Relationship between household member vaccine acceptance and individual vaccine acceptance among women in rural Liberia

Background Despite the availability of COVID-19 vaccines, vaccination uptake remains low in Liberia. Social norms, and in particular an individual’s family preferences can have a strong normative influence on health behavior. However, few studies across the globe have explored how behavioral intent about COVID-19 vaccination among household members affects individual vaccination acceptance, particularly in rural, resource-limited settings. We respond to this gap in knowledge by analyzing data from a household survey of women in rural Liberia with the goal of understanding how household COVID-19 beliefs and vaccine behavioral intent correlated with those of individual household members. Methods Data was analyzed from a household survey of 2,620 women aged 15-49 in 2,201 households in rural Grand Bassa County, Liberia, from March to April 2021. The survey included a COVID-19 module on protective health behaviors and intention to accept a COVID-19 vaccine when available. Each household was defined as being concordantly vaccine-hesitant, concordantly vaccine-accepting, or discordant. A multivariable logistic regression model was fitted to identify correlates of concordant acceptance, adjusting for potential confounders. Results The survey found that only approximately one in three households in rural Liberia were fully COVID-19 vaccine accepting. About 42% of households had discordant views on the vaccine, while 33% had concordantly accepting views, and 25% had concordantly hesitant views. The demographic characteristics of households with different vaccine beliefs were similar. Having a household member who accepted the COVID-19 vaccine was associated with an 18.1 percentage point greater likelihood of an individual accepting the vaccine (95% confidence interval, CI=7.3-28.9%, P=0.001). Conclusions Social norms around vaccine acceptance within households are strongly associated with individual acceptance. Interventions that target hesitant households and individuals could have a significant impact on vaccine acceptance rates.