Barriers to the success of COVID-19 immunisation programs in New Ireland Province, Papua New Guinea.

Introduction: Although guidance exists for the public health activities recommended for the management of COVID-19 in Papua New Guinea (PNG), community vaccine hesitancy has been identified as a major challenge. Vulnerable groups such as the elderly, children, people living in rural and remote communities, the socioeconomically disadvantaged and those with certain pre-existing medical conditions are disproportionally affected by COVID-19. This project aimed to address the reasons for community vaccine hesitancy in New Ireland Province, PNG.

Methods: To understand the reasons for vaccine hesitancy and intent to vaccinate within the community, a mixed-methods approach was used in conjunction with two methods of data collection. First, a survey was provided to community members. The survey was adapted from two pre-existing validated survey instruments, the Oxford COVID-19 Hesitancy Scale and the Oxford COVID-19 Vaccine Confidence and Complacency Scale. Community leaders and healthcare workers were invited to participate in semi-structured interviews to provide a more detailed response of their experience of vaccine acceptance.

Results: A total of 181 participants from New Ireland Province were surveyed. Although vaccine awareness among the cohort was high (86.7%), overall uptake of vaccination was low (7.2%). Despite this, only 27.6% of participants indicated they would receive the vaccine should it be made available to them. Participants had concerns regarding vaccine safety, vaccine advice, and the authenticity and origins of the COVID-19 virus itself. Religious and political influence compounded the mistrust community members had for vaccine recommendations. Some community members stated their community had suffered for many years with serious illness, expressing a fatalistic acceptance of the virus, as they do other illnesses.

Conclusion: Vaccine hesitancy is a significant problem that has the potential to negatively affect population-level health. An urgent focused effort to strengthen immunisation programs in PNG is evident. Preventative primary health care is a national priority; however, for the successful delivery of vaccination initiatives, well-formed immunisation programs that include education that will dispel myths and misinformation are required.