COVID-19 Vaccine Acceptance Among Marginalized Populations in Kosovo | Insight from a Qualitative Study

Kosovo has fully vaccinated 45.5 percent of the population, below what is needed to slow the spread of COVID-19. The Roma, Ashkali, and Egyptian communities, as marginalized ethnic groups, have been identified as high risk for acquiring COVID-19 and for lower acceptance of vaccines. Factors associated with vaccine acceptance are examined in this qualitative study among Roma, Ashkali, and Egyptian community members and representatives from civil society, community leaders, health care providers, and government working directly within these communities. Using a social-ecological model, intrapersonal, interpersonal, community, and structural factors influencing vaccine acceptance were identified. Intrapersonal-level factors centered on fear of side effects and doubt about vaccine safety and effectiveness, and lack of trust of health care providers; at the interpersonal level, male head of households decided for the entire family whether to receive the vaccine; in the social context at the community level, exposure to prolific misinformation on social media, television news, and paper pamphlets distributed in study communities created fear, doubt, and anxiety about vaccines, and stereotypes about the strong immune systems of ethnic minority groups reinforced beliefs about the communities low susceptibility to COVID-19; and structural-level barriers included the requirement for identification documents, and a buildup of doubt about motivations of the vaccinators created by massive vaccine-promotion efforts and police harassment in implementing curfew, and other protective measures targeting ethnic minority communities. Implications of these findings highlight a need for a segmented approach in designing subgroup-specific and multicomponent interventions to promote vaccine acceptance. Strategies include training local opinion leaders in door-to-door awareness raising, directly addressing misinformation, and distributing vouchers to be exchanged for incentives after vaccination; using social media where respected health care providers and community members post videos promoting vaccination; and removing or providing an alternative to identification requirements.