Structural and social factors affecting COVID-19 vaccine uptake among healthcare workers and older people in Uganda: A qualitative analysis.

The COVID-19 vaccine rollout programme in Uganda was launched in March 2021 for priority groups: Healthcare Workers (HCWs), older persons (≥50 years), and persons with chronic conditions. Misinformation, distrust in healthcare systems, and cultural beliefs, pose significant challenges to vaccine uptake. We describe the social and structural factors affecting the uptake of COVID-19 vaccines among HCWs and older people in Uganda. Between September and October 2021, we conducted 33 in-depth interviews with 25 HCWs aged 21-63 years from three hospitals in central Uganda and eight older people from Wakiso district. Participant selection was purposive, based on sex, occupation, education, cadre of HCWs and vaccination status. We explored participants' knowledge, beliefs, personal experiences, barriers, and facilitators to vaccine uptake as well as suggestions for future COVID-19 vaccine rollout. Interviews were audio-recorded, transcribed and translated into English, coded, and analysed by theme. Twenty-two of the 25 (88%) HCWs and 3 of the 8 (38%) older people had received at least one dose of the COVID-19 vaccine at the time of interview. The structural facilitating factors to vaccine uptake included access to correct information, fear of a risky work environment, and mandatory vaccination requirements especially for frontline HCWs. Age, chronic health conditions, and the fear of death were facilitating factors for older people. Misconceptions about COVID-19 vaccines and fear of side effects were common social barriers for both groups. Long distances to vaccination centres, vaccine stock-outs, and long queues at the vaccination centres were specific barriers for older people. The prerequisite of signing a consent form was a specific structural barrier for HCWs. Future roll out of new vaccines should have a comprehensive information dissemination strategy about the vaccines. Improved access to vaccines through community outreach, reliable vaccine supplies and addressing vaccine misinformation, may enhance COVID-19 vaccine uptake.