Acceptance of a newly introduced COVID-19 vaccine among pregnant women and their decision influencers: a qualitative study in The Gambia.

BACKGROUND

Pregnant women infected with SARS-CoV-2 face an increased risk of severe illness and adverse maternal and neonatal outcomes. Despite the importance of the SARS-CoV-2 vaccination, acceptance among pregnant women is low in many regions, raising concerns about integrating newly introduced maternal vaccines into antenatal services. This study explored the factors shaping COVID-19 vaccine access and acceptance among pregnant women and their identified decision influencers in The Gambia.

METHODS

This qualitative study was part of a larger study involving over 5000 pregnant women, both vaccinated and unvaccinated against COVID-19. Data were collected through 12 focus group discussions and 21 semi-structured interviews with decision influencers like family members and religious leaders. Thematic analysis revealed key themes interpreted using the "5-P model": perceived disease susceptibility and severity, pregnancy protection, perceived benefits, provider-patient dynamics, and perceived information sufficiency.

RESULTS

Participants' COVID-19 vaccination decisions were shaped by their knowledge of the disease, the vaccine's benefits, and socio-cultural and religious beliefs. Key influencers, mainly husbands, played a significant role. Experiences with healthcare systems, unclear policies, and inconsistent messaging about vaccine safety during pregnancy affected choices. Misinformation from social media increased fear and hesitation, while conflicting advice from trusted sources diminished confidence. Differences in perceived risk and the quality of communication encounters further shaped how women evaluated vaccination during pregnancy.

CONCLUSION

This study highlights the importance of decision influencers and the impact of misinformation and inconsistent messaging on COVID-19 vaccine acceptance among pregnant women in The Gambia. By clarifying how women and their influencers navigate vaccine decisions, the findings offer practical entry points for strengthening communication and supporting the introduction of future maternal vaccines.