Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base

Background Studies have shown that healthcare workers (HCWs) are considered trusted sources of coronavirus disease 2019 (COVID-19) information in their communities, ideally placing them as effective vaccine advocates. However, limited data exist on the role of HCWs in the promotion of vaccines, and whether they feel adequately equipped to fulfil this role. This study therefore aimed to determine the willingness of HCWs in promoting COVID-19 vaccines, how this correlated with their own vaccination behaviour and attitudes to alternative therapies, and whether they felt they had adequate knowledge and skills to communicate effectively with patients. Methods A mixed-methods design was adopted, involving an online web-based survey and in-depth interviews (IDIs). HCWs were recruited for the online survey from an integrated health system database in South Africa using voluntary response sampling, with follow-up qualitative interviews conducted with HCWs who indicated interest in participating in an interview. Univariate and multivariate logistical regression models were used to understand how demographic characteristics, HCW roles, vaccination status, attitudes and practices around alternative medications, and information on COVID-19 vaccines were related to the willingness of HCWs to recommend vaccination to their patients. Results Most of the survey sample were vaccinated (90.7%) and indicated that they would recommend vaccination (81.7%). However, a significant proportion of the sample (58.6%) felt that they did not have enough information on COVID-19 vaccines, while 59.8% felt that they required additional guidance on how to educate their patients on COVID-19 vaccines. Vaccinated HCWs were more likely to recommend vaccination (OR=10.63 [95% CI: 6.53-17.31]) than their unvaccinated counterparts. The qualitative results provide further insights into why HCWs were willing or unwilling to administer and promote vaccines, with three themes emerging: (i) HCWs’ belief in the value of vaccines and their promotion strategies; (ii) challenges facing HCWs in fulfilling their mandate of administering and promoting COVID-19 vaccination; and (iii) the rationale for HCWs discouraging vaccination and promoting alternative medicines for COVID-19 prevention and treatment. Conclusions This study posits that if HCWs are key to the success of national vaccination programmes, then they will need to be provided with clear, contextual, up-to-date information in order to enhance patient communication and vaccine uptake.