
869G:HD; /H,=:K6AJ:D; I=:EG:H:CI HIJ9N:MI:C9H
7:NDC9 I=: GDA: D; /H >C EGDBDI>C< '.! K68
8>C:H7JI6EEA>:HID C6I>DC6A>BBJC>H6I>DCEGD<G6BB:H
BDG: 7GD69AN (6I>:CIH 6G: A>@:AN ID FJ:HI>DC 7DI= I=:
7:C:XI 6C9 H6;:IN D;6K6>A67A: K688>C:H L>I= /H:M
E:8I:9 ID 8DBBJC>86I: G:A>67AN ;GDB 6 8A:6G :K>9:C8:
76H:
,=:XC9>C<HD;I=>HHIJ9N8DCIG>7JI:IDI=:;:LHIJ9>:H
ID 96I: I=6I =6K: :MEADG:9 / >CI:G68I>DCH L>I= E6
I>:CIH 6GDJC9 '.! K688>C:H +E:8>X86AAN I=:G: G:
B6>CH69:6GI=D;96I6DC />CI:G68I>DCHL>I=E6I>:CIH
DC I=: >HHJ: D; '.! K688>C:H >C I=: +DJI= ;G>86C
6C9 7GD69:G ;G>86C 8DCI:MI  HIG:C<I= D; I=: HIJ9N >H
I=6I>I:BEADN:9B>M:9 B:I=D9H JH>C< 7DI= FJ6A>I6I>K:
6C9 FJ6CI>I6I>K: 6EEGD68=:H ID ;JAAN 86EIJG: I=: ;DGB
6C98DCI:CI D; /:C<6<:B:CI L>I=E6I>:CIH>C +DJI=
;G>86
-H:D;6CJCG:HIG>8I:9H:A;69B>C>HI:G:9HJGK:NL6H6
A>B>I6I>DC6HI=:HJGK:N L6H 9:E:C9:CI DC / 688:HH
IDH:A:8I:9DCA>C:96I676H:H,=>HA>B>I6I>DCB6N=6K:>C
IGD9J8:9H:A:8I>DC 7>6H6C9A>B>I:9<:C:G6A>H67>A>IN JG
I=:G<:D<G6E=>86A 9>HIG>7JI>DC D; I=: HIJ9NE6GI>8>E6CIH
L6HCDI;68IDG:9 >CID I=: HJGK:N 6C9 L6HI=:G:;DG:CDI
@CDLC 6C9 >C9>K>9J6A >CI:GEG:I6I>DC D; I=: I:GB RE6
I>:CIHSB6N=6K:>CYJ:C8:9=DL /HG6I:9I=:>GL>AA>C<
C:HHIDEGDBDI:K688>C:H
Conclusions
,=>H HIJ9N >C9>86I:H I=6I E:GHDC6A K688>C: 7:=6K>DJG D;
/HA6G<:AN B>GGDG:9I=:>GL>AA>C<C:HHIDEGDBDI: K68
8>C6I>DC ID E6I>:CIH ,=>H >H EDH>I>K: <>K:C I=: =><= EGD
EDGI>DC D; /H L=D L:G: K688>C6I:9 6C9 L=D L:G:
HJ7H:FJ:CIAN L>AA>C< ID 6HHJB: I=: GDA: D; K688>C: 69
KD86I:H  A6G<: CJB7:G D; /H HI6I:9 I=6I I=:N 9>9
CDI=6K:HJZ8>:CI>C;DGB6I>DCDCI=:6K6>A67A:K688>C:H
8DCIG>7JI>C<IDI=:B6?DG>INL=D;:AII=6II=:NC::9:9G:
A>67A:<J>96C8:DC=DLID:9J86I:E6I>:CIH,=:96I6>C
9>86I: I=6I I=:H: ;68IDGH8DCIG>7JI:ID / L>AA>C<C:HH
ID EGDBDI: K688>C:H ID E6I>:CIH AI=DJ<= 6 B>CDG>IN
I=:HIJ9NG:K:6A:9 I=6I HDB: JCK688>C6I:9 /H L:G:
I6@>C<6C9G:8DBB:C9>C<6AI:GC6I>K:I=:G6E>:HEDHH>7AN
6 8DCH:FJ:C8: D; 6 A68@ D; 8A:6G 8DBEG:=:CH>7A: :K>
9:C8:76H:96C9G:A>67A:HDJG8:HD;K688>C:>C;DGB6I>DC
,=:G:;DG:>; /H6G:ID7:8DB:I=:;JA8GJBD;C6I>DC6A
K688>C6I>DC EGD<G6BB:H I=:N L>AA C::9 ID 7: EGDK>9:9
L>I= 8A:6G 8DCI:MIJ6A JEID96I: :K>9:C8:76H:9 >C;DG
B6I>DCID:C=6C8:7DI=LDG@YDL6C9E6I>:CI8DBBJC>
86I>DC
Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base
4:9-+7.(&3*&19-*;.*< 
Acknowledgments
JC9>C<,=:*!$$EGD?:8IL6HHJEEDGI:97NI=:D<6GIN
!CI:GC6I>DC6A :CIG: ! &6I>DC6A !CHI>IJI:H D; :6AI=
&! DBBDCJC9'Z8:D;+IG6I:<>8DDG9>C6I>DC';
X8:D;I=:>G:8IDG ''+&! 'Z8: D; !+ *:
H:6G8= 'Z8: D; I=: >G:8IDG '*&!  6C9 &6I>DC6A
!CHI>IJI: D; %:CI6A :6AI=&6I>DC6A !CHI>IJI:H D; :6AI=
&!% &! JC9:G6L6G9 CJB7:G,/JC9:G
I=: H8>:CI>X8 6G:6H D; !.!+ B:CI6A =:6AI= =:6AI=
EGD;:HH>DCH:9J86I>DC=:6AI=G:H:6G8=:I=>8H6C9=:6AI=
HNHI:BHG:H:6G8=,=:8DCI:CI>HHDA:ANI=:G:HEDCH>7>A>IN
D;I=:6JI=DGH6C99D:HCDIC:8:HH6G>ANG:EG:H:CII=:D;
X8>6AK>:LHD;I=:&! 
Con0icts of interests
DJ<A6H /6HH:C66G >H I=: =6>G D; I=: -C>K:GH>IN D;
#L62JAJ&6I6A >DB:9>86A *:H:6G8= I=>8H DBB>II::
*I=6I6EEGDK:9I=>HHIJ9N,=:8DCY>8ID;>CI:G:HI
L6H9:8A6G:9ID*6C9I=>H6EEA>86I>DCL6HB6C6<:9
>C9:E:C9:CIAN 7N 6 * :EJIN=6>G ,=: DI=:G 6J
I=DGH9:8A6G:CD8DCY>8ID;>CI:G:HI
77G:K>6I>DCH
Abbreviation Description
* >DB:9>86A*:H:6G8=I=>8H
DBB>II::
! 8DCX9:C8:>CI:GK6A
'.! 8DGDC6K>GJH9>H:6H:
'  :E6GIB:CID; :6AI=
( DJC96I>DC;DG(GD;:HH>DC6A
:K:ADEB:CI
/ =:6AI=86G:LDG@:G
!! >C9:EI=>CI:GK>:L
'* D99HG6I>D
(G( EG::MEDHJG:EGDE=NA6M>H
+*+ H:K:G:68JI:G:HE>G6IDGNHNC9GDB:
,% ,G69>I>DC6A=>C:H:%:9>8>C:
/ ' /DGA9 :6AI='G<6C>O6I>DC
,=>H>H6CDE:C688:HH6GI>8A:9>HIG>7JI:9JC9:GI=:I:GBHD;I=:G:6I>K:DBBDCHIIG>7JI>DC!CI:GC6I>DC6A$>
8:CH:1&.>:LI=>HA>8:CH:SHA:<6A9::96I=IIEH8G:6I>K:8DBBDCHDG<A>8:CH:H7NC86C9A:<6A8D9:
6I=IIEH8G:6I>K:8DBBDCHDG<A>8:CH:H7NC8A:<6A8D9:;DGBDG:>C;DGB6I>DC
Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base
4:9-+7.(&3*&19-*;.*< 
References
$>%$JD1/6IHDC*:I6A :6AI=86G:LDG@:GHS
 /H6II>IJ9:H6C9G:A6I:9;68IDGHIDL6G9H
'.!K688>C6I>DC6G6E>9HNHI:B6I>8G:K>:L
489,7&)*)(J7A>H=:9DCA>C:9D>
EDHI<G69B:9?
/6C<"">C<*$6>0:I6A88:EI6C8:D;
'.!K688>C6I>DC9JG>C<I=:'.!
E6C9:B>8>C=>C6"&((.3*89D>
K688>C:H
#LD@#'$>##/:>/!,6C</DC<+1+$::
++G:L:G:69NL=:C'.!K688>C:>H
6K6>A67A:+IJ9NDCCJGH:HSK688>C:=:H>I6C8N>C
DC<#DC<2*)=.;(J7A>H=:9DCA>C:9D>
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A+6C6X%+6AA6B%(HN8=DAD<>86A
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Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base
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Understanding COVID-19 Vaccine Hesitancy among Healthcare Workers in South Africa
Article
Full-text available
  • Feb 2023
Healthcare workers (HCWs) were the first population group offered coronavirus disease 2019 (COVID-19) vaccines in South Africa because they were considered to be at higher risk of infection and required protecting as they were a critical resource to the health system. In some contexts , vaccine uptake among HCWs has been slow, with several studies citing persistent concerns about vaccine safety and effectiveness. This study aimed to determine vaccine uptake among HCWs in South Africa whilst identifying what drives vaccine hesitancy among HCWs. We adopted a mul-timethod approach, utilising both a survey and in-depth interviews amongst a sample of HCWs in South Africa. In a sample of 7763 HCWS, 89% were vaccinated, with hesitancy highest among younger HCWs, males, and those working in the private sector. Among those who were hesitant, consistent with the literature, HCWs raised concerns about the safety and effectiveness of the vaccine. Examining this further, our data revealed that safety and effectiveness concerns were formed due to first-hand witnessing of patients presenting with side-effects, concern over perceived lack of scientific rigor in developing the vaccine, confidence in the body's immune system to stave off serious illness, and both a general lack of information and distrust in the available sources of information. This study, through discursive narratives, provides evidence elucidating what drives safety and effectiveness concerns raised by HCWs. These concerns will need to be addressed if HCWs are to effectively communicate and influence public behaviour. HCWs are key role players in the national COVID-19 vaccination programme, making it critical for this workforce to be well trained, knowledgeable, and confident if they are going to improve the uptake of vaccines among the general population in South Africa, which currently remains suboptimal.
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Strategic silences, eroded trust: The impact of divergent COVID-19 vaccine sentiments on healthcare workers' relations with peers and patients
Article
Full-text available
Background Polarized debates about Covid-19 vaccination and vaccine mandates for healthcare workers (HCWs) challenge Belgian HCWs ability to discuss Covid-19 vaccine sentiments with peers and patients. Although studies have identified drivers of HCWs vaccine hesitancy, they do not include effects of workplace interactions and have not addressed consequences beyond vaccine coverage. Methods Interviews and focus group discussions with 74 HCWs practicing in Belgium addressed Covid-19 vaccine sentiments and experiences of discussing vaccination with peers and patients. Results Most participating HCWs reported difficulties discussing Covid-19 vaccination with peers and patients. Unvaccinated HCWs often feared that expressing their vaccine sentiments might upset patients or peers and that they would be suspended. Consequently, they used social cues to evaluate others’ openness to vaccine-skeptical discourses and avoided discussing vaccines. Surprisingly, some vaccine-confident HCWs hid their vaccine sentiments to avoid peer and patient conflicts. Both vaccinated and unvaccinated HCWs observed that unvaccinated patients occasionally received suboptimal care. Suboptimal care was central in unvaccinated HCW unwillingness to express their vaccine sentiments to peers. Both vaccinated and unvaccinated HCWs described loss of trust and ruptured social relations with peers and patients holding divergent vaccine sentiments. Discussion Belgian HCW perceived Covid-19 vaccines as a risky discussion topic and engaged in “strategic silences” around vaccination to maintain functional work relationships and employment in health institutions. Loss of trust between HCW and peers or patients, along with suboptimal patient care based on vaccination status, threaten to weaken Belgium’s, and by implication, other health systems, and to catalyze preventable disease outbreaks.
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South African University Staff and Students’ Perspectives, Preferences, and Drivers of Hesitancy Regarding COVID-19 Vaccines: A Multi-Methods Study
Article
Full-text available
  • Aug 2022
COVID-19 vaccine hesitancy poses a threat to the success of vaccination programmes currently being implemented. Concerns regarding vaccine effectiveness and vaccine-related adverse events are potential barriers to vaccination; however, it remains unclear whether tailored messaging and vaccination programmes can influence uptake. Understanding the preferences of key groups, including students, could guide the implementation of youth-targeted COVID-19 vaccination programmes, ensuring optimal uptake. This study examined university staff and students’ perspectives, preferences, and drivers of hesitancy regarding COVID-19 vaccines. A multi-methods approach was used—an online convenience sample survey and discrete choice experiment (DCE)—targeting staff and students at the University of KwaZulu-Natal, South Africa. The survey and DCE were available for staff and students, and data were collected from 18 November to 24 December 2021. The survey captured demographic characteristics as well as attitudes and perspectives of COVID-19 and available vaccines using modified Likert rating questions adapted from previously used tools. The DCE was embedded within the survey tool and varied critical COVID-19 vaccine programme characteristics to calculate relative utilities (preferences) and determine trade-offs. A total of 1836 staff and students participated in the study (541 staff, 1262 students, 33 undisclosed). A total of 1145 (62%) respondents reported that they had been vaccinated against COVID-19. Vaccination against COVID-19 was less prevalent among students compared with staff (79% of staff vs. 57% of students). The vaccine’s effectiveness (22%), and its safety (21%), ranked as the two dominant reasons for not getting vaccinated. These concerns were also evident from the DCE, with staff and students being significantly influenced by vaccine effectiveness, with participants preferring highly effective vaccines (90% effective) as compared with those listed as being 70% or 50% effective (β = −3.72, 95% CI = −4.39 to −3.04); this characteristic had the strongest effect on preferences of any attribute. The frequency of vaccination doses was also found to have a significant effect on preferences with participants deriving less utility from choice alternatives requiring two initial vaccine doses compared with one dose (β = −1.00, 95% CI = −1.42 to −0.58) or annual boosters compared with none (β = −2.35, 95% CI = −2.85 to −1.86). Notably, an incentive of ZAR 350 (USD 23.28) did have a positive utility (β = 1.14, 95% CI = 0.76 to 1.53) as compared with no incentive. Given the slow take-up of vaccination among youth in South Africa, this study offers valuable insights into the factors that drive hesitancy among this population. Concerns have been raised around the safety and effectiveness of vaccines, although there remains a predilection for efficient services. Respondents were not enthusiastic about the prospect of having to take boosters, and this has played out in the roll-out data. Financial incentives may increase both the uptake of the initial dose of vaccines and see a more favourable response to subsequent boosters. Universities should consider tailored messaging regarding vaccine effectiveness and facilitate access to vaccines, to align services with the stated preferences of staff and students.
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COVID-19 vaccine hesitancy and anti-vaxxers - supporting healthcare workers to navigate the unvaccinated: Reflections from clinical practice
Article
Full-text available
An important step in preparation for the fourth COVID-19 wave is to provide healthcare workers (HCWs) with skills to facilitate behaviour change in vaccine-hesitant patients. Convincing members of the public who are vaccine hesitant rather than anti-vaxxers should be the focus of our efforts. Our experience is that vaccine-hesitant individuals and anti-vaxxers are generally distinct cohorts, with differing reasons for their vaccine reluctance. If we are to truly address hesitancy, we must take time to understand the reasons for an individual's hesitancy. Developing a conceptual framework and skills for HCWs during encounters with unvaccinated individuals will be important not only for shifting some to get vaccinated, but also to manage the complex emotions that HCWs will undoubtedly be forced to confront during the fourth wave.
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Healthcare Workers Attitudes, Practices and Sources of Information for COVID-19 Vaccination: An Italian National Survey
Article
Full-text available
Vaccination of healthcare workers (HCWs) is a crucial element to overcome the COVID-19 pandemic. The aim of this survey was to assess attitudes, sources of information and practices among Italian Healthcare workers (HCWs) in relation to COVID-19 vaccination. Methods: From 19 February to 23 April 2021, an anonymous voluntary questionnaire was sent to the mailing list of the main National Health Service structures. Data were collected through the SurveyMonkey platform. Results: A total of 2137 HCWs answered. Hesitancy towards COVID-19 vaccination was more frequent in females, in those with lower concern about COVID-19, and in nurses, auxiliary nurses (AN) and healthcare assistants. Hesitant professionals were more likely to not recommend vaccination to their patients or relatives, while a high concern about COVID-19 was related to an increased rate of recommendation to family members. HCWs were mostly in favor of mandatory vaccination (61.22%). Female sex, a lower education level, greater hesitancy and refusal to adhere to flu vaccination campaigns were predictors influencing the aversion to mandatory vaccination. All categories of HCWs referred mainly to institutional sources of information, while scientific literature was more used by professionals working in the northern regions of Italy and in infection control, infectious diseases, emergencies and critical areas. HCWs working in south-central regions, nurses, AN, healthcare technicians, administrators and HCWs with a lower education level were more likely to rely on internet, television, newspapers, and the opinions of family and friends. Conclusions: Communication in support of COVID-19 immunization campaigns should consider the differences between the various HCWs professional categories in order to efficiently reach all professionals, including the most hesitant ones.
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Assessing Knowledge, Attitude, and Practices towards Ivermectin Pre-exposure Prophylaxis for COVID-19 among Health Care Workers
Article
Full-text available
Background: Health care workers (HCWs) are more likely to be at high risk of SARS-CoV-2 infection due to their direct and/or indirect participation in treatment facilities. Here, we aimed to evaluate the knowledge, attitude, and practices of ivermectin pre-exposure prophylaxis (PEP) in HCWs. Materials and Methods: In this observational study HCWs who were directly/indirectly involved in the medication of COVID-19 patients were selected. The study questionnaire included demographic data; knowledge, attitudes, practices, and associated adverse drug reactions (ADR) after using ivermectin as pre-exposure prophylaxis in COVID-19. Results: The mean age of the selected 306 participants was 34.41 {±standard deviation 4.08}. 66.66% of the participants were men. 15.69% of individuals had co-morbidities. HCWs were about COVID-19, and 94.12% of people know the role of ivermectin as PEP. Additionally, 180 participants (58.82%) realized that ivermectin can cause adverse drug reactions (ADRs). 70.59% of the study-participants admitted that ivermectin has a protective effect on COVID-19, while 62.75% of the participants believed that the PEP benefits of using ivermectin outweigh the risks. 57.37% (n = 210) of HCW used ivermectin and completed the recommended medication process. Eighteen participants (8.57%) experienced adverse reactions and reported to the ADR monitoring center. Conclusion: 70.59% of the studied participants agreed that ivermectin has a protective effect on COVID-19, and 57.37% of the participants have taken ivermectin as PEP. However, 8.57% of the individuals reported ADR, but none of the participants were severe enough to discontinue the drug.
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Factors Influencing Australian Healthcare Workers’ COVID-19 Vaccine Intentions across Settings: A Cross-Sectional Survey
Article
Full-text available
  • Dec 2021
Healthcare workers’ COVID-19 vaccination coverage is important for staff and patient safety, workforce capacity and patient uptake. We aimed to identify COVID-19 vaccine intentions, factors associated with uptake and information needs for healthcare workers in Victoria, Australia. We administered a cross-sectional online survey to healthcare workers in hospitals, primary care and aged or disability care settings (12 February–26 March 2021). The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework informed survey design and framing of results. Binary regression results adjusted for demographics provide risk differences between those intending and not intending to accept a COVID-19 vaccine. In total, 3074 healthcare workers completed the survey. Primary care healthcare workers reported the highest intention to accept a COVID-19 vaccine (84%, 755/898), followed by hospital-based (77%, 1396/1811) and aged care workers (67%, 243/365). A higher proportion of aged care workers were concerned about passing COVID-19 to their patients compared to those working in primary care or hospitals. Only 25% felt they had sufficient information across five vaccine topics, but those with sufficient information had higher vaccine intentions. Approximately half thought vaccines should be mandated. Despite current high vaccine rates, our results remain relevant for booster programs and future vaccination rollouts.
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Health Care Providers’ Trusted Sources for Information About COVID-19 Vaccines: Mixed Methods Study
Article
Full-text available
  • Dec 2021
Background Information and opinions shared by health care providers can affect patient vaccination decisions, but little is known about who health care providers themselves trust for information in the context of new COVID-19 vaccines. Objective The purpose of this study is to investigate which sources of information about COVID-19 vaccines are trusted by health care providers and how they communicate this information to patients. Methods This mixed methods study involved a one-time, web-based survey of health care providers and qualitative interviews with a subset of survey respondents. Health care providers (physicians, advanced practice providers, pharmacists, nurses) were recruited from an integrated health system in Southern California using voluntary response sampling, with follow-up interviews with providers who either accepted or declined a COVID-19 vaccine. The outcome was the type of information sources that respondents reported trusting for information about COVID-19 vaccines. Bivariate tests were used to compare trusted information sources by provider type; thematic analysis was used to explore perspectives about vaccine information and communicating with patients about vaccines. ResultsThe survey was completed by 2948 providers, of whom 91% (n=2683) responded that they had received ≥1 dose of a COVID-19 vaccine. The most frequently trusted source of COVID-19 vaccine information was government agencies (n=2513, 84.2%); the least frequently trusted source was social media (n=691, 9.5%). More physicians trusted government agencies (n=1226, 93%) than nurses (n=927, 78%) or pharmacists (n=203, 78%; P
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Psychological Determinants of COVID-19 Vaccine Acceptance among Healthcare Workers in Kuwait: A Cross-Sectional Study Using the 5C and Vaccine Conspiracy Beliefs Scales
Article
Full-text available
  • Jun 2021
Acceptance of coronavirus disease 2019 (COVID-19) vaccination appears as a decisive factor necessary to control the ongoing pandemic. Healthcare workers (HCWs) are among the highest risk groups for infection. The current study aimed to evaluate COVID-19 vaccine acceptance among HCWs in Kuwait, with identification of the psychological determinants of COVID-19 vaccine hesitancy. The study was conducted using an online anonymous survey distributed between 18 March 2021 and 29 March 2021. The sampling strategy was convenience-based depending on chain-referral sampling. Psychological determinants of COVID-19 vaccine acceptance were assessed using the 5C subscales and the Vaccine Conspiracy Beliefs Scale (VCBS). The total number of study participants was 1019, with the largest group being physicians (28.7%), pharmacists (20.2%), dentists (16.7%), and nurses (12.5%). The overall rate for COVID-19 vaccine acceptance was 83.3%, with 9.0% who were not willing to accept vaccination and 7.7% who were unsure. The highest rate for COVID-19 vaccine acceptance was seen among dentists (91.2%) and physicians (90.4%), while the lowest rate was seen among nurses (70.1%; p < 0.001). A higher level of COVID-19 vaccine hesitancy was found among females, participants with a lower educational level, and HCWs in the private sector. A preference for mRNA vaccine technology and Pfizer-BioNTech COVID-19 vaccine was found among the majority of participants (62.6% and 69.7%, respectively). COVID-19 vaccine hesitancy was significantly linked to the embrace of vaccine conspiracy beliefs. The highest 5C psychological predictors of COVID-19 vaccine acceptance were high levels of collective responsibility and confidence, and lower levels of constraints and calculation. The VCBS and 5C subscales (except the calculation subscale) showed acceptable levels of predicting COVID-19 vaccine acceptance based on receiver operating characteristic analyses. The participants who depended on social media platforms, TV programs, and news releases as their main sources of knowledge about COVID-19 vaccines showed higher rates of COVID-19 vaccine hesitancy. An overall satisfactory level of COVID-19 vaccine acceptance was seen among HCWs in Kuwait, which was among the highest rates reported globally. However; higher levels of vaccine hesitancy were observed among certain groups (females, nurses and laboratory workers, HCWs in the private sector), which should be targeted with more focused awareness programs. HCWs in Kuwait can play a central role in educating their patients and the general public about the benefits of COVID-19 vaccination to halt the spread of SARS-CoV-2, considering the high rates of vaccine hesitancy observed among the general public in Kuwait and the Middle East.
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Healthcare workers' (HCWs) attitudes and related factors towards COVID-19 vaccination: A rapid systematic review
Article
  • Jun 2021
Herd immunity through vaccination is a key measure to control COVID-19 pandemic. However, vaccine hesitancy remains a public health threat, which is still common among healthcare workers (HCWs). This systematic review aimed to synthesise evidence on HCWs’ attitudes towards COVID-19 vaccination and analyse associated factors to provide information for vaccine policy development and practice. We searched PubMed, Embase, ScienceDirect, Web of Science and three Chinese databases for literature published on 12 February 2021. Two researchers screened the literature independently, and 13 studies were included in the systematic review. Vaccine acceptance varied widely and ranged from 27.7% to 77.3%. HCWs had positive attitudes towards future COVID-19 vaccines, while vaccine hesitancy was still common. Demographic variables such as men, older age and physicians were positive predictive factors. Women and nurses had more vaccine hesitancy. Previous influenza vaccination and self-perceived risk were facilitators. Concerns for safety, efficacy and effectiveness and distrust of the government were barriers. Influences of direct (COVID-19) patient care towards vaccination intention were less conclusive. Tailored communication strategies were needed to increase the uptake rate of COVID-19 vaccines among HCWs. More importantly, more data and information on the safety and efficacy of vaccines should be provided with transparency.
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