Multi-method findings on COVID-19 vaccine acceptability among urban refugee adolescents and youth in Kampala, Uganda

ABSTRACT

Scant studies have explored COVID-19 vaccine acceptability among refugees. However, contexts of forced migration may elevate COVID-19 vulnerabilities, and suboptimal refugee immunisation rates are reported for other vaccine-preventable diseases. We conducted a multi-methods study to describe COVID-19 vaccine acceptability among urban refugee youth in Kampala, Uganda. This study uses cross-sectional survey data from a cohort study with refugees aged 16–24 in Kampala to examine socio-demographic factors associated with vaccine acceptability. A purposively sampled cohort subset (n = 24) participated in semi-structured in-depth individual interviews, as did key informants (n = 6), to explore COVID-19 vaccine acceptance. Among 326 survey participants (mean age: 19.9; standard deviation 2.4; 50.0% cisgender women), vaccine acceptance was low (18.1% reported they were very likely to accept an effective COVID-19 vaccine). In multivariable models, vaccine acceptance likelihood was significantly associated with age and country of origin. Qualitative findings highlighted COVID-19 vaccine acceptability barriers and facilitators spanning social-ecological levels, including fear of side effects and mistrust (individual level), misinformed healthcare, community and family attitudes (community level), tailored COVID-19 services for refugees (organisational and practice setting), and political support for vaccines (policy environment). These data signal the urgent need to address social-ecological factors shaping COVID-19 vaccine acceptability among Kampala’s young urban refugees.

Trial registration: ClinicalTrials.gov identifier: NCT04631367.

KEYWORDS:

• Refugee
• youth
• COVID-19
• vaccines
• multi-methods
• Uganda

Acknowledgments

The authors have no conflicts of interest to declare. Funders played no role in study design, data collection, analysis, interpretation, nor the writing of the report or the decision to submit for publication. We acknowledge the support of Young African Refugees for Integral Development (YARID), International Research Consortium (IRC) Kampala, Ugandan Ministry of Health, OGERA, as well as the peer navigators, research assistants and coordinators.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was funded by the Canadian Institutes of Health Research (CIHR) Project Grant (#389142), and the International Development Research Centre (IDRC) (#109549-001). Dr. Logie’s efforts were in part supported by the Ontario Ministry of Research, Innovation and Science's Early Researcher Award, the Canada Research Chairs Program (SSHRC Tier 2 Canada Research Chair in Global Health Equity and Social Justice with Marginalized Populations), and the Canada Foundation for Innovation (JELF).