Barriers Remain for HBV Vaccination in Zambia for Health Care Workers

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Acceptability of the vaccine was high among the completers and some non-completers that felt it was safe and offered them protection.

There are many barriers in place that prevent health care workers from getting vaccinated against hepatitis B virus (HBV) in remote parts of Africa, including access, activation, and awareness.1

A team, led by Mqiza Nyasa, Social and Behavioral Science Unit, Research Department, Centre for Infectious Disease Research in Zambia (CIDRZ), explored the barriers and facilitators to uptake of the hepatitis B vaccine offered free of charge to health care workers and nursing students in Kalulushi district, Copperbelt Province of Zambia.

Why Vaccination Uptake is Low

It is well known that health care workers are especially vulnerable to HBV infections due to the nature of their jobs. In many places the hepatitis B vaccine is recommended for health care workers.

However, uptake of this vaccine in Sub-Saharan Africa is generally low among health care workers.

In the study, the investigators conducted 29 in-depth interviews in person or via telephone with participants before and after receiving the vaccines. The investigators analyzed the barriers and facilitators to full or partial vaccination by using Penchasky and Thomas’s (1981) 5A’s (Access, Affordability, Awareness, Acceptance and Activation) taxonomy framework for vaccine hesitancy.

The Program

Every participant was offered the vaccine free of charge and was aware of HBV infection as an occupational risk.

The results show health care workers felt more sensitization was needed to increase awareness and knowledge of the vaccine.

In addition, acceptability of the vaccine was high among the completers and some non-completers that felt it was safe and offered them protection.

The team provided specific examples here.

A responder felt coerced to accept the first dose because of supervisor expectations and would have liked to be given more time to decide. However, the majority of participants felt that vaccination should ultimately be compulsory for health care workers.

The investigators also found among the non-completers, vaccine uptake was hindered by late or no notification of appointments as the main reason they did not complete the full vaccination schedule.

Health care workers said that for countrywide roll-out, at least a 1 week notification would be needed for health care workers to plan and be mentally prepared to be at their workstations when the vaccination is taking place.

“The need to offer the vaccine free of charge locally to ensure easy access and affordability is essential to increase vaccine uptake. Vaccination policies and guidelines for health workers, ongoing training and knowledge sharing are required,” the authors wrote. “Involving trained champions in the facility can also help encourage HCWs to get vaccinated.”


Nyasa, M., Chipungu, J., Ngandu, M., Chilambe, C., Nyirenda, H., Musukuma, K., Lundamo, M., Simuyandi, M., Chilengi, R., & Sharma, A. (2023). Health Care Workers' reactions to the newly introduced hepatitis B vaccine in Kalulushi, Zambia: Explained using the 5A taxonomy. Vaccine: X, 100274.