Willingness to receive COVID-19 booster dose and its associated factors in Ghana: A cross-sectional study

Abstract

Background and Aim

The COVID-19 booster dose has been cited as an important supplement for the control of the COVID-19 pandemic due to reports of waning immunity among fully vaccinated persons. Determining factors that would affect its acceptability is necessary for initiating successful vaccination programs. In this study, we aimed to evaluate the factors associated with the acceptability of the COVID-19 booster dose in Ghana.

Methods

We conducted an online cross-sectional survey among the public. A self-administered questionnaire was used to collect information on demographic characteristics, willingness to vaccinate, perceptions toward COVID-19 vaccines, and trust in the government. Participants provided reasons and sources of advice that may affect their willingness to accept a booster dose. Using IBM SPSS and R Statistic; descriptive, univariate, and multivariate analyses were performed.

Results

Out of 812 respondents, 375 (46.2%) intended to accept the booster dose. Individuals who were males (adjusted odds ratio [aOR] 1.63, 95% confidence interval [CI] 1.07−2.48), had previously received other forms of vaccination twice (aOR 1.96, 95% CI 1.07−3.57) or in most years (aOR 2.51, 95% CI 1.38−4.57), tested positive for COVID-19 (aOR 3.46, 95% CI 1.23−10.52), have high trust in government (aOR=1.77, 95% CI: 1.15-2.74) and had positive perceptions regarding COVID-19 vaccines (OR = 14.24, 95% CI: 9.28−22.44) were more likely to accept a booster dose. Experiencing side effects from the primer dose (aOR 0.12, 95% CI 0.08−0.18) was associated with reduced acceptance. Concerns about vaccine safety and efficacy were the common reasons impeding willingness, while advice from health professionals would be the most considered.

Conclusion

Low intention to accept the booster dose which is associated with a range of factors including the perception of vaccines and trust in the government, is a cause for concern. Thus, more effort would have to be taken through education and policy interventions to increase booster vaccine acceptability.

INTRODUCTION

In December 2019, a disease with characteristics similar to pneumonia was reported in Wuhan, China. It was then determined by the World Health Organization (WHO) that the disease was caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).¹ In January 2020, the WHO declared COVID-19, a public health emergency of international concern, and on Wednesday, March 11, 2020, declared it a pandemic.² Ghana recorded its first two cases of COVID-19 which were imported from Norway and Turkey on March 12, 2020.³ Since its discovery, the pandemic has overwhelmed hospital systems, undermined economic activity worldwide, and instilled fear in the general populace causing increased morbidity and mortality.^4–6

Cumulative reported cases of COVID-19 by WHO as of July 15, 2022 were 557,917,904 with 6,358,899 deaths.⁷ The cumulative cases in Africa on the same date were 9,167,010 with 173,840 deaths. In Ghana, the cumulative confirmed case toll to 167,215 with cumulative death cases of 1456 as of July 9, 2022.⁸ COVID-19 has hurt the world's economies including Ghana, as the daily increase in confirmed SARS-COV-2 infections called for partial and total lockdowns on March 30, 2020.³ This resulted in an economic breakdown due to the collapse of private jobs, loss of jobs, and suspension of academic, religious, and social activities.

In fighting the pandemic, vaccines are marked as one of the major weapons. As a result, clinical trials have been conducted to produce vaccines at an accelerated rate.¹ Vaccines against COVID-19 have demonstrated exceptional protection against COVID-19 infection, reducing hospitalizations and deaths.^9–11 As a result, vaccination programs are highly prioritized. Globally, a total of 12,130,881,147 vaccine doses have been administered as of 12th July 2022.⁷ In Ghana, five brands of COVID-19 vaccines were approved for use. They were AstraZeneca, Sputnik-V, Moderna, Pfizer-BioNTech, and Janssen.⁸ As of June 30, 2022, a total of 17,409,005 doses had been administered.⁸ Of this number, 10,733,719 (47% of the eligible population of 22.9 m and 33.8% of the total population of 30.8 m) had received at least one dose while 7,510,586 (32% of the eligible population of 22.9 m and 23.7% of total population 30.8 m) had been fully vaccinated.

Even though SARS-CoV-2 vaccines such as mRNA-1273 are highly effective in reducing detectable symptomatic infections and severe complications of COVID-19, several viral variants with changes in the S protein have emerged, some of which have been identified as VOCs (Alpha [B.1.1.7], Beta [B.1.351], Gamma [P.1], and Delta [B.1.617.2]).¹² Evidence suggests that protection against severe COVID-19 may be driven by neutralizing antibody levels far lower than those induced by mRNA vaccinations. Furthermore, when exposed to VOCs after immunization, germinal center memory B cells may produce a fast anamnestic response.¹³ Some COVID-19 vaccines, however, have shown lower effectiveness against the B.1.351 and B.1.617.2 strains.¹⁴ In a retrospective study in Israel, rates of breakthrough infection amongst patients fully vaccinated with the Pfizer Biotech vaccine were significantly higher among those vaccinated earlier than those vaccinated later.¹⁵ An observational study conducted among fully vaccinated nursing home residents revealed that the vaccine efficacy dropped from 74.7% to only 53.1% in a few months.¹⁶ Another study found that vaccines' effectiveness against infections amongst New Yorkers waned from 91.7% to 79.8% between May 3 and July 25, 2021.¹⁷

This decline called for a considerable discussion about the eventual need for a booster dose in response to concerns about waning immunity, the emergence of variant strains of the virus, and the transmission of breakthrough infections.^18–20 To address this possible danger, researchers are continuing to produce modified versions of the prototype mRNA-1273 vaccination that incorporate the genetic sequence of the mutant S protein. These variant vaccinations are intended to generate an immune response against important neutralizing sites changed on the S protein of variant viruses, as well as, in the event of a multivalent vaccine, against the wild-type strain.¹²

Several countries have started administering booster doses already. However, the acceptance of a booster dose poses a potential public concern. In Ghana, only 1,192,595 representing 15.9% of those fully vaccinated and 6.9% of the vaccinated population had received the first booster dose as of June 30, 2022.⁸ COVID-19 vaccination in Ghana has been hindered by hesitancy, mistrust, misconception, beliefs, and reports of adverse effects.^21–23 And there is the fear of similar factors impeding the coverage of booster dose coverage in the country. To maximize efforts to increase booster dose uptake, it is prudent to know the public willingness to accept it and the factors which moderate their decision. Willingness to accept the booster dose is reported to be higher in developed countries such as America,²⁴ China,^25,26 and the United Kingdom.²⁷ In developing countries, there is not only limited data on willingness to receive the booster dose but reported studies from countries such as Algeria²⁸ and Jordan²⁹ are considerably low. This study reports, for the first-time determinants of willingness to accept COVID-19 booster dose in Ghana. We further highlight the reasons given for individuals' unwillingness and sources of information that may impact the decision to accept the booster dose.

METHODS Study design

This was a descriptive cross-sectional survey using a self-administered questionnaire designed and shared using Google forms from January to February 2022.

Sample size and participants

The minimum sample size of 768 required for the study was determined using the StatCalc function of Epi Info software, Version 7.2.5.0 (Center for Diseases Control, and World Health Organization). The following assumptions were made: a population size of 30.8 m from the 2021 housing and population census,³⁰ a confidence level of 95%, an expected COVID-19 booster acceptance of 50%, an error margin of 5%, and a design effect of 2.0. A final sample of 812 obtained at the end of the study was therefore considered sufficient.

The convenience sampling technique and snowball approach were employed to invite participants to respond to the study through the WhatsApp messaging platforms. The google link was circulated to individuals on the contact list of authors to complete the survey and to circulate it to people on their contact list to do the same. The participants were required to be (i) Ghanaians, (ii) aged 18 years and above, and (iii) have received at least one dose of the primer COVID-19 vaccine.

Survey instrument

The questionnaire for the survey was developed by the researchers through a review of published studies,^31–35 consultation with professionals, preliminary interviews, and discussion. To get a desirable outcome, the questionnaire was shared among immediate colleagues to scrutinize it for accessibility, clarity, and relevance, and to rule out biases. The questionnaire was also piloted among 30 nonselected individuals to confirm its validity, and the necessary modifications were made based on the feedback. A Cronbach's alpha greater than 0.7 obtained for the items in each domain after the pilot study was considered appropriate for the reliability and validity of the questionnaire. The data obtained from these participants were not included in the final analysis.

The questionnaire contained 35 items divided into 7 parts and collected information on participants' characteristics, willingness to vaccinate, perception of COVID-19 vaccines, trust in the government, the reason for unwillingness, and source of information that may impact willingness to vaccinate. The primary outcome of the study was the willingness to receive the COVID-19 booster dose in Ghana. We also explored the independent predictors of willingness to receive the COVID-19 vaccine.

• 1.

  Sociodemographic and socioeconomic characteristics (12 items): Sociodemographic and socioeconomic characteristics of respondents such as age, gender, religion, occupation, marital status, educational attainment, residence, and monthly income were collected. Respondents were also asked to indicate whether they were health workers or not. For these questions, options were provided for respondents to choose the working cadre which was true about them.

• 2.

  Health-related characteristics (5 items): Respondents were asked to indicate whether they have active health insurance, a regular health care provider, tested positive for COVID-19 before, and experienced side effects after primer dose receipt. Respondents were supposed to indicate “Yes” or “No” to these items. One item required respondents to indicate the frequency of past vaccination with four options (1 = never; 2 = once; 3 = twice; 4 = annually, and 5 = most years).

• 3.

  Trust in government (5 items): Respondents' trust in the government's approach and the ability to manage the pandemic was assessed. Five items encompassing respondents' perceptions of governments' openness and honesty, competency, commitment, care, concern, and ability were used. The Likert scale was used to assess respondents' responses (1 = not at all; 2 = somewhat; 3 = very, and 4 = extremely). The responses to these questions were used to calculate a trust in government score which varied from 5 to 20. Two binary variables were created to indicate “a lot of” (14−20) versus “low” (5−13) trust in the government's approach to handling the pandemic.

• 4.

  Perceptions regarding COVID-19 vaccines (10 items): A total of ten items assessed participants' perceptions of the COVID-19 vaccine. These assessed perceptions regarding vaccines' ability to cause miscarriage, diseases, and weakened immune systems. The items also assessed whether participants believe vaccines have reduced efficiency, are less effective compared to physiological immunity, are meant to capture individual biodata, are likened to the mark of the beast, or are likened to the new world order. Respondents were asked to indicate whether their religion forbids vaccination and whether they believed in God's protection over the vaccine's protection. A 5-point Likert scale was used to assess respondents' responses (1 = Disagree; 2 = Somewhat agree; 3 = Not sure; 4 = Somewhat agree, and 5 = Agree). The responses to these questions were reverse-coded and used to calculate the COVID-19 perception score which varied from 10 to 50. Two binary variables were created to indicate “negative” (10−30) versus “positive” (31−50) perceptions towards COVID-19 vaccines.

• 5.

  Willingness to receive the booster dose (1 item): Willingness to receive the booster dose was assessed using the question, “will you accept the COVID-19 booster dose introduced in Ghana?”. Willingness to receive the COVID-19 vaccine was dichotomized (0 = no; and 1 = yes).

• 6.

  Reasons for unwillingness to vaccinate (1 item): This item required respondents who answered “no” to the item assessing willingness to select the most likely reason for their unwillingness from 4 options (1 = inconvenience; 2 = concern about vaccine safety; 3 = concern about the efficacy of the vaccine; and 4 = risk of being infected). Respondents had the option of typing their reason if it was not part of the options provided.

• 7.

  Sources of advice which may influence willingness (1 item): Respondents were asked to select the most likely source of advice/information which may influence their willingness to accept the booster dose from 5 options (1 = family and friends; 2 = government; 3 = religious leader; 4 = doctors and health experts; and 5 = celebrities).

Ethical considerations

The Declaration of Helsinki and local regulatory requirements were followed during the design and implementation of this study. The messages sent to invite participants included statements that indicated the purpose of the study and gave all details including what the outcome of the study would be used for, their right to either give or withdraw their consent, data protection, and issues regarding confidentiality. Responses from respondents were anonymized. A section was created in the online form detailing consent to participate in the study before completing the survey questions. Respondents' consent was implied by the submission of the online survey.

Statistical analysis

Data collated from the online survey tool were directly saved into a Microsoft Excel sheet and were exported into IBM SPSS version 26 (IBM Corp.) and R statistic for analysis. All figures were generated using GraphPad Prism version 8. The demographic characteristics of respondents and responses to survey items were analyzed and presented as frequencies and percentages.

We determined the factors significantly associated with willingness to receive a booster dose using binary logistic regression models based on respondents' characteristics and responses to the study items. We estimated adjusted odds ratios of willingness to accept a COVID-19 booster dose using all the variables that showed significance (p < 0.05) in a univariate analysis. All analyses were 2-tailed with p-values less than 0.05 being considered statistically significant.

RESULTS Respondents' characteristics

Table 1 details the sociodemographic, socioeconomic, and health-related characteristics of respondents for the study. In all, 812 adults made up of 65.5% males and 34.5% females participated in the study. The most represented age group in the study was 20−29 (61%) years, with those more than 60 years (0.4%) being the least represented. More than half of the participants had a diploma or bachelor's degree with only a few representing senior high school and below. Two hundred and eighty-eight of the respondents representing 35.5% were health care staff. Specifically, this number was made up of 160 (19.7%) allied health personnel, 86 (10.6%) nurses and midwives, 25 (3.1%) health care administrators, 12 (1.5%) medical doctors, and 5 (0.6%) pharmacists. Many respondents were Christians (90.8%), single (72.3%), employed by the government (42.6%), and earning GH₵ 2000−5000 monthly (29.1%). Responses came from all 16 regions of the country with the majority (68.5%) having urban residences. Figure 1 shows the regional distribution of participants with the largest proportions of respondents coming from the Greater Accra and Central Regions.

Table 1 Characteristics of Ghanaian participants who participated in the study.

Variable	Categories	Frequency	Percentage
Sociodemographic and socioeconomic characteristics
Age in years	<20	39	4.8
	20-29	495	61
	30-39	205	25.2
	40-49	58	7.1
	50-59	12	1.5
	≥60	3	0.4
Gender	Female	280	34.5
	Male	532	65.5
Educational attainment	Senior high school and below	40	4.9
	Diploma and bachelor's degree	433	53.3
	Master's degree and above	339	41.7
Health care staff	No	524	64.5
	Yes	288	35.5
Religion	Christian	737	90.8
	Muslim	54	6.7
	Traditional	5	0.6
	Atheist	10	1.2
	Nonreligious	6	0.7
Marital status	Single	587	72.3
	Married	219	27
	Widowed	2	0.2
	Divorced	4	0.5
Residence	Rural	122	15
	Urban	556	68.5
	Semi-Urban	134	16.5
Employment	Government	346	42.6
	Private	193	23.8
	Self-employed	73	9
	Unemployed	200	24.6
Health-related characteristics
Have a regular health care provider	No	385	47.4
	Yes	427	52.6
Have an active health insurance	No	112	13.8
	Yes	700	86.2
Frequency of vaccinations in the past	Never	114	14
	Once	167	20.6
	Twice	222	27.3
	Annually	69	8.5
	Most years	240	29.6
Experienced side effects after COVID-19 primer vaccination	No	336	41.4
	Yes	476	58.6
Tested positive for COVID-19	No	785	96.7
	Yes	27	3.3

Figure 1. Regional distribution of respondents.

In terms of their health-related characteristics, we observed a larger portion of participants possessing active health insurance (86.2%) and having a regular health care provider (52.6%). Only 14% of respondents had never been vaccinated before. More than half of the respondents reported experiencing side effects after receiving COVID-19 vaccination. Only 27 (3.3%) reported having previously tested positive for COVID-19.

Perceptions toward COVID-19 vaccine

To understand the factors that may impact willingness to accept the COVID-19 vaccine among Ghanaian adults, we explored respondents' attitudes and perceptions towards vaccines for COVID-19. The findings revealed that 499 (61.5%) of the respondents had a “positive” attitude with 313 (38.5%) having a “negative” attitude towards the COVID-19 vaccine. Figure 2A summarizes the distribution of responses to the survey items used to evaluate attitudes toward COVID-19 vaccines. The two items that received the highest disagreement were those which stated that: (i) My religious denomination does not allow for vaccination (85.0%) and (ii) Vaccine likened to the mark of the beast (48.4%). The statement “Belief in God's protection against COVID-19 compared to vaccine's protection” received the highest agreement (34.9%).

Figure 2. Distribution of responses to items measuring (A) public perception toward COVID-19 vaccines and (B) public trust in the government's approach to COVID-19 pandemic.

Trust and confidence in government

We further assessed respondents' trust in government as government intervention and involvement were extremely high during the pandemic and we believe may impact vaccine acceptance. The results of the responses showed that only 187 (23.0%) had “a lot of” trust in the government's approach to managing the pandemic. Figure 2B summarizes the distribution of responses to the survey items used to assess participants trust and confidence in the government.

COVID-19 vaccine booster acceptance and determinants

Out of the 812 respondents of the study, 375 (46.2%) indicated that they are willing to receive a COVID-19 vaccine booster dose with 437 (53.8%) reporting unwillingness. We observed significant differences in vaccine acceptance based on the distinctive characteristics of respondents as shown in Table 2. Multivariate analysis was performed to assess independent predictors of willingness to accept COVID-19 booster doses among Ghanaians. After adjusting for the significant covariates, the predictors of willingness included being a male (adjusted odds ratio [aOR] 1.63, 95% CI 1.07−2.48, p = 0.023), having previously received vaccination twice (aOR 1.96, 95% CI 1.07−3.57, p = 0.028) or in most years (aOR 2.51, 95% CI 1.38-4.57, p = 0.003). Those who experienced side effects upon receiving the primary vaccines (aOR 0.12, 95% CI 0.08−0.18, p < 0.001) were less likely to receive the booster dose. Booster dose acceptance was also higher among those who had previously tested positive for COVID-19 (aOR 3.46, 95% CI 1.23−10.52, p = 0.022). Finally, those who have high trust in the government's approach to the COVID-19 pandemic and had positive perceptions regarding COVID-19 vaccines were more likely to accept a booster dose (aOR = 1.77, 95% CI: 1.15−2.74, p = 0.002 and OR = 14.24, 95% CI: 9.28−22.44, p < 0.001, respectively).

Table 2 Determinants of COVID-19 booster dose acceptance among Ghanaians based on univariate and multivariate logistic analysis.

[Table omitted. See PDF]

Level of significance:

*

p < 0.05

**

p < 0.01

***

p < 0.001.

Respondents' reasons for their unwillingness to accept the vaccine

Figure 3A shows the reasons given by the respondents for their unwillingness to receive the booster doses. The most frequently mentioned reasons for participants' unwillingness to receive the booster dose of the COVID-19 vaccine were concerns about the safety (48.1%) and efficacy (27.0%) of the vaccine. Thirty-one of the respondents who were unwilling to receive the booster dose gave other reasons for their choice of response. These reasons included the belief that the primary doses should be sufficient for protection (18), fear of experiencing side effects (10), and the perception that the vaccine may hurt the immune system (3).

Figure 3. The frequency of (A) reasons reported by respondents for unwillingness and (B) sources of advice that may influence the decision to accept the COVID-19 booster vaccine.

Sources of advice likely to be considered in the vaccine acceptance

On evaluating the source of information likely to impart the willingness to accept the COVID-19 booster dose, the most reported source was information from health professionals (80.9%) with media personalities (2.2%) being the least mentioned as shown in Figure 3B.

DISCUSSION

To the best of our knowledge, this is the first study to report the willingness to receive the COVID-19 booster dose in Ghana. We report that a moderate number of Ghanaian adults intend to receive the booster dose. Their willingness to accept the booster dose depends on factors such as their gender, history of vaccination and experience of side effects upon vaccination with the primer dose. Other factors such as previous COVID-19 infection, trust in the government, and perceptions about COVID-19 vaccines tend to affect willingness to accept the booster dose.

Because of reports of waning immunity to the virus, governments worldwide have started to offer booster vaccines to citizens. Public willingness to receive the booster dose could shore up efforts to minimise the emergence of new variants,¹⁵ thus boosters have been recommended for increased protection with some evidence supporting this claim.^36,37 Thus, countries including Ghana have made efforts in fighting the pandemic and understanding the factors that may influence it is necessary for policy direction. Through our findings, the Ministry of Health and other stakeholders may be able to formulate focused measures to constantly expand the acceptability and coverage of the booster dose for COVID-19.

The rate of willingness to accept the booster may vary from one country to the other and even within the same country. In the present study, 46.2% of Ghanaian adults report that they are willing to receive the booster dose with the remaining majority reporting unwillingness. This number is widely below the pooled prevalence of 78% of individuals who are willing to receive the booster dose globally.³⁸ The rates recorded in Ghana are in line with low willingness rates from developing countries like Saudi Arabia (55.3% in 2021), Algeria (51.6%), and Jordan (39%).^28,29,39 There seems to be a lower willingness to receive the booster dose in developing countries compared to developed countries. Earlier studies have reported rates of willingness as high as 87.8% among German students,⁴⁰ 79.1% and 83.6% among American adults and health workers,^24,41 95.5% among Danes,⁴² 93.7% in China⁴³ and 87.5% in Italy.⁴⁴ Heterogeneity in booster acceptance can be explained by several factors. People from developing countries are more likely to receive the booster dose because of high trust in the government, employer recommendations, access to COVID-19 and vaccine-related knowledge, high susceptibility, and risk perception.⁴³

In earlier studies, concerns regarding booster vaccine safety, efficacy, and side effects, as well as the perception that primer vaccines offer adequate immunity, have been reported as the main reasons for booster vaccine hesitation.^28,29,43 These reasons were similarly reported in the present study as reasons for unwillingness to receive the booster dose. The most frequent of which were concerns about the safety and efficacy of the booster dose. Increased education on vaccines, as well as improved surveillance and management of side effects, are necessary to increase trust in the booster dose.

In the present study, we evaluated respondents' trust in the government and perceptions of the COVID-19 vaccine. These variables are important determinants in the acceptance of COVID-19 vaccines and have been demonstrated in several studies.^45–48 Trust in vaccines, the provider, the health system, government, and vaccine-related information plays an important role in vaccine acceptance.⁴⁹ In the present study, we report that a high number of participants have “low” trust in the government concerning the approach to managing the pandemic. Similarly, a “negative” perception of the COVID-19 vaccine was observed among a considerable number of respondents. Earlier studies conducted in Ghana before the introduction of vaccines reported low trust in authorities and poor perception towards the vaccines.⁵⁰ It is therefore worrying that these perceptions have not changed.

We observed that participants with “a lot of” trust in the government and “positive” perceptions regarding COVID-19 vaccines are more likely to accept the booster dose. These observations have similarly been reported in Hong Kong⁵¹ and the United Kingdom.⁵² Persons who have trust or confidence either in the government or in the vaccine itself are more likely to get vaccinated.^53,54 Changing people's views towards vaccination, in general, may be more beneficial since it can spur the usage of additional vaccinations. This finding also reveals that boosting public trust in the government can significantly impact the uptake of the booster doses against COVID-19. The study further reveals a general trust in health workers similar to earlier reports⁵⁰ and highlights the need to incorporate the health worker in communicating the uptake of the booster dose. Recommendation from experts or scientists is likely to increase willingness to accept the booster dose as reported in Algeria.²⁸

The finding that men are more willing to receive the booster dose is consistent with previous studies from various countries.^24,28,55,56 Gender variations in psychology and hormonal characteristics could account for this difference.⁵⁷ Vaccination involves potential hazards, such as adverse effects, therefore the observed difference between genders could be explained by the fact that women tend to be more careful in taking risks and require more time to arrive at a decision.⁵⁸ We further observed that people who had previously received vaccination for other diseases were more likely to receive the booster dose as observed in previous studies.^59,60 Similarly, studies in China⁶¹ and the United States⁶² found that persons who had already received the influenza vaccination exhibited a stronger readiness to take the COVID-19 vaccine. People who have previously been vaccinated are more likely to understand and appreciate the need for vaccination. It is also possible that these individuals had a positive experience with the vaccines earlier received.

We found that respondents who experienced adverse effects after receiving the primer dose were less likely to receive the booster dose similar to earlier reports.^29,60,63 One of the main reasons impeding COVID-19 vaccine acceptance is concerns about vaccine safety.⁶⁰ People who experienced adverse effects upon receipt of the primer doses have fears of potentially experiencing these adverse effects again and are most likely to resist any effort to receive another dose. These findings show that Ghanaians require information on vaccine safety and effectiveness, and authorities need to actively provide data as they become available to ensure public confidence. We found that respondents who were previously infected by COVID-19 were most likely to accept the booster dose consistent with a study in Greece⁶⁴ and this could be explained by perceived susceptibility and desire not to experience COVID-19-related symptoms again.

Strengths and limitations

To the best of our knowledge, this is the first study to report the willingness to receive the COVID-19 booster dose in Ghana and highlights key areas for consideration to increase its acceptance. The online surveying nature of the study means that participants had privacy to provide honest and accurate responses minimizing any possible social desirability or interviewer biases. The findings of the present study may be considered taking into consideration some limitations associated with the study. Some groups, including people without internet access, uneducated, and those from rural settings, were not adequately represented, limiting the study's generalizability, although the online survey nature attracted a considerable sample size from all representative regions of the country. Because of the cross-sectional design used for the study, the results could not imply any cause-effect relationship as reverse causality remains a possibility. Finally, the study design employed in this study limited our ability to obtain reasons behind participants' vaccine acceptance decisions. For that matter, a mix-method study would be appropriate in finding these answers and is recommended for future studies on a similar subject.

CONCLUSION

Low intention to accept the booster dose, which is associated with a range of factors including the perception of vaccines and trust in the government is a cause for concern. Thus, more effort would have to be taken through education and policy interventions to increase the chances of citizens accepting the booster dose. Stakeholders need to be open and give clear and honest information about vaccine procurement, safety, and efficacy to improve public trust. Health workers and scientists should be involved in communicating the uptake of the booster dose.

AUTHOR CONTRIBUTIONS

Rebecca Peniel Storph: Conceptualization; investigation; methodology; project administration; writing—original draft; writing—review and editing. Mainprice Akuoko Essuman: Conceptualization; data curation; formal analysis; investigation; methodology; software; supervision; validation; writing—original draft; writing—review and editing. Ruth Duku-Takyi: Conceptualization; investigation; methodology; writing—original draft; writing—review and editing. Albert Akotua: Data curation; formal analysis; investigation; visualization. Samuel Asante: Investigation; writing—review and editing. Richard Armah: Data curation; formal analysis; investigation; software; visualization. Irene Esi Donkoh: Investigation; writing—original draft; writing—review and editing. Prince Anim Addo: Data curation; investigation; methodology; project administration; validation; writing—review and editing.

ACKNOWLEDGMENTS

The authors are grateful to the respondents of the survey for taking the time to participate in the survey. Without their participation and feedback, this study would not have been possible. The authors received no financial support for the research, authorship, and/or publication of this article.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT

Full data for this research are available through the corresponding author upon request.

TRANSPARENCY STATEMENT

The lead author Mainprice Akuoko Essuman affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.