ABSTRACT
COVID-19 vaccine rollout in Kenya has been challenged by both the supply of and demand for vaccines. With a third of the adult population classifying as vaccine hesitant, reaching vaccination targets requires an understanding of how people make decisions regarding vaccines. Globally, pregnant and lactating women have especially low uptake rates, which could be attributed to the "infodemic,” or constant rush of new information, as this group is vulnerable to misinformation and uncertainty. While presentation of COVID-19 vaccines in the media allows for easy access, these sources are also susceptible to misinformation. Negative and unfounded claims surrounding SARS-CoV-2 infection and COVID-19 vaccines contribute to vaccine hesitancy. Given the influence that the media may have on people's attitudes toward vaccines, this study examines the relationship between the media and the vaccine decision-making process among pregnant and lactating women, healthcare workers, community members (male relatives, male neighbors, and gatekeepers), and policymakers in Kenya. Data were collected through in-depth interviews in urban and rural counties in Kenya to understand how media information was utilized and consumed. While healthcare workers were the most frequently cited information source for pregnant and lactating women, other healthcare workers, and community members, findings also show that the media (traditional, social, and Internet) is an important source for obtaining COVID-19 information for these groups. Policymakers obtained their information most frequently from traditional media. Ensuring that information circulating throughout these media channels is accurate and accessible is vital to reduce vaccine hesitancy and ultimately, meet COVID-19 vaccination goals in Kenya. Copyright © 2023 Fesshaye, Lee, Paul, Zavala, Singh, Karron and Limaye.
ABSTRACT
Background: This case describes the circumstances of an older woman and her daughter faced with the dilemma of whether or not to receive the COVID-19 vaccine at the end of life. Methods: Ms. V was a 90-year-old woman with past medical history of major neurocognitive disorder, asthma, and hypertension on home hospice after experiencing a rapid decline beginning in November 2020. By January 2021, she had significantly deteriorated with a prognosis of weeks. At this time, the COVID-19 vaccine had become available to high-risk individuals and their household members. Because Ms. V lacked capacity to make her medical decisions, her daughter and healthcare power of attorney, Ms. B, had to determine her wishes. Ms. V's goals were comfort care and to avoid hospitalization. Although she had worked as a nurse, she had declined her annual influenza vaccine in the past. However, Ms. B felt that her mother would have wanted to help her children and caretakers get the vaccine, which would only be possible if she got the vaccine first. Results: Extensive conversations with Ms. V's children, hospice team, and geriatrician were held utilizing the 4-box approach to ethical decision making.1 Ms. B decided that her mother would have wanted to receive the vaccine for the main purpose of also vaccinating her children, who both had advanced heart failure and were at high risk for complications from COVID-19. She received one dose of the Pfizer COVID-19 vaccine and died ten days later. Her children and live-in caregiver all received the Pfizer Covid-19. Conclusion: Although Ms. V had previously refused annual influenza vaccinations, her daughter felt that her mother would have gotten the vaccine to provide protection for her children and caregiver. While it was acknowledged that Ms. V would probably gather little immunity benefit from the vaccine due to her poor prognosis, her daughter felt that the benefits of the entire household receiving the vaccine outweighed any potential risks. Her family called this final act of protection her dying wish.