Understanding perceptions towards COVID-19 vaccination and strategies to increase vaccine uptake among Ebola- affected communities in North Kivu, Democratic Republic of the Congo: a qualitative study.

backgroundNorth Kivu, in eastern Democratic Republic of the Congo (DRC), was the epicenter of the second largest Ebola Virus Disease (EVD) outbreak in history and has been an active conflict zone for decades. The COVID-19 pandemic further exacerbated an already complex situation. This qualitative study, conducted as part of a broader investigation into Ebola vaccine hesitancy and at the onset of COVID-19 vaccination rollout in the DRC, assessed perceptions, beliefs, and attitudes toward the COVID-19 virus and vaccines among community members and healthcare workers who had experienced the 2018-2020 EVD outbreak, during which a novel vaccine was also administered.

methodsBetween May and June 2021, thirty-three focus group discussions (FGDs) and fifteen key informant interviews were conducted across three health zones that had offered Ebola vaccination (rVSV-ZEBOV) during the 2018-2020 EVD outbreak. Participants included healthcare workers (HCWs) and community members, as well as leaders, administrative officials, and frontline workers who had supported outbreak response and vaccination services.

resultsAcross all locations and groups, perceived risk of COVID-19 was low, with many participants doubting its existence and relevance, particularly when compared to other needs and endemic health conditions in their communities. COVID-19 was believed to primarily affect white, affluent individuals in urban areas, and not those residing in hot climates. Vaccine hesitancy was driven by perceived insufficient transparency and communication regarding COVID-19 vaccines, including questions about their composition, potential side effects, and rationale behind prioritizing certain groups. COVID-19 vaccine perceptions also reflected broader concerns, including mistrust of the government and rumors related to past Ebola outbreaks and vaccination efforts. To increase uptake, respondents recommended ensuring COVID-19 vaccination is voluntary and free of charge, working with non-traditional local demand generation and vaccination actors, strengthening local vaccine production capacity, and increasing the impact of interpersonal communication through social media messaging.

conclusionsThese findings add to growing evidence on how prior exposure to another disease of international concern (Ebola) and the associated vaccine, as well as historical context, influence perceptions of novel vaccines. Community engagement and tailored communication to address community concerns and misinformation are essential to building trust. Policymakers and implementers should consider more innovative approaches for developing and implementing vaccination policies in collaboration with local actors.