By Paul Bouanchaud, PSI Senior Research Advisor
In the past couple of weeks we have heard encouraging news from several studies suggesting that effective COVID–19 vaccines have been developed and will be available in certain markets in the near future. As these supply-side activities start to get going, we at PSI have also been thinking about demand-side barriers that may hinder COVID–19 vaccine uptake in the countries where we work.
Between April and May 2020, we conducted telephone interviews with 4193 people to understand what effect the pandemic is having on their lives. Between September and October 2020, we conducted follow-up interviews with 1371 people from within that original sample, to understand the pandemic’s ongoing impacts and effects. In the second round, we also specifically asked some questions about a potential COVID-19 vaccine. The sample consisted of people with mobile phone access, and therefore is not representative of the full Mozambique population. It is biased towards wealthy, urban residents.
Here are some of the things we learned:
While people are concerned about COVID-19, this does not translate into intention to take up the COVID-19 vaccine. There is a lot of work to be done to close the know-do gap. Just over a third of our respondents (37%) said that they would definitely be willing to take a COVID–19 vaccine if it were available. This leaves around two thirds of the people we spoke to with some degree of vaccine hesitancy: about half the sample say that they probably would, and around one in ten people say that they probably would not take the vaccine. Among those not likely to take the vaccine, around 70% cited concerns about its safety, and a further 20% about side effects, while just 2% said that they wouldn’t vaccinate because they are skeptical about the dangerousness of COVID–19. This is supported by other results from the study showing that across all provinces of the country, COVID–19 is the most commonly mentioned topic that people are concerned about, cited by 61% of people. This is followed by their income, and their health (26% and 22%, respectively). This suggests a gap exists between concerns about the pandemic and willingness to be vaccinated.
Intention to take up the COVID-19 vaccine varies by individual characteristics. We need to learn more about how to reach different groups, and tailor SBC messaging for them. When we dig a bit deeper into the data, we see that younger people are more skeptical than older people about a COVID-19 vaccine, with just 28% of those aged 18 to 24 saying they would definitely take the vaccine, compared with 51% of the over 45’s. A person’s level of education also seems to be related to their willingness to vaccinate – people who have completed their secondary schooling in Mozambique have are the least willing (32% saying they would definitely vaccinate), compared to 59% of those who did not complete primary school. These results largely mirror those in the US and UK, where age and education significantly predicted vaccine hesitancy in a recent study by LSHTM published as a pre-print, where people with higher educational attainment (below post-grad) and those in younger age groups were less likely to intend to vaccinate.
When we asked people how much they trust various sources of information, we found a similar pattern. In the Mozambique study as a whole, older ages tended to score all sources of information as being more trustworthy than their younger counterparts; people with lower levels of schooling also tended to trust information sources more than their better educated peers. These findings suggest that younger, better educated groups are both less trusting of information sources, and less likely to be willing to vaccinate.
The epidemic is experienced locally by consumers and programs must be responsive to changing perceptions regarding trusted communication channels. Who conveys messaging and how that messaging is conveyed should be tailored to communities and be adaptable over time. Looking at the different information sources separately, in Mozambique as a whole, while trust in doctors and journalists seems to have stayed fairly high and quite stable across the country between April and October, trust in other sources of information shows greater variability across provinces and through time. Trust in national and local government is higher in Manica, Sofala, and Gaza and lower in Maputo Cidade and Maputo Province than elsewhere. Small declines have been seen in Zambezia province, while small increases have been seen in Cabo Delgado between April and October this year.
While it is encouraging that older people, who are more at risk of serious complications and mortality from COVID–19, seem more certain about getting vaccinated, our results nevertheless pose some important questions for the successful roll out of any vaccination campaign. How can reliable information about vaccination be shared with people who are less likely to want to vaccinate, and already more skeptical about information trustworthiness? The provincial variability in trust in some sources also points to the need for a more diversified and segmented approach to any campaign in Mozambique.
While some reservations about safety are perhaps understandable in a novel vaccine, as more safety and efficacy data emerges for COVID-19 vaccines, a major task will be to ensure that this information is communicated through trusted channels to help people make informed decisions around their health. Understanding levels of trust in different institutions and being able to target information to groups who need it most is likely to be an essential part of the next phase of the pandemic response.
PSI continues to adapt and support programming based on these insights in Mozambique and as well as the other countries we serve.
Banner photo credit: NIAID Flickr.