A Descriptive-Multivariate Analysis of Community Knowledge, Confidence, and Trust in COVID-19 Clinical Trials among Healthcare Workers in Uganda

Article Authors: Keneth Iceland Kasozi, Anne Laudisoit, Lawrence Obado Osuwat, Gaber El-Saber Batiha, Naif E. Al Omairi, Eric Aigbogun, Herbert Izo Ninsiima, Ibe Michael Usman, Lisa M. DeTora, Ewan Thomas MacLeod, Halima Nalugo, Francis P. Crawley, Barbara E. Bierer, Daniel Chans Mwandah, Charles Drago Kato, Kenedy Kiyimba, Emmanuel Tiyo Ayikobua, Linda Lillian, Kevin Matama, Shui Ching Nelly Mak, David Onanyang, Theophilus Pius, David Paul Nalumenya, Robinson Ssebuufu, Nina Olivia Rugambwa, Grace Henry Musoke, Kevin Bardosh, Juma John Ochieng, Fred Ssempijja, Patrick Kyamanywa, Gabriel Tumwine, Khalid J. Alzahrani and Susan Christina Welburn

Abstract

Background—misinformation and mistrust often undermines community vaccine uptake, yet information in rural communities, especially of developing countries, is scarce. This study aimed to identify major challenges associated with coronavirus disease 2019 (COVID-19) vaccine clinical trials among healthcare workers and staff in Uganda. Methods—a rapid exploratory survey was conducted over 5 weeks among 260 respondents (66% male) from healthcare centers across the country using an online questionnaire. Twenty-seven questions assessed knowledge, confidence, and trust scores on COVID-19 vaccine clinical trials from participants in 46 districts in Uganda. Results—we found low levels of knowledge (i.e., confusing COVID-19 with Ebola) with males being more informed than females (OR = 1.5, 95% CI: 0.7–3.0), and mistrust associated with policy decisions to promote herbal treatments in Uganda and the rushed international clinical trials, highlighting challenges for the upcoming Oxford–AstraZeneca vaccinations. Knowledge, confidence and trust scores were higher among the least educated (certificate vs. bachelor degree holders). We also found a high level of skepticism and possible community resistance to DNA recombinant vaccines, such as the Oxford–AstraZeneca vaccine. Preference for herbal treatments (38/260; 14.6%, 95% CI: 10.7–19.3) currently being promoted by the Ugandan government raises major policy concerns. High fear and mistrust for COVID-19 vaccine clinical trials was more common among wealthier participants and more affluent regions of the country. Conclusion—our study found that knowledge, confidence, and trust in COVID-19 vaccines was low among healthcare workers in Uganda, especially those with higher wealth and educational status. There is a need to increase transparency and inclusive participation to address these issues before new trials of COVID-19 vaccines are initiated.

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  • Affiliation

    Infection Medicine, Deanery of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh EH8 9JZ, UK

    School of Medicine, Kabale University,Box 317 Kabale, Uganda

    EcoHealth Alliance, 520 Eighth Ave, Suite 1201, New York, NY 10018, USA

    School of Health Sciences, Soroti University, Box 211 Soroti, Uganda

    Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour 22511, AlBeheira, Egypt

    Department of Internal Medicine, College of Medicine, Taif University, Box 11099, Taif 21944, Saudi Arabia

    Kampala International University Western Campus, Box 71 Bushenyi, Uganda

    Department of Writing Studies and Rhetoric, Hofstra University, Hempstead New York, USA

    Faculty of Medicine, Mbarara University of Science and Technology, Box 1410 Mbarara, Uganda

    Good Clinical Practice Alliance-Europe and Strategic Initiative for Developing Capacity in Ethical Review, BE-1050 Brussels, Belgium

    Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA

    Faculty of Science, Muni University, Box 725 Arua, Uganda

    College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Box 7062 Kampala, Uganda

    Department of Pharmacology and Therapeutics, Faculty of Health sciences, Busitema University,
    Box 206 Mbale, Uganda

    Uganda National Health Laboratory Services, Ministry of Health, Box 7272 Kampala, Uganda

    Department of biology, Faculty of Science, Gulu University, Box 166 Gulu, Uganda

    Department of Library and Information Science, Faculty of Computing, Library and Information Science, Box 317 Kabale, Uganda

    Faculty of Science and Technology, Cavendish University, Box 33145, Kampala, Uganda

    Center for One Health Research, School of Public Health, University of Washington, Seattle, WA, USA

    Department of Clinical Laboratories sciences, College of Applied Medical Sciences, Taif University, Box  11099, Taif 21944, Saudi Arabia

    Zhejiang University-University of Edinburgh Joint Institute, Zhejiang University, International Campus, 718 East Haizhou Road, Haining 314400, China