A qualitative exploration of deterrents to COVID-19 vaccination uptake among adults in post-war Tigray, Northern Ethiopia

Coronavirus disease 2019 (COVID-19) has had a profound impact on developing countries and continues to pose a serious global threat. Vaccination is essential for protecting public health, yet vaccine hesitancy remains a significant barrier to uptake. Evidence on the deterrents to COVID-19 vaccination in post-war contexts, particularly in Ethiopia, is limited. This study explored the factors hindering COVID-19 vaccine uptake in post-war Tigray, Northern Ethiopia. An exploratory qualitative study was conducted in Tigray from August 1 to 30, 2023. Six focus group discussions (FGDs) and seven in-depth interviews (IDIs) were held in host communities and internally displaced persons (IDP) centers, along with seven key informant interviews (KIIs) with public health experts. Participants were purposively selected, and data were collected using semi-structured guides refined through immediate debriefing. All sessions were audio-recorded, transcribed verbatim, and analyzed inductively using Atlas.ti (version 9.0). Five themes emerged as deterrents to COVID-19 vaccination uptake in post-war Tigray: perceived risk of COVID-19, reliance on cultural practices, post-war-related hindrances, infodemic-related barriers, and limited vaccine accessibility. The most frequently reported deterrents were low perceived risk, post-war challenges, fear of side effects, and accessibility issues, whereas reliance on cultural practices was mentioned less often. Low COVID-19 vaccine uptake in post-war Tigray is driven by individual perceptions, sociocultural beliefs, logistical barriers, and post-war challenges. Strengthening uptake requires engaging local religious leaders, implementing gender-sensitive campaigns addressing fertility concerns, and integrating vaccination with humanitarian food aid or health outreach programs.