Understanding the Perceptions of Religious Leaders on COVID-19 Vaccination in Ghana: A Qualitative Research Study and Operational Recommendations for Vaccine Demand Creation

"When I met people who had taken the vaccine, I started to realize that it was ok to take it." - study participant

Risk communication and community engagement (RCCE) mechanisms are an integral part of vaccine demand creation. In Ghana, community and religious leaders can play a key role in community mobilisation, as they are a trusted source of COVID-19-vaccine related information (see Related Summaries, below). However, there is little information on how these leaders perceive the vaccine. To mend this gap, the United Nations Children's Fund (UNICEF) Ghana conducted a qualitative study among community and religious leaders in May 2021. The findings of this study are being used to draft recommendations how to mobilise these leaders to support COVID-19 vaccine campaigns in Ghana.

The sample included 14 community leaders, consisting of five Christian leaders, three Muslim leaders, and six traditional leaders from Accra and the Central and North areas of the country. The interviews revealed that none of the respondents was generally against vaccines. However, three of them had refused the COVID-19 vaccine; the remaining eight were either planning to take the vaccine or were at least considering it.

The study identified number of factors influencing vaccine confidence of the respondents, offering recommendations for each, as follows:

• Belief in negative consequences of the vaccine - For example, they did not have firsthand information about people who had taken the vaccine, which made worries related to side effects even stronger. Common rumours of side effects were linked with impotency and infertility. Sample recommendation: Provide community leaders with information about the rigorous process of vaccine development and the systems of monitoring adverse events following vaccines abroad and in Ghana.
• Lack of knowledge about which sources of information are reliable - For example, respondents highlighted that contradictory and different information was flowing (constituting an "infodemic"). Sample recommendation: Promote reliable sources of information, especially about different vaccine types.
• Lack of trust in authorities - For example, many considered the vaccine programme just a political act of the government to gain popularity. Sample recommendation: Keep in mind wider social cultural influences, including political narratives linked with the vaccine, and develop separate strategies for COVID-19 acceptors and rejectors.
• Belief in inefficacy of the vaccines - For example, many respondents said they believed vaccines administered in Ghana were of poor quality, as they came from foreign countries. Sample recommendation: Do not address conspiracies directly; instead, list the benefits of the vaccine.
• Low pandemic risk perception - For example, most respondents believed that communities in Ghana had much more severe and complicated public health issues to be considered than COVID-19. Sample recommendation: Collect testimonials of influential people who experienced COVID-19. Make the pandemic real and concrete.

Three Muslim leaders from the North explained being ready to take the vaccine if offered because of: trust towards health officials and government officials, who would not harm people; the encouraging example of the president of Ghana having taken the vaccine; and trust in friends and personal contacts who advocate for vaccines.

In conclusion: "Community leaders are confident about their abilities to promote COVID-19 vaccine in their communities, but they do not necessarily feel confident talking about the vaccine in particular because of fear of side effects and other negative consequences of the vaccine. Community leaders do not want to involve themselves in vaccine promotion when they feel they can lose community trust....Community leaders are positively influenced by positive messaging, role models and examples."