A vaccine against COVID-19 has been suggested as an effective strategy to end the pandemic [21, 22]. Despite this epidemiological knowledge, only few studies, especially in sub-Saharan Africa have explicitly investigated perceptions on vaccines and which vaccination approach would yield positive uptake. This contribution investigated the effects of vaccine health and safety perceptions on COVID-19 vaccine uptake in Ghana. Understanding people’s perceptions and preferences for COVID-19 vaccination could help guide public health policy measures on the vaccination rollout in the country.
Preliminary findings found evidence that 80.32% and 73.06% of participants believed that vaccines were healthy and safe, although 81.19% of the respondents were particularly concerned about the source of the vaccine. Other evidence revealed that 78.55% and 71.45% of respondents indicated their willingness for mandatory and voluntary COVID-19 vaccine uptake or shot respectively. These observed rates are comparable with other studies (i.e., ranging from 64.7–90.6%) [e.g 23, 24, 25, 26]. Current findings indicate that majority of the studied population are supportive of the COVID-19 vaccine in the country regardless of the uptake approach (either mandatory or voluntary). This pattern observed is not surprising because the study was conducted around the period (i.e., January-March 2021) when the number of COVID-19 cases in Ghana were on a steady rise, thus vaccines were seen as a key strategy to halt the escalation of the COVID19 pandemic. Overall, the observed figures suggest a positive attitude towards COVID-19 vaccination which could hinge on the highly reported pandemic impact across many societies and perceive benefits (e.g., reduce risk) the vaccines may bring.
Although majority of the studied sample will either take mandatory or voluntary COVID-19 vaccine shot, small proportions (i.e., 21.45% and 28.55%) were unwilling to take a vaccine shot, perhaps due to safety concerns or vaccine uncertainty. Additionally, two-thirds of the sample also had concern or uncertainty about the source of vaccines. This vaccine hesitancy and concern should be of public health interest because of the potential delays and/or outright refusal of vaccination across the population until the safety of vaccines is confirmed. Previous studies have often cited public concerns as a foremost barrier to vaccination decision making, especially for newly rollout vaccines which have not been ecologically tested [27, 28, 29, 30, 31, 32].
Across all the regression models, confidence or belief and safety of vaccines predicted mandatory and/ or voluntary COVID-19 vaccine uptake of the studied Ghanaian population. This finding supports previous studies on public belief or trust on the health and safety or efficacy in the COVID-19 vaccine as relevant factors that could increase COVID-19 vaccine uptake [e.g.,10, 33, 34, 35]. Current evidence suggests the significance of enhancing public trust and belief in COVID-19 vaccines and improving healthcare services to facilitate considerable vaccine uptake. This goal can be achieved through the use of trusted well-tailored messages on COVID‐19 and confidence‐building advocacy on identified vaccines through transparency and expectation management [36]. For example, Tam et al. [37] reiterated that worries about vaccines’ long term side effects, safety issues and public distrust can lead to vaccine hesitancy. Hence, considerable community level engagements or interactions on vaccine related concerns for appropriate feedback should be done to counteract misinformation and/or disinformation as well as other biases against impending vaccine rollout [34, 38, 39, 40]. According to Schwartz [40], when public trust or confidence associated with COVID-19 vaccination is weak, uptake programs are likely to suffer. Therefore, public messages on the vaccines’ safety and continuous monitoring as well as tackling of false information are crucial [38, 41, 42].
Increasing age, religion, and geographical zone increased the odds of COVID-19 vaccine mandatory uptake. This finding mirrors similar trends that identified older people to show more support for mandatory uptake compared to younger cohorts based on an established premise that case-fatality rates increase with age [10, 43]. Alternatively, high perceived vulnerability and/or susceptibility to disease infection often associated with increasing age could also account for the present finding [44].
Consistent with previous studies [e.g., 45, 46], self-reported religious affiliation was identified as significant factor in the determination of mandatory COVID-19 vaccination uptake in the current study. Specifically, Muslims were 1.6 times more likely to take a mandatory COVID-19 vaccine compared to Christians. The observed variation is not surprising because Christian religious concerns about immunization or vaccination date back to antiquity where some individuals prohibited Edward Jenner’s 1796 mode of smallpox vaccination as contrary to God’s will [47]. Some Christian denominations (e.g., Jehovah Witness) have a strong tradition of declining some health services like blood transfusion, including immunization on the concerns about their adverse effects similar to the happenings after smallpox vaccination during the 18th century. The basis for this objection by members of these denominations includes declining immunization instead of making members less dependent on God [48, 49, 50, 51]. The noted differences in the COVID-19 vaccine uptake between Muslim and Christian groups in the current study might not hinge on their religious beliefs, instead the variations may be reflections on safety and other health concerns [52].
Study participants from the middle zone (e.g., Ashanti, Brong-Ahafo, Western North Regions) of Ghana were 2.3 times more likely to take mandatory COVID-19 vaccine than their counterparts from the southern zone (e.g., Greater Accra, Eastern and Volta Regions). Geo-spatial metrics (e.g., population density) could possibly explain the current observation [53, 54]. Previous research has shown that vaccination rates may suffer amongst varied population groups, especially in areas of deprivation [55, 56, 57]. For example, individuals from less densely populated areas in the middle zone of the country might spend less time or waiting period for a vaccine uptake. Users are likely to perceive that uptake process as less stressful than respondents from highly densely populated areas such as Greater Accra, where access to healthcare services is often compounded by unfriendly and stressful population dynamics (e.g., long queues, huge traffic congestion, and long waiting hours). Additionally, respondents from geographical areas with readily available healthcare services and easily accessible facilities with considerable health logistical support (e.g., vaccination sites) are more likely to accept mandatory vaccine uptake compared to participants from other geographical boundaries with less endowed health infrastructure and logistics. Therefore, health inequities or disparities may restrict or negatively impact mandatory COVID-19 vaccine uptake [58, 59]. It is important that major stakeholders address these population dynamics and resources that might be instrumental in facilitating comprehensive vaccine uptake in the country.
Other findings show that Ghanaians who are married were 1.438 times more likely to take a voluntary COVID-19 vaccine shot compared to their single counterparts. Being married comes with more household interaction and connectedness. Hence, we speculate that those married might have additional responsibility of protecting the entire family due to high risk perception and would show more willingness or positive intention towards taking COVID-19 vaccine, though voluntarily. Previous research has cited social interaction and connectedness as important risk factors of COVID-19 infection [60, 61]. Raising continuous awareness about the risk of COVID-19 infection, especially among the unmarried population is essential towards reducing case fatality [35].
Counterintuitively, participants with tertiary education were 71% less likely to take a voluntary COVID-19 vaccine shot compared to their counterparts with no formal education. This finding demonstrates the complexity of infectious disease dynamics: an observation that overrides conventional standards in epidemiological assessment. Individuals’ risk perception may determine one’s intention to get vaccinated against COVID-19, with those perceiving a higher risk towards COVID-19 more likely to show the intention to voluntarily vaccinate against the virus. It is likely that sampled tertiary educated individuals might have less risk perception against the new virus, hence their intention to voluntarily vaccine is low. For individuals with no educational background, the new virus may create enormous psychological distress triggered by worrying concerns and fears that could heighten their voluntary intention to take a vaccine shot [62, 63, 64, 65]. The current finding also mirrors the risk as feelings model that confirms the role risk perception plays on judgement and decision making in health care for diseases of severe magnitude and uncertain outcome, demonstrating how one’s perceived risk might influence the decision to vaccinate [see 66, 67, 68]. Therefore, the general public ought to realize the severity of COVID-19, hence underestimating their risks of contracting the virus may prevent them from being vaccinated [69]. Current finding implies that considerable efforts ought to be targeted at those in the population with the highest severity [70]. Regular educational campaigns to promote COVID-19 vaccines should target personal risks to the disease through persuasive communication in the general population.
Strengths and Limitations
This is the first study to provide estimates on individual preferences relative to their predictors associated with COVID-19 vaccine uptake across a cross-section of the population in Ghana. Current findings advance theoretical knowledge by providing a better understanding in the context of COVID-19 health policies. Empirical evidence provided can aid stakeholders on which COVID-19 vaccination policy to implement. Despite these strengths, the present study has some limitations.
Preferences and/or intentions are hypothetical scenarios that vary from real life behaviors; consequently, it is likely that individual reactions to real life COVID-19 events might be stronger such that our current findings could be seen as conservative approximations [71, 72]. Additionally, it is also possible that the responses during the data collection were relative to time, with the possibility of change over patterns in intentions and subsequent action tendencies once the vaccines were made available [73]. For example, COVID-19 vaccine rollout had not begun at the time of the data collection (i.e., actual vaccine uptake was not measured), hence, respondents’ real sense of judgement on vaccine uptake might not be conditioned by the resolutions taken later on the vaccines. Finally, due to the self-reported nature of the study design, we cannot discount reporting biases. Since data were collected through an online survey via social media platforms, there is a possibility of biasness against those who had no access to social media, internet and those who could neither read nor write. These people are mostly married, uneducated, older and live in the country-side and parts of Northern sector of the country.
Practical Implications
Current evidence suggests that public belief or trust, uncertainties, health and safety issues as well as socio-cultural considerations surrounding COVID-19 vaccines should guide future rollout programs. Despite present results indicating respondents’ positive attitude towards vaccine rollout spectrum (i.e., more restrictive: compulsory mandates and less restrictive options: opt-in voluntarily), the current health emergency and the fluctuations in the epidemiological data (e.g., fatality and mortality metrics) leaves no room for low vaccine uptake. Based on observed findings, policies on vaccines in the country could provide a balance between the two different strategies for the administration of COVID-19 vaccines. Therefore, designed interventions and support mechanisms are required for vaccine uptake in Ghana. Vaccination campaigns in the country should be based on scientific evidence on the vaccine efficacy, safety, and side effects made available to the public. Regular education, appropriate information and communication should target health and safety concerns associated with COVID-19 vaccines. It is important that public trust and confidence are built through transparent and truthful communications on the vaccines. Developing vaccination initiatives through health technological interventions (e.g., providing regular telephone reminders, motivational text message reminders) and smart phone applications may consolidate and further boost positive vaccination behavior and improve vaccination rates in the country.