In any major public health emergency, Healthcare Workers (HCWs) are on the frontlines, interacting directly with the public and serving as trusted sources of information.
Sierra Leone is a country that has recent experience with major public health challenges. It was an epicentre of the Ebola epidemic in 2014-2016. However, when faced with the COVID-19 pandemic, one of the biggest hurdles the health care sector had to overcome was resistance from those charged with convincing the population to get vaccinated, that is from a number of its Health Care Workers.
A cross-sectional study published in Vaccines, a MDPI open access scientific journal entitled “ COVID-19 Vaccine Hesitancy among Healthcare Workers and Trainees in Freetown, Sierra Leone” in May 2022 classified 60.1% of the survey respondents as COVID-19 ‘vaccines hesitant’ while 13.8% were classified as ‘highly hesitant’ and therefore unlikely to vaccinate.
The study assessed COVID-19 vaccine hesitancy and associated factors among a diverse group of Health Care Workers (HCWs), specifically doctors, pharmacists, nurses and medical trainees, namely students of medicine, pharmacy and nursing in Freetown, Sierra Leone. The survey was conducted from January to March 2022.Overall, 592 participants submitted responses (67.2% female, mean age 29 years, 5.6% physicians/pharmacists, 44.3% medical students, 29.2% nurses, 20.9% nursing students).
Of those responding, only 38.3% of the survey respondents said they had received at least one COVID-19 dose. It was noted that survey respondents were more likely to be COVID-19 vaccine hesitant if they had previously refused to get a recommended vaccine. “Negative experiences, especially serious adverse reactions to previous vaccines, can shape attitudes towards vaccination and may help explain this association,” the study authors said.
The study conclusion was that a high prevalence of COVID-19 vaccine hesitancy was observed among healthcare professionals in Freetown who gave various reasons for their resistance and wariness, including worries about unforeseen future side-effects, a preference for natural immunity, and profiteering/mistrust of health authorities, which were the most common concerns expressed.
Given that healthcare professionals are disproportionately at risk of COVID-19 exposure and are a trusted source of information for the general public, the study findings call for addressing vaccine hesitancy among this group as an essential component of the overall strategies aimed at increasing COVID-19 vaccine uptake in this key public health sector. .
For those who have been on the frontlines of the COVID-19 vaccination push, the findings from this study were not surprising.
Dr. Tom Sesay, Program Manager, Child Health/Expanded Program on Immunization (CH/EPI) during the start of the 2021 vaccination campaign spoke about the challenges they faced.
Myths about COVID-19 vaccines were the biggest hurdle to vaccination coverage amongst the population and the HCWs were not excluded from that hesitancy challenge, he said, noting that at the time when the vaccination drive first started in March 2021, hesitancy was not mostly felt among the population but chiefly amongst HCWs.
There were a lot of rumours circulating, including conspiracy theories on the efficacy of the vaccines, he continued, and seeing that HCW are also set of people that always frequent the social media the rumors that were being passed along via social media affected their perception of the vaccine. For example, there were rumours questioning the safety of the vaccine and even that it would be used to control the population.
Sierra Leone recorded its first positive COVID19 case in March 2020. However the country did not receive its first shipment of vaccines until a year later. On March 8, 2021, Sierra Leone received the first batch of 96,000 doses of the AstraZeneca-Oxford COVID-19 vaccine shipped via the COVAX Facility, a partnership between the Government Sierra Leone, CEPI, Gavi, UNICEF and WHO.
A country-wide COVID-19 Vaccination campaign was launched few days later by Sierra Leone’s President Julius Maada Bio, who publicly, alongside other dignitaries, received his first dose. He was followed by Vice President Juldeh Jalloh. The public ceremony was aimed at reassuring the public that the vaccine is safe and to drum up support for its rollout.
However, according health providers, by the time these vaccines arrived and started to be distributed to the public there was already a lot of distrust among the public.
Then, in June 2021, the country’s Healthcare Workers (HCWs) received the shocking news that one of their own, a midwife, had died after receiving a COVID-19 shot. This news came just as the Ministry of Health and Sanitation (MoHS) had issued a mandatory vaccination policy for all HCWs.
The MoHS was quick to react, issuing a press release to address the matter and countering the rumours with facts, stating that the deceased, age 53, had some underlying health conditions, she was asthmatic, and that no relationship had been established between her death and the vaccination.
The MoHS also firmly stated that any medical event (including serious side-effects or death) following administration of any COVID-19 vaccine would be systematically investigated following national and international vaccination protocols.
It emphasized that all the available scientific data showed that the COVID-19 vaccines being rolled-out in Sierra Leone were deemed safe and effective and MoHS repeated its appeal for people to get vaccinated, stating that, “COVID-19 vaccines remain one of the country’s biggest hopes for saving lives in the country.” The MoHS warned that any attempt to undermine public confidence in these vital components in its efforts to contain the outbreak would only go to prolong the suffering of its people.
The health ministry was not the only entity in Sierra Leone faced with countering the rumours circulating following the midwife health care worker’s death.
In 2021, Zhou Shuisen, Health Attaché of the Chinese Embassy in Sierra Leone, issued a statement calling out two local newspapers saying the papers had rushed to a hasty conclusion not backed by scientific evidence by linking the death of the midwife health care worker to Sinopharm, a vaccine developed and manufactured in China.
In support of its Chinese partners, the MoHS also issued a statement thanking the Chinese government for its medical assistance and calling on the media to be responsible in its reporting. “We continue to be thankful to the government and people of the Peoples Republic of China and all our development partners for coming to our aid with these critical lifesaving vaccines. News agencies are urged to report responsibly, and members of the public to fact-check their sources and avoid spreading misinformation at this critical time in the fight against COVID-19,” the ministry declared.
Despite reassurances, these rumours created serious controversy about the vaccine from China and many people were refusing to get inoculated with Sinopharm due to the negative image being portrayed by the media and social media, including those in the health care workers sector.
Nurse Kadijatu Kamara said even though the ministry of health had issued a policy that all HCWs should be vaccinated, it came just at the time when the health sector was overpowered by rumours relating to the death of the HCW midwife.
“I for one was strongly opposed to getting inoculated,” she said. “We caught so many rumours from WhatsApp. Many messages were doing the rounds all blaming the vaccine for her untimely death. I was scared, knowing fully well that one of the WhatsApp audios making the rounds was shared by a HCW.”
Timing also played a part in the public’s attitudes and perceptions about getting vaccinated, added Dr. Sesay.
The first COVID-19 case in Sierra Leone was registered in March 2020. The first shipment of vaccines arrived in the country a year later. Dr. Sesay said by the time the COVID-19 vaccines appeared in the market place, many people had simply stopped being as fearful, noting that by the time they started with the vaccination campaign the mortality of COVID-19 had reduced drastically.
“When COVID-19 started at the early part of 2020, we seem to have had a higher mortality rate, we lost colleagues and that was the time everybody was looking for a vaccine or any other medication” he said.
But by the time the vaccines were made available, the mortality rate had declined and the fear people had about the virus had, too. He said the attitude had shifted to one where people were thinking that the COVID-19 infection is not as bad as they had thought and therefore the demand for the vaccines was not too high, not only amongst HCWs, but the population as well.
He said it’s true that initially there was hesitancy to take the jab from a number of HCWs. “When we started there was some hesitation amongst them and we have very senior healthcare workers who were hesitant to take the vaccines,” he said. However, he added, “As the vaccination continues and more people come forward to take it, seeing that it is safe that convinced a lot of healthcare workers to take it.”
Access was another challenge for those HCWs who were ready to get the jab, he said, in particular those staying far off from district headquarters, they were cut-off from the vaccination centres as initially, out of 1,500 health care facilities in the country only 72 facilities were providing COVID-19 vaccination.
“So you can imagine, the majority of those in the remote areas were not provided with vaccination, they had challenges in coming to centers where the vaccines were being provided, he continued, adding that finally this challenge was addressed.
“We got around that through outreach and mobile vaccination campaign. Teams leave the various headquarters and go to the various centers and do mobile vaccination for the HCWs” Dr. Sesay said. By the last quarter of 2021 the vaccine was available at nearly all the health facilities and access was no longer a problem, he added.
According to figures, as of July 2022, around 50,770 health care workers had received at least one vaccine dose. The figures represent all persons working in the health care sector, both medical professionals, administrators, and support staff.
Lab Technician, Amara Kallon, said the rumours did not influence or discourage him from taking the vaccines. “We should not joke with getting inoculated, that’s a mistake some of my colleagues were and still making. But, learning from the Ebola experience I am not going to take any chances” he said.
Interviews with various other HCWS revealed that their decision to take or not to take the vaccination was mostly influenced by information obtained from electronic or printed media and social media followed by vaccine producers. However, HCW’s working in COVID-19 admission centres were more willing to take the vaccine than those who were just working at general facilities.
Current figures from the MoHS state that Sierra Leone has achieved over 70% of fully vaccinated individuals for COVID-19 vaccination.