Abstract
Coronavirus Disease 2019 (COVID-19), which first surfaced in Wuhan, China, in December 2019, became a global pandemic threatening all aspects of life. Samoa, a low-income Pacific Island country with fluctuating immunisation rates and still recovering from the 2019 measles epidemic, was still dealing with vaccine hesitancy when the pandemic hit. Immunisation is the best public health measure in combating vaccine-preventable diseases. With a novel COVID-19 vaccine, this research explores the knowledge, attitudes, and practices of Samoans and Samoan health professionals in Samoa and New Zealand towards a new vaccine. Samoans make up the majority of Pacific peoples in New Zealand and travel frequently between the two countries. This study explores differences between the two cohorts and identifies areas for consideration for future immunisation campaigns and pharmacovigilance support to Samoa.
This is a mixed-methods study, predominantly qualitative, using Pacific research methodologies of talanoa and fa’afaletui in focus group sessions and individual interviews with 22 participants: Samoan mothers and healthcare workers (doctors and nurses) in rural Samoa and a cosmopolitan city in New Zealand. Qualitative data was thematically analysed to identify main themes. A brief survey was conducted before each session to gather contextual information. Talanoa sessions and the quantitative survey were delivered in English and Samoan, depending on the participants’ preference.
Three years since COVID-19 first surfaced, all participants had a good understanding of the disease and were all accepting of the COVID-19 vaccine. However, there was some confusion about how vaccines generally worked in both community cohorts. In Samoa and New Zealand cohorts, despite receiving the vaccine, there was fear and uncertainty towards a quickly manufactured vaccine, driven by concern for family and community safety, and long-term side effects, particularly for young children. Spirituality generated optimism and control over the situation. Following the beginning of the pandemic, both cohorts were more vigilant about evidence-based information towards vaccination. The differences between the two cohorts were fuelled by the timing of the disease and the different resources, health systems, and government policies of the two countries. This affected the level of knowledge and the level of healthcare received by communities and delivered by healthcare workers.
In conclusion, these findings highlighted the need for immunisation campaigns to be targeted, acknowledging correct and ethnolect language, and ensuring this is delivered in a culturally safe and accepting environment without coercion. Health authorities in both countries should consider developing strong policies and robust educational campaigns promoting voluntary vaccination and navigating how to make the best decisions for healthcare workers and patients from appropriate cultural, spiritual, social, and political perspectives. The study supports consideration of a robust general practice training program in Samoa to build the primary care service, and an efficient pharmacovigilance system in Samoa to better understand and monitor vaccines (and medication) brought into the country, providing public reassurance.