Factors That Influence-Covid-19 Vaccine Uptake and Hesitancy among a Population in the West Department of Haiti: Implications for Enhancing Effectiveness of Immunization Programs

Introduction The COVID-19 pandemic in Haiti led to increased challenges for a population concurrently dealing with natural and social disasters, poor quality health care, lack of clean running water, and inadequate housing. While half a million vaccines for COVID-19 were donated by the United States to the government of Haiti, less than 5% of the population agreed to be vaccinated. This resulted in thousands of unused doses that were diverted to other countries. The purpose of this study was to evaluate population characteristics related to vaccine uptake in order to inform future interventions to improve COVID-19 vaccine uptake as well as inform strategies to safeguard against future global health security threats. Methods This was a mixed-methods, cross-sectional study conducted in the West Department of Haiti within peri-urban communes. Survey participants consisted of adults of this setting responding to an electronic survey between June – Sept 2022. The survey assessed demographic information, household characteristics, religious beliefs, past vaccine use, and current COVID-19 vaccine status. Multivariate regression modeling was conducted to assess predictors of vaccine hesitancy. Qualitative focus group discussions were conducted among community leaders and health professionals to provide additional, community-level context on perceptions of the COVID-19 pandemic and vaccines. Results A total of 1,923 respondents completed the survey; of which a majority were male (52.7%), were between the age of 18-35 (58.5%), had a medical visit with the last year (63.0%) and received the COVID-19 vaccine (46.1%). Compared to those who had been COVID-19 vaccinated, participants who had not been vaccinated were more likely to be male (57.7% vs 46.8%, p<.0001), have classical education (30.5% vs 16.6%, p<.001), unemployed (20.3% vs 7.3%, p<.0001) and had a medical visit 3 or more years ago (30.2% vs 11.2%, p<.0001). Unvaccinated COVID-19 participants were also more likely to have never received any other vaccine (36.1% vs22.5%, p<.0001), have a religious leader speak out against the vaccine (20.0% vs 13.1%, p<.0001), not believe in the effectiveness of the vaccine (51.2% vs 9.1%, p<.0001) and did not trust the healthcare worker administering the vaccine (35.2% vs 3.8%, p<0.0001). Conclusion These results show that targeted interventions to religious leaders and health care workers on how to engage with the community and share clearer messages around the COVID-19 vaccination may result in increased vaccine uptake. Results also shed light on how activities surrounding vaccinations can be tailored to meet client needs addressing the misinformation encountered to achieve greater health impact thereby safeguarding the population against future global health security threats. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Through a faculty led review process and in consultation with the Dean for Research, the GUMC research restart discretionary fund was offered to encourage, reward, and facilitate research endeavors. This plan focused only on the research mission of the University and did not cover the other central missions of teaching medical, graduate students and service, both in clinical enterprise and in administration of academics. Martine Etienne-Mesubi was a recipient of these funds. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Georgetown/Medstar IRB System reviewed and approved this study: STUDY00004690 The National Committee of Bioethics in Haiti also reviewed and approved this study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data files will be made available according to the PLOS Global Health data policy requirements during the peer review process or before a submission can be accepted for publication.