With the assumption that COVID-19 vaccine would freely be provided by the government, the level of vaccine acceptance (53.6%); risk perception (46%) and acceptance of clinical trials (44.6%) is relatively average. According to the East African Consortium for Clinical Research (25), the Uganda Virus Research Institute (UVRI) is partnering with Imperial College London to start the first Covid-19 vaccine trial in the country by December, 2020. However, the success or failures of vaccine trials are community driven (12). In order to avoid anti-vaccination campaigns like in the early 1996 and 1997, where the oral polio vaccine was criticized by the public that the oral poliovirus vaccine was contaminated with HIV and ineffective, the government needs proper mobilization and community engagement (13) (26). In 2019, the Congo’s Ebola vaccine hesitancy was geared by community mistrust due to social and cultural factors that arose during the West Africa Ebola outbreak, even though these communities seriously needed the Ebola vaccine (14). Studies have shown that vaccine refusal is associated with increases in illness and death from vaccine preventable diseases which is also secondary to large economic costs for health care (6). Our study shows that 46.4% (Table 1,2&3) are not willing to take the vaccine however despite the very high benefit-to-risk ratio of vaccines, the fear of negative side effects can discourage many people from getting vaccinated from killer diseases (15).
In general comparison of vaccine acceptance levels in our findings (Table 1), there were higher acceptance levels of hypothetical COVID-19 vaccine in countries such as Chine (91.3% (16); Indonesia (93.3%) (9) and USA (69%) (17). We attribute these differences to low levels of global vaccine clinical trials in African (4), inadequate research facilities and limited funding needed in development of vaccines (18). Financial and knowledge constrains in most African countries, have cause highest mortality rates by infectious diseases (19). However, low vaccine acceptance in Uganda could be attributed to fear or potential risks that can be encountered especially where a vaccine has not been well evaluated. A similar study in sub-Saharan Africa showed an overall positive acceptance towards the new malaria vaccine however there were challenges of inadequate community engagement due to lack of information about the vaccine and fear of the vaccine side effects (20).
Africa has a high population and a growing economy (21), which would be an advantage for increasing potential market for vaccines however there is a lot of political prejudice and policy setting influence which may be a factor hindering good health service delivery to the people (18). It is popular that in most African countries political leaders often misuse government resources meant for health service procurements (22).
According to our results, it shows that 46.9% of the respondents had fear for the vaccine. Previous study on HIV vaccine trial in Uganda showed that before researchers start any trials of HIV vaccines, they need to gain support from politicians, the media, and the general public. Generally, all stakeholders must be involved in discussions about important scientific, social, legal, ethical, and other concerns before the study begins (23). We believe that this approach could help mitigate fears about COVID-19 vaccination and clinical trials in the community.
Among the most risky group were the males respondents, students, low income earners (< 1,000, 000) and those with no salary income who perceived the vaccine as being risky. When carrying out community sensitization, efforts have to be made by the government to ensure that this group of people in followed closely.
Therefore the government of Uganda through its Scientists, policymakers, and public health experts must start involving communities now as discussions and plans progress toward finding a vaccine not after the scientific breakthrough but before. There is need to sensitize the population against their fears early enough before the trials can progress. The government can establish messages and trainings for its people especially the risky group regarding vaccination against COVID-19. This can be done through radios, televisions, newspapers, seminars and phone messages.