COVID-19 Vaccine Perceptions Among Ebola-Affected Communities in North Kivu, Democratic Republic of the Congo

The COVID-19 vaccination is considered the most effective way to reduce morbidity and mortality from COVID-19; however, the DRC has one of the lowest COVID-19 vaccination rates in the world. North Kivu, in eastern DRC, was the epicenter of the second largest Ebola Virus Disease (EVD) outbreak in history and remains an active conflict zone. This mixed-methods study assessed perceptions, beliefs, and attitudes toward COVID-19 and COVID-19 vaccines among community members (CMs) and healthcare workers (HCWs) affected by the 2018–2020 EVD outbreak, during which a novel vaccine was also deployed. In March 2021, International Medical Corps, in collaboration with the CDC and Brown University, conducted a cross-sectional survey among 631 CMs and 438 HCWs, alongside a qualitative component conducted between May and June 2021, consisting of thirty-three focus group discussions and fifteen key informant interviews across three health zones that had offered Ebola vaccination.

The survey found that 81.7% of HCWs and 53.6% of CMs felt at risk of contracting COVID-19; however, vaccine intention was low. In both groups, the perceived risk of contracting COVID-19, general vaccine confidence and male sex were associated with the intention to get vaccinated, with security concerns preventing vaccine access being negatively associated. Among CMs, getting the Ebola vaccine was associated with the intention to get vaccinated. Among HCWs, concerns about new vaccines’ safety and side effects, religion’s influence on health, security concerns and governmental distrust were negatively associated with vaccine perceptions.

Qualitative findings indicated that perceived risk of COVID-19 was generally low, with many participants doubting the disease’s existence or relevance, particularly when compared to other needs and endemic health conditions in their communities. COVID-19 was often viewed as affecting mainly affluent or foreign populations. Vaccine hesitancy was shaped by poor communication, lack of transparency, mistrust of government, and rumors linked to past Ebola responses. Participants emphasized the importance of voluntary, free vaccination and engagement of trusted local actors.

Together, these findings highlight the role of risk perception, prior outbreak experience, insecurity, and institutional trust in shaping vaccine acceptance, underscoring the need for enhanced community engagement and communication that address concerns to improve vaccine perceptions and vaccination decisions, which could facilitate the success of future vaccine campaigns in North Kivu and similar conflict-affected settings.