Determinants of COVID-19 Vaccine Acceptability in Mozambique: The Role of Institutional Trust

ABSTRACT Background Vaccination plays an imperative role in protecting public health and preventing avoidable mortality. Yet, the reasons for vaccine hesitancy are not well understood. This study investigates the factors associated with the acceptability of COVID-19 vaccine in Mozambique. Methods The data came from the three waves of the COVID-19 Knowledge, Attitudes and Practices (KAP) survey which followed a cohort of 1,371 adults in Mozambique over three months (N=3,809). Data collection was through a structured questionnaire using telephone interviewing (CAPI). Multilevel regression analysis was conducted to identify the trajectories of, and the factors associated with COVID-19 vaccine acceptability. Results There was great volatility in COVID-19 vaccine acceptability over time. Institutional trust was consistently and strongly correlated with different measures of vaccine acceptability. There was a greater decline in vaccine acceptability in people with lower institutional trust. The positive correlation between institutional trust and vaccine acceptability was stronger in younger than older adults. Vaccine acceptability also varied by gender and marital status. Conclusions Vaccine acceptability is sensitive to news and information circulated in the public domain. Institutional trust is a central driver of vaccine acceptability and contributes to the resilience of the health system. Our study highlights the importance of health communication and building a trustful relationship between the general public and public institutions in the context of a global pandemic.