Cholera vaccination readiness in six African countries: A psychological and ecological study

OBJECTIVES: This study examines the psychological construct vaccination readiness against cholera in six African countries (Ghana, Kenya, Nigeria, South Africa, Tanzania, and Uganda) based on the 7C model of vaccination readiness (measuring confidence, complacency, constraints, calculation, collective responsibility, compliance, conspiracy). This allows investigating the validity of the 7Cs in a non-WEIRD and previously under-researched infection context with a low to moderate vaccination rate (<50%), which can provide valuable insights for vaccine roll-out and epidemic (and pandemic) preparedness. METHODS: A total of 14,132 English-speaking participants were recruited via Facebook and took part in an experimental online study and this survey. The experiment did not affect the research questions addressed in this manuscript. Measurement invariance analyses of the 7Cs showed scalar invariance, which allows cross-country mean comparisons and provides initial evidence for the generalizability of cholera vaccination readiness across countries. RESULTS: At the individual level, vaccination readiness was significantly associated with self-reported vaccination status against cholera (d = 0.32) and general vaccination status across several vaccines (r = 0.35). Individuals with personal experience with cholera showed higher vaccination readiness (d = 0.14). At the country level, average vaccination readiness correlated strongly with cholera incidence over the past three years (ρ = 0.89), suggesting a higher vaccination readiness in countries with higher disease burden and risk. CONCLUSION: The study provides initial validity evidence for the generalizability of the 7Cs model across countries and infectious diseases and shows that cholera vaccination readiness is related to self-reported risk and disease experience. For pandemic preparedness the data suggest that vaccination readiness builds where disease experience already exists, leaving populations without prior exposure at greatest risk during a novel outbreak.