Influence of COVID-19 and COVID-19 rumours on trust and uptake of single-dose male HPV vaccination in the Add-Vacc cluster-randomised trial, northwest Tanzania.
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BACKGROUND: The COVID-19 pandemic impacted public health services and vaccination uptake globally. Trust in health services and vaccination programmes is critical for vaccine acceptance. Between 2020 and 2022, Tanzania shifted its acknowledgement of COVID-19 and its prevention strategies. National COVID-19 vaccination coverage reached 51% by April 2023. The Add-Vacc cluster-randomised trial (CRT) provided single-dose, human papillomavirus (HPV) vaccination to 14-18-year-old males in 2023-2024, the first time HPV vaccination was offered to young men in Tanzania. The Tanzania national vaccination programme promotes HPV vaccination for girls as the vaccine to prevent cervical cancer. OBJECTIVE: This qualitative study investigated the influence of vaccine and COVID-19 rumours on uptake of male HPV vaccination offered through the trial. METHODS: Between May 2023 to May 2024, field teams collected rumours data using an electronic-rumours tracking tool, key informant interviews, in-depth interviews, focus group discussions and rapid ethnography with stakeholders including adolescents, parents, teachers, health workers and community leaders. RESULTS: Data from community members, including youth, indicated that changes in Tanzania's COVID-19 policies between 2020 and 2022 prompted mistrust and concerns about the trial vaccine. Documented concerns included questions regarding the motives of national leadership and vaccination programmes, rumours that the vaccine offered through the trial was a concealed COVID-19 vaccine or was for- depopulation or led to changes in fertility and/or male virility. Rapid assessment of trial-related rumours and responsive, ongoing community engagement activities to address rumours supported efforts to enhance vaccination uptake and acceptance. CONCLUSION: Shifting COVID-19 policies during the height of the SARS-CoV-2 pandemic subsequently influenced trust and HPV vaccine acceptance during the vaccination phase of the Add-Vacc CRT. Documenting and monitoring community concerns early in a project delivering a vaccine to a new population group can inform ongoing, dynamic community engagement aimed towards promoting dialogue and building trust across stakeholder groups and implementation teams.