Qualitative exploration of COVID-19 vaccine uptake among healthcare workers in Sierra Leone: do the ‘trusted messengers’ trust the vaccine?

Introduction: Vaccine hesitancy is a global issue, and the important role of healthcare workers in addressing vaccine hesitancy is well documented. However, there is limited theory-guided research on the uptake of COVID-19 vaccinations among healthcare workers in low- and middle-income countries (LMICs). This study examined COVID-19 vaccine uptake among healthcare workers in Sierra Leone and assessed the relevance of the 5C model-which posits that vaccine uptake is shaped by confidence, complacency, constraints, calculation and collective responsibility-in explaining their vaccination attitudes, intentions and behaviours. Methods: 24 indepth interviews were conducted in 2022 with healthcare workers in Freetown, Makeni and Kenema. The resulting narratives were thematically analysed to identify factors that promoted or deterred COVID-19 vaccination. Findings: with the Ebola outbreak, indicating that prior epidemic memory influenced how the 5C domains were interpreted and operationalised in relation to vaccine uptake in contexts such as Sierra Leone. Conclusions: This paper examines social determinants of vaccine uptake and offers policy recommendations to enhance vaccine uptake among trusted messengers in the region, thereby supporting global COVID-19 recovery and improving LMIC preparedness for future outbreaks. Future responses to public health emergencies in LMICs should be informed by local contextual experiences, and vaccine programmes must consider these factors during planning and implementation.