Since the outbreak of COVID-19 pandemic in December 2019 and the subsequent search for an appropriate antidote, there have been mixed reactions in vaccine uptake globally. The COVID-19 vaccines manufactured have ranged from Johnson and Johnson, AstraZeneca, Pfizer, Moderna, and Sinovac.
Despite these efforts, Uganda, like many East African countries is grappling with low uptake levels for the vaccines. Having launched its vaccination drive on March 10, 2021 targeting to vaccinate around 22 million people by the end of 2022 in a phased manner, the country has thus far fully vaccinated only approximately 3.7 million people while 9.9 million have received one dose.
These figures are far below the required estimate recommended by experts for achieving vaccine-induced herd immunity. Yet, vaccination is currently the most powerful strategy in the fight against COVID-19. It reduces the risk and severity of illness caused by COVID-19, consequently offering strong protection against death. Studies have shown that vaccination reduces the likelihood of transmitting the virus to others.
Whereas the number of people receiving vaccination is increasing overtime, the low uptake levels are still a cause for concern, with health authorities seeking to amend the Public Health Act 1935 (Cap. 281) to legally institute mandatory COVID-19 vaccination. The World Health Organization estimates that out of the 26.6 million vaccine doses received by Uganda as of January 2022, only 9.8 million (36.8%) doses have been administered. 
Why the low COVID-19 vaccine uptake levels?
Lack of trust in the safety of the vaccines and the health system administering the vaccines. This lack of trust in the safety of the vaccine is primarily driven by the short time taken to develop and approve the COVID-19 vaccines for human use. This is exacerbated by bans of different vaccines in some countries especially in Europe, yet the same vaccines are mostly donated for use in Uganda.
The lack of trust in the health system is largely driven by peoples’ past experiences. For example, the Hepatitis B vaccination drive in 2018 was marred with many controversies, which make people question subsequent drives. The recent scandal in which 800 people were given counterfeit COVID-19 vaccines creates uncertainty, discouraging uptake.
The convenience/reliability with which people can access the vaccine also affects the uptake levels, especially for multi-dose vaccines. If people have to wait for an entire day and, in some instances, bounce at vaccination centres due to lack of vaccines, it is likely to deter them from getting the vaccine. Some people have to search for the vaccine from centre to centre.
Glaring information gap giving room to false information to prevail. For example, misinformation regarding the effect of the vaccine on fertility. If people are not adequately informed on the content of the vaccines, how they work and the possible side effects, they are likely to hesitate to take the vaccine until when they have acquired enough information to decide.
Further still, certain segments of the population have a perceived low risk of acquiring COVID-19. This is especially common among the rural dwellers who believe that COVID-19 is a disease for urban dwellers. Notably, the observance of Standard Operating Procedures like social distancing quickly vanishes as one moves from the urban areas (especially Kampala and surrounding metropolitan areas) towards the rural areas. Most rural dwellers argue that they do not have COVID-19 and that it is urban dwellers that are taking it to them. Consequently, this results in low uptake of the vaccine, especially among the rural dwellers.
What needs to be done to boost vaccination efforts?
Vaccine uptake is influenced by a combination of factors ranging from personal, cultural, spiritual/religious, and political factors. Therefore, a combination of interventions is necessary to foster uptake levels:
As the government makes vaccines available to the population, it should intensify mass sensitization on the available vaccines and ensure honesty and transparency about vaccine side effects. Information should be relayed in different languages in an easy-to-understand format that is culturally sensitive such that the public can understand and embrace it.
More clarity on what the vaccine does (prevents one from severe illness when they contract COVID-19), benefits of vaccination and the different vaccines’ typical and rare side effects is needed to counter misinformation and alleviate fears that arise due to limited information. In this regard, the Ministry of Health should manage an up-to-date central registry to track all side effects among the vaccinated population and ensure public awareness about the existence of the same.
In addition, the government can utilize behavioural nudges and the peer effect to convince more people to take the vaccine. By exploiting social norms, success may be achieved in convincing more people to take the vaccine. Some people are urged to take the vaccine when they know that several of their peers have taken it and if they are nudged to believe that taking the vaccine is not just for themselves but for the general good. A campaign akin to the “I choose peace” drive used during the 2021 general elections may boost vaccination efforts. This can be regularly broadcast in mainstream media, social media with the help of influential personalities and even at personal levels for example with car stickers showing one’s vaccination status and through door-to-door word of mouth campaigns.
It is also important to depoliticize the vaccination drive to ensure more acceptability by the wider population. A combination of trusted leaders from different institutions (cultural, religious, and political) should be involved in the vaccination drives. For example, whereas health experts ensure that myths concerning vaccination are countered by scientific evidence to allay people’s fears about the vaccines’ contents and potential side effects, cultural and religious leaders may appeal to a broader audience and connect with people on an emotional level.
In conclusion, a combination of interventions that influence personal and collective decisions favouring vaccination is crucial to boost COVID-19 vaccine uptake. Notwithstanding the availability of vaccines, the country may not achieve its vaccine targets in the absence of such interventions.