COVID-19 vaccine hesitancy: vaccination intention and attitudes of community health volunteers in Kenya

Abstract Background: In Kenya, community health volunteers link the formal healthcare system to urban and rural communities and advocate for and deliver healthcare interventions to community members. Therefore, understanding their views towards COVID-19 vaccination is critical to the country's successful rollout of mass vaccination. Objectives: The study aimed to determine vaccination intention and attitudes of community health volunteers and their potential effects on national COVID-19 vaccination rollout in Kenya. Methods: This cross-sectional study involved community health volunteers in four counties: Mombasa, Nairobi, Kajiado, and Trans-Nzoia, representing two urban and two rural counties, respectively. The alluvial diagrams were analysed and plotted using R script programming. Hierarchical binary logistic regression was the primary analytical method, and the results were presented in adjusted odds ratios and significant p values. Results: COVID-19 vaccination intention among community health volunteers was 81% (95% CI: 0.76-0.85). On individual binary logistic regression level, contextual influence: trust in vaccine manufacturers; individual and group influences: trust in the MoH; belief in COVID-19 vaccine safety, and vaccine safety and issues: risk management by the government and vaccine concerns, were significantly associated with vaccination intention. Overall, the government's belief in COVID-19 vaccine safety and risk management were significantly associated with vaccination intention. Conclusion: Overall vaccine hesitancy among community health volunteers in four counties in Kenya was 19% (95% CI: 0.15-0.24), ranging from 10.2−44.6% across the counties. These pockets of higher hesitancy are likely to impact national vaccine rollout and future COVID-19 vaccination campaigns negatively. The determinants of hesitancy arise from contextual, individual and group, and vaccine or vaccination specific concerns and vary from county to county. Keywords: COVID-19, Contextual Influences, Individual & Group Influences, Kenya, Vaccination Attitudes, Vaccine Hesitancy, Vaccination Intention, Vaccine Safety