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Under normal circumstances, one would expect frontline health workers to be lining up in thousands to receive the much-anticipated lifesaving COVID-19 vaccine that does not only offer scientifically proven protection to them but also saves the lives of the eager patients.
The COVID-19 outbreak has ushered in some strange behaviours among some front-line health workers in Uganda among which is vaccine hesitancy. Who could have imagined that health workers would be hesitant about a vaccine whose benefits they know very well?
Strangely, some have retreated to the end of the vaccination line in a wait-and-see posture, while for others it is an outright no to the vaccine – at least for now.
Official figures from the Ministry of Health indicate that out of over 80,000 health workers expected to receive the vaccine, slightly over 10,000 had been vaccinated by 31st March 2021. This is not only strange but also worrying, given that health workers are often looked at as influencers, whose opinion and actions tend to determine uptake of services such as the ongoing COVID-19 vaccination.
The situation was worsened by misinformation and negative rumours peddled on social media and the doubts cast over the AstraZeneca vaccine that were beamed to the world from some WHO regions. This is the worst nightmare every communicator or mobilizer dreads especially when tasked to promote or create demand for a health product over which their very own are hesitant, thereby fuelling larger community doubt.
“During mobilization in the different hospital departments, most health workers confessed that they would not take up the vaccine because some of their senior doctors had told them about the possible long term adverse health effects of the vaccine,” Jude Kaliisa, the social mobilizer for Hoima Regional Referral vaccination centre said when asked to explain this hesitancy.
That response set the scene and summarized the task ahead of the Ministry of Health and WHO field team based in Hoima. There was no time to lose or room for failure given that the Minister of Health Dr Jane Ruth Aceng had made it clear at the national launch of the COVID-19 vaccination at Mulago National Referral Hospital that health workers were not only the priority group given the nature of their work but most importantly they should set an example for the rest of the country.
Therefore, vaccine hesitancy by health workers was least expected as this would derail the programme which is unacceptable. Consequently, targeted messages were designed and several one-on-one or group sessions were organised to address hesitancy and doubt among health workers. Using Information, Communication and Education materials from the Ministry of Health and WHO country office, facts were synthesised, misinformation corrected, rumours dispelled, and benefits of the vaccine clearly explained.
On the day the vaccine was launched in the sub-region, WHO team members had to take the vaccine in full view of other health workers and the community to assure them of its safety and efficacy. It was therefore great relief when, after a few engagements and demonstration, several health workers such as nurse Margret from Kagadi Hospital agreed to be vaccinated for their “own safety but also to protect their communities.”
“At first I doubted the vaccines when one of the doctors I look up to refused to receive it. However, after a one-on-one with the WHO officer, I made up my mind to get the jab to protect myself, patients, and family members,” said nurse Margret. At present that is the trend, and many health workers are increasingly taking up the vaccine in the sub-region.
The role of peer influence was well demonstrated in the uptake of the vaccine at Kagadi hospital. For instance, some health workers hesitated because their leader, the head of the case management team had not yet taken it. “Doctor, we want to see you take the first jab then we follow,” they requested him at the launch function. He complied while explaining, that the COVID-19 vaccine is an individual decision that should be taken with informed consent which they all should exercise.
In addition, the health workers in the sub-region are now vaccination ambassadors as they encourage clients of the hospital who fall under the targeted groups to immediately take up vaccine.
“I heard from the nurse at the waiting area in the Out-Patient Department encouraging people above 60 years and those with diseases such as high blood pressure, and diabetes to get vaccinated because they are at risk. I had to get the vaccine to protect myself and live longer to see my children get married and bear me grandchildren,” said 60-year-old Miriam Kwikiriza as she exited the OPD at Hoima Regional Referral Hospital.
As indicated, initially, the turn-up of health workers was low in most district vaccination centres in the sub-region. They have since taken up the vaccine and figures from the district health offices show that by the second week of April 2021, over 800 out of 1,000 health workers have been vaccinated in Hoima, 111 out of 250 in Kiryandongo; 82 out of 262 in Bulisa; 62 in Kibaale.
At Hoima Regional Referral Hospital vaccination centre, the situation is even better with 358 out of 400 health workers vaccinated. It should be remembered that vaccine hesitancy in this district started at this centre following doubts by some senior consultants. They are now encouraging other health workers to take up the vaccine after Continuous Medical Education sessions were held from which they got more scientific information on the vaccine.
“The side effects are normal and are part of the reactions like any other drug and they will go after two days,” Dr Charles Barungi a senior gynaecologist assured one of the nurses who was complaining about the mild side effects.
Meanwhile, the District, Ministry of Health and WHO field teams have intensified their activities in the sub-region as the vaccination is cascaded to other priority groups. They are relying on direct engagements, group meetings, using influencers and change agents to break the barriers. These are age-old and proven interventions that should help to return the situation and circumstances to normal default.