The findings of this study revealed that one in three healthcare workers did not take up COVID-19 vaccines despite their availability. This finding contrasts with that of Patrick et al. (2023), who reported that one in ten healthcare workers in Uganda were unwilling to receive the COVID-19 vaccine (30). The difference in findings may be attributed to differences in the study setting. Our study was conducted in an urban setting, while Patrick et al. conducted the study in a rural setting. It is also well known that vaccine non-uptake is context specific, varying from place to place, time to time and between populations (19). Two-thirds of healthcare workers in the Patrick et al. study were nurses, and most were low-cadre healthcare workers; similar studies have reported low rates of COVID-19 vaccine uptake among nurses (9, 31). Globally, healthcare workers were among the priority groups for COVID-19 vaccination due to their increased risk of exposure to infections, and since they are a trusted source of information, non-uptake could have impacted the overall uptake of the vaccines by the general population. Furthermore, studies have shown that COVID-19 vaccine hesitant healthcare workers are less likely to recommend a COVID-19 vaccine to their patients (32).
Young age was associated with non-uptake of the vaccines, a finding that has been reported by similar studies (8, 9). This finding is not surprising since higher morbidity and mortality rates due to COVID-19 have been reported among older patients (33, 34). While being young is associated with a low risk of severe COVID-19, non-uptake of vaccines among this age group should be addressed. A study by James et al. 2021 that explored the factors associated with COVID-19 severity in US children and adolescents reported that 20% of the children admitted to the hospital suffered from severe disease (35), and being black was associated with greater disease severity. Furthermore, young individuals are highly mobile and could contribute to increased transmission of the SARS-CoV-2 virus.
Access to vaccination services is a critical determinant of vaccine uptake. In this study, we found that working in a private health facility was associated with increased non-uptake of vaccines compared with working in healthy government facilities. In Uganda, the rollout of COVID-19 vaccination has been concentrated in government healthcare facilities. This inaccessibility to vaccination services could have led to higher non-uptake rates among HCWs in these facilities. Being a private HCW is also associated with stringent work schedules, and some HCWs (22.6%) reported not being able to leave their workplaces to go for vaccination. Inaccessibility to COVID-19 vaccines has been reported to be one of the barriers to COVID-19 vaccine uptake (36).
This study explored the effect of prior testing for coronavirus infection on vaccine uptake among HCWs. We found that HCWs who had never been tested for the coronavirus were less likely to take the vaccines than were the participants who had ever been tested. A study by Laura et al. (2023) reported that 96% of participants consumed a COVID-19 vaccine at least once, mostly after infection with the coronavirus (37). This difference in uptake could be due to differences in risk perceptions among HCWs. However, in our study, there was no relationship between the test results and the use of COVID-19 vaccines.
The study further revealed that healthcare workers who were not involved in COVID-19 vaccination-related activities were less likely to take up vaccines than those who were involved in vaccine-related healthcare. Healthcare workers who participate in vaccination services are trained about vaccines, which improves their understanding of vaccines, how they work and their safety, hence building confidence and trust in vaccination services. However, there is a paucity of data in this area; hence, further research is needed.
Using the 5C constructs (confidence, convenience, complacency, calculation, and collective responsibility model) of the determinants of vaccine uptake, we found that a lack of confidence in vaccines and an increased search for information were associated with the non-uptake of vaccines. Greater than 50% of the healthcare workers did not take up the vaccines due to safety concerns, increased vaccine production and concerns about side effects after vaccination. These concerns have also been reported by other studies as reasons for non-uptake of the vaccines (8, 30, 38, 39). Hence, vaccine confidence should be regularly monitored to detect new trends to prompt interventions to build and maintain vaccine confidence. More than two-thirds of the healthcare workers who never received the vaccines reported having read negative media about COVID-19 vaccines, needed more time to understand COVID-19 vaccines and weighed the benefits vs the risks before deciding to receive the vaccines. This is not surprising, as COVID-19 vaccines are associated with many myths and misconceptions (40). This indicates that information-seeking actions such as deciding to take the vaccine based on the sought or established reliable information were important determinants of vaccine uptake. Therefore, providing information that meets the expectations of the public is critical for one’s decision to vaccinate, specifically the trust that COVID‐19 vaccines are safe and effective.
This study is one of the few studies that has explored the reasons for non-uptake of COVID-19 vaccines among health care workers in sub-Saharan Africa. Information was collected during the peak of the epidemic, when the morbidity and mortality rates due to COVID-19 were highest. Therefore, the reasons for non-uptake would be most expressed during this time. Therefore, the findings of this study reflect true healthcare workers’ perceptions about COVID-19 vaccines. However, this study used convenience sampling; hence, the findings may not be generalizable to all healthcare workers. Only those HCWs who were on duty at the time of data collection were contacted and included in the study.