Case study of COVID-19 immunization behaviour in the Maldives

Abstract

Introduction: COVID-19 scenario and people's reaction to vaccination changed rapidly across the globe, including the Maldives. In this context, a formative assessment on vaccine hesitancy to inform then and future risk communication and community engagement was conducted.
Methods: Qualitative inquiry methods were adopted. Vaccine hesitancy and acceptance was conceptualized through the Protection Motivation Theory. Primary data collection was conducted in five locations of the Maldives; Male', HA, Ihavandhoo, ADh. Digurah, L. Gan and GDh. Madaveli from July-October 2023. Focus group discussions were used for primary audience groups consisting of the elderly, those with chronic disease conditions (co-morbidities), migrant workers, youth, parents and caregivers of elderly, using flashcards to prompt the inquiry, and in-depth interviews were conducted with secondary audiences consisting of frontline workers, faith-leaders, community leaders, and influencers using an interview guide.
Results: Overall, protection motivation was low among the public, there was complacency about COVID-19 booster vaccinations, driven by low threat appraisal and low coping appraisal. This situation poses a significant challenge for health and communication experts working to improve vaccine coverage. The main causes of these issues were that (i) perception that the COVID-19 vaccine was not effective in preventing infections, (ii) the misconceptions were not addressed particularly on the rumors on adverse effects and anecdotes on social media about the vaccines, (iii) there was mismatch in where people seek information and where healthcare-workers provide information. In the early stages of vaccination, regulatory requirements for travel across localities was the main reason for vaccine acceptance while the social value of protecting dependents in family is the core motivation of COVID-19 vaccine acceptance in the later stages.
Conclusions: The protection motivation for vaccination for COVID-19 vaccine is low among the public due to the perceived low vaccine efficacy in preventing disease and adverse effects. The risk communication messaging needs to reposition vaccination about protection of family and loved ones and reducing severity of disease through trusted healthcare workers on social media most frequented by the population groups.