# Equity in COVID-19 Vaccine Resource Distribution: An Exploration of Vaccine Uptake Among Health Workers in a Low-Income Setting

## TL;DR

This study explores vaccine uptake among healthcare workers in Sierra Leone, highlighting the need for equitable vaccine distribution and better communication to improve booster rates.

## Contribution

The study provides insights into vaccine perceptions and uptake among healthcare workers in a low-income setting, emphasizing equity and communication challenges.

## Key findings

- Approximately 80% of healthcare workers received a COVID-19 vaccine, but only 34% received a booster dose.
- Knowing someone with serious COVID-19 increased odds of vaccination and booster uptake.
- Qualitative data revealed barriers like limited information and inequities in vaccine distribution.

## Abstract

Background: Healthcare workers are at the forefront of the global battle against COVID-19. Their vaccination perspectives, particularly in regions like Sierra Leone that have faced health crises such as the Ebola outbreak, are essential for shaping public health strategies in low-income countries that routinely face infectious disease outbreaks. Objective: This research sought to understand the perceptions and experiences of Sierra Leone’s healthcare workers concerning COVID-19 vaccination and booster doses, set against the backdrop of global health resource disparities and regional vaccine distribution challenges. Methods: Utilizing a mixed-methods approach, the study analyzed data from an online survey, which saw 1001 complete responses from 2060 participants across six Ebola-impacted districts (October–November 2022), and in-depth interviews with 24 health workers from three of these districts (February–July 2022). Results: Approximately 80% of respondents reported having received a COVID-19 vaccine, predominantly Sinopharm and AstraZeneca, yet only 34% of vaccinated participants had received a booster dose. In multivariable analyses, personally knowing someone who experienced serious COVID-19 illness or death was associated with higher odds of both initial vaccination and booster uptake (p < 0.05). By contrast, prior Ebola-related experiences were not consistently associated with vaccination outcomes. Qualitative findings contextualized these patterns, highlighting the roles of professional exposure, limited booster-related information, and inequities in vaccine availability and distribution. Conclusion: These findings indicate that vaccination strategies must move beyond initial rollout to address barriers to sustained engagement, particularly for booster uptake among healthcare workers. They also emphasize the need for equitable vaccine access and transparent, locally tailored communication to mitigate structural and informational constraints in low-income settings.