Sociodemographic inequity in COVID-19 vaccine uptake among youth in Zimbabwe

IntroductionCOVID-19 vaccine acceptance research has mostly originated from high-income countries and reasons why youth may not get vaccinated may differ in low-income settings. Understanding vaccination coverage across different population groups and the sociocultural influences in healthcare delivery is important to inform targeted vaccination campaigns. MethodsA population-based survey was conducted in 24 communities across three provinces (Harare, Bulawayo and Mashonaland East) in Zimbabwe between October 2021 and June 2022. Youth aged 18 - 24 years were recruited using random sampling. Data on sociodemographic information and COVID-19 vaccination uptake and reasons for non-uptake were collected. ResultsA total of 17,682 youth were recruited (n=10,743, 60.8% female). The median age of survey participants was 20 (IQR: 19 - 22) years. Almost two thirds (n=10,651, 60.2%) of participants reported receiving at least one dose of COVID-19 vaccine. A higher proportion of men than women had been vaccinated (68.9% vs 54.7%), and vaccination prevalence increased with age (<19 years: 57.5%, 20-22: 61.5%, >23: 62.2%). Lack of time to get vaccinated, belief that the vaccine was unsafe and anxiety about side effects (particularly infertility) were the main reasons for not getting vaccinated. Factors associated with vaccination were male sex (OR=1.69, 95%CI:1.58-1.80), increasing age (>22 years: OR=1.12, 95%CI:1.04-1.21), education level (post-secondary: OR=4.34, 95%CI:3.27-5.76), and socioeconomic status (least poor: OR=1.32, 95%CI:1.20-1.47). ConclusionThis study found vaccine inequity across age, sex, educational attainment and socioeconomic status among youth. Strategies should address these inequities by understanding concerns and tailoring vaccine campaigns to specific groups. What is already known on this topicMany countries have faced challenges when rolling out COVID-19 vaccines. Infrastructure, logistics, misinformation and vaccine hesitancy have been barriers to vaccine access and uptake globally. Vaccine nationalism by high-income countries has particularly affected countries in Africa and Asia, resulting in inequity between countries and regions. What this study addsVaccine uptake among youth in Zimbabwe was more than 50% across all age-groups. Men, those with more education and those living under less socially deprived socioeconomic conditions were more like to be vaccinated. Fear of side effects and myths circulating on social media were barriers. Religion was less of a barrier than other studies reported, likely due to religious institutions collaborations in COVID-19 vaccination efforts. How this study might affect research, practice or policyVaccination campaigns should actively address specific concerns of communities, especially concerns around fertility and early death, and provide vaccines in easy-access and convenient locations. Involving community leaders in both education and vaccination efforts is pivotal given the trust and influence they have.