COVID-19 Vaccine Acceptability and Adherence to Preventive Measures in Somalia: Results of an Online Survey
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Article COVID-19 Vaccine Acceptability and Adherence to Preventive Measures in Somalia: Results of an Online Survey Mohammed A. M. Ahmed 1,2 , Robert Colebunders 3 , Abdi A. Gele 4, Abdiqani A. Farah 5, Shariff Osman 1, Ibraahim Abdullahi Guled 1,6, Aweis Ahmed Moalim Abdullahi 1, Ahmed Mohamud Hussein 1, Abdiaziz Mohamed Ali 1,7 and Joseph Nelson Siewe Fodjo 3,8,* 1 Department of Paediatrics, Faculty of Medicine and Surgery, Mogadishu University, Mogadishu P.O. Box 004, Somalia; [email protected] (M.A.M.A.); [email protected] (S.O.); [email protected] (I.A.G.); [email protected] (A.A.M.A.); [email protected] (A.M.H.); [email protected] (A.M.A.) 2 Department of Paediatric Cardiology, Uganda Heart Institute, Kampala P.O. Box 7051, Uganda 3 Global Health Institute, University of Antwerp, 2610 Antwerp, Belgium; [email protected] 4 Norwegian Institute of Public Health, 0213 Oslo, Norway; [email protected] 5 Department of Economics, Puntland State University, Wadajir, Garowe P.O. Box 090, Somalia; [email protected] 6 Mogadishu Somali-Turkey Training and Research Hospital, Mogadishu P.O. Box 004, Somalia 7 De Martino Hospital, Hamar Jajab, Mogadishu P.O. Box 004, Somalia 8 Brain Research Africa Initiative (BRAIN), Yaoundé P.O. Box 25625, Cameroon * Correspondence: [email protected] Citation: Ahmed, M.A.M.; Abstract: Most countries are currently gravitating towards vaccination as mainstay strategy to quell Colebunders, R.; Gele, A.A.; COVID-19 transmission. Between December 2020 and January 2021, we conducted a follow-up Farah, A.A.; Osman, S.; Guled, I.A.; online survey in Somalia to monitor adherence to COVID-19 preventive measures, and COVID-19 Abdullahi, A.A.M.; Hussein, A.M.; vaccine acceptability and reasons for vaccine hesitancy. Adherence was measured via a composite Ali, A.M.; Siewe Fodjo, J.N. adherence score based on four measures (physical distancing, face mask use, hand hygiene, and COVID-19 Vaccine Acceptability and ± Adherence to Preventive Measures in mouth covering when coughing/sneezing). We analyzed 4543 responses (mean age: 23.5 6.4 years, Somalia: Results of an Online Survey. 62.4% males). The mean adherence score during this survey was lower than the score during a similar Vaccines 2021, 9, 543. https:// survey in April 2020. A total of 76.8% of respondents were willing to receive the COVID-19 vaccine. doi.org/10.3390/vaccines9060543 Flu-like symptoms were more frequently reported in the current survey compared to previous surveys. Multiple logistic regression showed that participants who experienced flu-like symptoms, Academic Editors: Tiziana Ramaci those in the healthcare sector, and those with higher adherence scores had higher odds for vaccine and Massimiliano Barattucci acceptability while being a female reduced the willingness to be vaccinated. In conclusion, our data suggest that the decreasing adherence to COVID-19 preventive measures may have caused increased Received: 26 April 2021 flu-like symptoms over time. COVID-19 vaccine acceptance in Somalia is relatively high but could be Accepted: 17 May 2021 improved by addressing factors that contribute to vaccine hesitancy. Published: 21 May 2021 Keywords: COVID-19; vaccination hesitancy; Somalia; adherence; preventive measures Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. 1. Introduction The long-term success of the coronavirus disease (COVID-19) public health response would rely on flattening the curve and reducing the burden on health systems until an ade- quate proportion of the population acquires immunity against the virus (herd immunity). Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. Achieving population immunity by natural means (whereby a significant proportion of This article is an open access article the population needs to become infected) would result in an unprecedented burden on distributed under the terms and healthcare services and could lead to 30 million deaths worldwide [1]. One key strategy conditions of the Creative Commons to stop the escalation of the COVID-19 pandemic is to develop effective vaccines. So far, Attribution (CC BY) license (https:// more than 100 COVID-19 vaccine candidates have been investigated. By 9th April 2020, creativecommons.org/licenses/by/ five vaccine candidates were in phase 1 clinical trials and by November 2020, 30 vaccine 4.0/). candidates were in phase 3 clinical trials [2]. As of January 2021, three vaccines of Western Vaccines 2021, 9, 543. https://doi.org/10.3390/vaccines9060543 https://www.mdpi.com/journal/vaccines Vaccines 2021, 9, 543 2 of 11 pharmaceutical companies had been approved by international regulatory authorities and vaccination had started with the Chinese and Russian vaccines [3]. Currently COVID-19 vaccines are being administered in high-income as well as some middle-income countries. However, to stop the COVID-19 epidemic it is also important that large scale COVID-19 vac- cination campaigns be initiated in low-income countries, including in sub-Saharan Africa (SSA). Given the large global population, and the observed high vaccine hesitancy coupled with relatively low vaccination coverage for currently available vaccines, understanding vaccine acceptance at the local level is critical [4]. Exploring predictors of vaccine attitudes in general terms has the potential to help policy makers recognize and adapt measures that improve vaccine trust that have previously been tested outside the COVID-19 pandemic [1]. Vaccines are widely recognized as a major tool for achieving public health success against the COVID-19 pandemic. Notwithstanding, certain groups of people may have doubts regarding the benefits of the available COVID-19 vaccines and concerns over their safety, causing them to question the need for vaccination; an attitude referred to as ‘vaccine hesitancy.’ Current literature shows disparities in vaccine acceptance across different geographical settings and population strata [5]. Some of the documented factors associated with COVID-19 vaccine acceptance in the general population include: vaccine effectiveness, adverse health effects, misinformation about the need for vaccination, lack of faith in the health system, lack of community awareness about vaccine-preventable diseases [5]. In China, higher vaccine acceptance rates were noted among healthcare workers (HCWs) compared to the general population [6]. Another study in the United States indicated that only one third of HCWs expressed willingness to receive the COVID-19 vaccine [7]. Globally, acceptance of COVID-19 vaccines was estimated to range from as low as 54.8% in Russia to as high as 88.6% in China; most Western countries showed relatively high public acceptance of the vaccine (59–75%) [8]. Besides vaccines, governments worldwide have been relying on large scale imple- mentation of non-pharmaceutical interventions (such as physical distancing, quarantining, face mask use, hands and coughing hygiene) to curb COVID-19 transmission. Data from SSA reveal only moderate adherence to the public health measures instituted to prevent COVID-19, suggesting that a vaccine may be needed to overcome the pandemic in such settings. A study among HCWs in the Democratic Republic of Congo found that only 28% of them were willing to receive a COVID-19 vaccine [9]. Such a low acceptance could be blamed on an infodemic of misinformation and rumors that make it difficult to find credible sources of information [9]. In Somalia, where adherence to measures for COVID-19 prevention was seen to decrease over time during two consecutive online surveys [10], no data are available yet regarding the acceptance of a COVID-19 vaccine. Therefore, in a third round of online surveying, we sought to investigate both adherence to COVID-19 preventive measures and acceptability of a COVID-19 vaccine among Somalis, as artifi- cial immunization may be the way forward in the face of decreasing observance of other recommended preventive practices. 2. Methods 2.1. Study Setting and Design Between 26th December 2020 and 28th January 2021, we conducted a third cross- sectional online survey in Somalia to investigate observance of preventive measures and associated factors in Somalia. This study came as a follow-up of previous online surveys about adherence to COVID-19 preventive measures in Somalia, conducted in April 2020 and July 2020 [10]. Considering the study period (December 2020–January 2021) during which this third survey was conducted, 313 new confirmed COVID-19 cases and 19 deaths were officially reported [11]. Until January 2021, the number of new COVID-19 cases seemed to be on a consistent decline; however, by February 2021, a record number of new COVID-19 cases and related deaths were reported (Figure1). Vaccines 2021, 9, x FOR PEER REVIEW 3 of 11 Vaccines 2021, 9, 543 3 of 11 seemed to be on a consistent decline; however, by February 2021, a record number of new COVID-19 cases and related deaths were reported (Figure 1). FigureFigure 1. 1. COVIDCOVID-19-19 in in Somalia Somalia Report Report Chart Chart from from March March 2020 up to February 2021 [12] [12].. 2.2.2.2. Survey Survey Too Tooll TheThe survey survey tool tool was was an an online online questionnaire questionnaire which which was was similar similar to to that used during previousprevious surveys byby the the International International Citizen Citizen Project Project COVID-19 COVID- (ICPcovid)19 (ICPcovid) consortium consortium [10].