Vaccine hesitancy and factors related to vaccine hesitancy in COVID vaccination among a tribal community of Meghalaya: A mixed methods study

Background Vaccine hesitancy should be dealt as an important issue as it carries both individual and community level risks; however, it lacks proper assessment in particular among the indigenous tribal population. Methods A community based sequential explanatory mixed methods study was conducted among 238 eligible individuals in Ri-Bhoi district, Meghalaya. The quantitative part involved a cross-sectional study to determine the proportion of vaccine hesitancy and the qualitative part comprised of in-depth interviews among the eligible residents and key informant interview among the health workers providing the vaccination services, to explore the facilitators and barriers of vaccine uptake. Results A total of 113 [47.5% (95% CI: 41.0%-54.0%)] participants were found to be hesitant to vaccination, among which 16.8% (95% CI: 12.4%-22.3%) were initially hesitant and 30.7% (95% CI: 24.9%-37.0%) had vaccine refusal. The themes generated through qualitative interviews were individual related, disease related, vaccine related, healthcare system and provider related and socio-cultural and religious. The main barriers for likelihood of action were perceived susceptibility and perceived severity under the individual perception along with ambiguity aversion, scepticism about the efficacy, mistrust, concerns on side effects, rumours and socio-cultural and religious misbeliefs. Conclusion and recommendations Vaccine hesitancy is found to be considerably higher and it depends on complacency towards the vaccine, confidence on its safety, perceived susceptibility to the disease and perceived severity to the disease coupled with modifying factors for cues for action. Healthcare workers should better communicate to improve the uptake of vaccine by reducing the barriers on the vaccine acceptance.