Barriers to the success of COVID-19 immunisation programs in New Ireland Province, Papua New Guinea.

INTRODUCTION: Although guidance exists for the public health activities recommended for the management of COVID-19 in Papua New Guinea (PNG), community vaccine hesitancy has been identified as a major challenge. Vulnerable groups such as the elderly, children, people living in rural and remote communities, the socioeconomically disadvantaged and those with certain pre-existing medical conditions are disproportionally affected by COVID-19. This project aimed to address the reasons for community vaccine hesitancy in New Ireland Province, PNG. METHODS: To understand the reasons for vaccine hesitancy and intent to vaccinate within the community, a mixed-methods approach was used in conjunction with two methods of data collection. First, a survey was provided to community members. The survey was adapted from two pre-existing validated survey instruments, the Oxford COVID-19 Hesitancy Scale and the Oxford COVID-19 Vaccine Confidence and Complacency Scale. Community leaders and healthcare workers were invited to participate in semi-structured interviews to provide a more detailed response of their experience of vaccine acceptance. RESULTS: A total of 181 participants from New Ireland Province were surveyed. Although vaccine awareness among the cohort was high (86.7%), overall uptake of vaccination was low (7.2%). Despite this, only 27.6% of participants indicated they would receive the vaccine should it be made available to them. Participants had concerns regarding vaccine safety, vaccine advice, and the authenticity and origins of the COVID-19 virus itself. Religious and political influence compounded the mistrust community members had for vaccine recommendations. Some community members stated their community had suffered for many years with serious illness, expressing a fatalistic acceptance of the virus, as they do other illnesses. CONCLUSION: Vaccine hesitancy is a significant problem that has the potential to negatively affect population-level health. An urgent focused effort to strengthen immunisation programs in PNG is evident. Preventative primary health care is a national priority; however, for the successful delivery of vaccination initiatives, well-formed immunisation programs that include education that will dispel myths and misinformation are required.

Improving the impact of non-pharmaceutical interventions during COVID-19: examining the factors that influence engagement and the impact on individuals.

BACKGROUND: During an evolving outbreak or pandemic, non-pharmaceutical interventions (NPIs) including physical distancing, isolation, and mask use may flatten the peak in communities. However, these strategies rely on community understanding and motivation to engage to ensure appropriate compliance and impact. To support current activities for COVID-19, the objectives of this narrative review was to identify the key determinants impacting on engagement. METHODS: An integrative narrative literature review focused on NPIs. We aimed to identify published peer-reviewed articles that focused on the general community (excluding healthcare workers), NPIs (including school closure, quarantine, isolation, physical distancing and hygiene behaviours), and factors/characteristics (including social, physical, psychological, capacity, motivation, economic and demographic) that impact on engagement. RESULTS: The results revealed that there are a range of demographic, social and psychological factors underpinning engagement with quarantine, school closures, and personal protective behaviours. Aside from the factors impacting on acceptance and compliance, there are several key community concerns about their use that need to be addressed including the potential for economic consequences. CONCLUSION: It is important that we acknowledge that these strategies will have an impact on an individual and the community. By understanding the barriers, we can identify what strategies need to be adopted to motivate individuals and improve community compliance. Using a behavioural framework to plan interventions based on these key barriers, will also ensure countries implement appropriate and targeted responses.