Over 5.8 million people have died worldwide since World Health Organization (WHO) announced the coronavirus disease 2019 (COVID-19) pandemic [1] , including over 1915 persons in Cameroon [2] . In Africa, particularly Cameroon, COVID-19 infection rates are declining. Private and public institutions/agencies have made a record-breaking global effort to create vaccines against the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). As the pandemic progressed, the world observed the emergence of a new variant [3] . The SARS-CoV-2 strains that have been characterised globally have been given the names Alpha (B.1.1.7 in the United Kingdom in September 2020), Beta (B.1.351 in South Africa, May 2020), Gamma (P.1 in Brazil, November 2020), Delta (B.1. 617.2 in India, October 2020), and the most recent Omicron (B.1.1.529 in many countries in the world) [3] . The global strategy has made vaccine distribution and development a top priority. The COVID-19 vaccination (COVAX) program, supported by the World Health Organization (WHO) and other international organisations, aims to send 600 million vaccine doses to Africa, enough to immunise at least 20% of the continent’s population. By April 2021, 18 million doses, or 2% of all vaccine doses administered globally, had been disseminated throughout 41 African countries [4] . As part of the global effort to combat the COVID-19 pandemic, the COVID-19 vaccine was being distributed in various nations; Cameroon joined the COVAX facility in April 2020. The COVAX facility is the Access to COVID-19 Tools (ACT) vaccine pillar accelerator, pursuing equitable and innovative access to diagnostics vaccination and treatment [5] . By March 23, 2023, there were zero vaccinations in clinical testing in Cameroon, just like in all nations where clinical trials have been conducted [6] .

As Cameroon qualified for the COVAX facility’s advance market commitment 92 funding mechanism [7] , the Chinese government sent 200,000 tablets of Sinopharm to the Prime Minister of Cameroon on April 11, 2021. On April 17, it received 391,200 doses of the 1,200,000 doses of Covishield vaccines that were anticipated. Four vaccines against SARS-CoV-2 have been approved by the Cameroonian health authorities, represented by the National Immunization Technical Advisory Groups (NITAG) and the Scientific Advice for Public Health Emergencies. These vaccines include the JNJ-78436735 (Johnson and Johnson), the AZD1222 (Oxford-Astra Zeneca), the BBIBP-CorV (Sinopharm), and more recently the BNT162b2 (Pfizer-BioNTech) [7] . Healthcare workers, security employees, persons over 50, and those with comorbidities were listed in the responses as the top priority target populations for COVID-19 immunisation. According to vaccination statistics, Sinopharm, Johnson and Johnson, AstraZeneca, and Pfizer SARS-CoV-2 vaccines work effectively against severe SARS-CoV-2 in 73%, 86%, 94%, and 95% of cases, respectively [8] . Three rounds of the national vaccination campaign were held to increase vaccination coverage to reach the target of at least 60% of the population being immunised. Forty-three thousand six hundred fifty-one individuals received at least one dose of the vaccine between April 12 and May 12, 2021. The target population for the COVID-19 vaccination has already received doses from 43,651 and 1061, respectively, representing 5.4% and less than 1% of the population [9] . As of 18^th November 2022, around 5% of the eligible population had received vaccinations, putting the nation far behind the worldwide goal of obtaining 70% vaccination coverage by the end of the year. The Johnson and Johnson vaccine was the most often requested vaccine, followed by the Oxford-Astra Zeneca vaccine, accounting for 48.24% and 38.49% of all delivered vaccine doses [9] . Representatives are working to increase population coverage and close vaccine equality disparities. During a five-day mission, representatives from the WHO, UNICEF, GAVI, USAID, and Africa CDC came together to convince senior government officials, religious leaders, and civil society organisations of the need to support the Ministry of Public Health’s COVID-19 vaccine campaign [10] . During a high-level COVID-19 vaccine delivery partnership (CoVDP) mission in Yaoundé, Cameroon, on November 14^th to 18^th, 2022, representatives and staff from the World Health Organization, UNICEF, GAVI, USAID, and Africa Centers for Disease Control (CDC) met to discuss strategies for accelerating COVID-19 vaccinations in the nation [10] .

A further barrier to vaccination uptake in African countries, including Cameroon, maybe a preference for conventional/traditional treatments. This is in addition to the poor availability of COVID-19 vaccines and resistance to receiving the vaccine. Despite not meeting safety and efficacy standards, traditional drugs have been utilised in Tanzania and Madagascar to treat COVID-19 [11] . It can be challenging to convince people in many countries to receive the COVID-19 vaccine [12] . The general population’s approval of COVID-19 immunisation was best in Vietnam (98%), India (91%), China (91%), Denmark (87%), and South Korea (87%), while it was lowest in Serbia (38%), Croatia (41%), France (44%), Lebanon (44%), and Paraguay (51%). According to reports from all over the world, HCWs have high rates of hesitancy essential to easing the effects of the epidemic through their work in giving immunisations and establishing an excellent example for prevention, which is crucial to reducing the consequences of the epidemic.

A review of 35 studies found that vaccination resistance rates varied from 4.3% to 72% globally [13] . Vaccine’s efficacy, safety, and possible adverse effects were significant issues facing medical practitioners. Higher socioeconomic status, direct patient contact, feeling of COVID-19 risk and fear, and having received an influenza vaccination in the past were all associated with higher vaccine uptake [13] . HCWs who refuse COVID-19 immunisation may increase the risk of viral transmission to their patients and society and be less likely to advise their patients and community to acquire the vaccine [13] . There is no evidence to support Cameroonian health personnel’s attitudes, viewpoints, and perceptions regarding COVID-19 vaccination in Cameroon. In this study, healthcare worker’s vaccination acceptance rates for the COVID-19 virus are evaluated along with the participant’s attitudes and perceptions about the COVID-19 vaccine and its related causes in Yaoundé, Cameroon.

This study aimed to determine the acceptance rate of COVID-19 vaccination and associated factors among HCWs in Yaoundé, Cameroon.

• There is a significant difference between the attitudes and perceptions to the acceptance of COVID-19 vaccines among healthcare workers in Yaoundé, Cameroon.

On-going efforts are being made to end the COVID-19 pandemic. Various COVID-19 vaccines have been distributed in many countries, including Cameroon. The overall knowledge, sound perception, and favourable attitude rates of the HCWs about COVID-19 vaccines were 63.1%, 52.8%, and 45.5%, respectively. In our study, 68.4% of the HCWs were been vaccinated, and 31.6% refused to do so. A similar vaccine acceptance rate was reported by a study in Iraq (61.7%) [15] and a study in Ethiopia, which reported a 64% acceptance rate [16] , which was higher than in two studies in the USA, where more than half of all HCWs were undecided and delayed the decision to be vaccinated [17] [18] . Low acceptance rates were also reported among healthcare workers in the Democratic Republic of Congo (27.7%), Egypt (21%), Nepal (38.3%) and Ghana (39.3%) [19] . Studies in Ghana and Saudi Arabia reported intended vaccine uptake rates of 50.2% [20] and 50.52% [21] , respectively. Low rates may be due to earlier study dates (when prospects of the vaccine rollout were uncertain), HCWs limited knowledge about vaccines, lack of trust in government management capacity, and concerns about vaccine safety. Some of the highest vaccine acceptance rates (above 80%) were reported from South and Southeast Asia, where HCWs were willing to be vaccinated because they perceived the pandemic to be severe, considered the vaccines to be safe, experienced few financial constraints and little stigmatization of being vaccinated, and trusted the health authorities [22] . Studies in China and Vietnam reported intended vaccine uptakes of 76.63% [23] and 76.10%, respectively [24] , slightly higher than ours. These high rates were associated with good knowledge regarding the severity of COVID-19, HCWs’ trust in the vaccines, and earlier study dates than in our study.

In this study, high rates of not intending to be vaccinated were associated with negative attitudes and low perception of the COVID-19 vaccine despite poor perception not being statistically significant. Our study also showed that HCWs of age between 20 and 50 years, without health insurance, have been nurses and midwives, grew up in rural and semi-rural areas, have attended training only once, and have a member of families or friends who had COVID-19 were not willing to be vaccinated. Still, this association between being a nurse and a midwife was not significantly associated with acceptance to be vaccinated for COVID-19, similar to a study in Ethiopia at Debre Tabor Hospital. In contrast to our findings, a study in India found vaccine acceptance to be highest among nurses [25] . However, Medical doctors and public health workers had higher acceptance rates, similar to a study in the Democratic Republic of the Congo, where the highest acceptance rates among HCWs were reported for medical doctors [26] and in Debre Tabor Hospital in northern Ethiopia, nurses had the lowest acceptance rates [27] . Our findings corroborate a study from the Democratic Republic of the Congo that reported a positive attitude towards COVID-19 vaccines, significantly associated with the willingness to receive a vaccine [28] . A study among HCWs of an inner-city hospital in New York [29] reported similar results. A study in Libya indicated that having a family member or friend infected with COVID-19 was positively associated with the likelihood of vaccine acceptance [29] . A community-based study in Wolaita Zone, Ethiopia, showed that family members and friends tested for COVID-19 were significantly associated with accepting the COVID-19 vaccine [30] . In our study, having COVID-19-infected family members, colleagues, or friends was significantly associated with increased vaccine uptake intention only in the multivariate analysis but not in the bivariate logistic model. In addition, as indicated in Table 4, 39.4% and 11.6% of the HCWs do not think their family members and colleagues, respectively, see vaccination as a good idea. Meanwhile, 45.1% of the HCWs associated vaccines with possible COVID-19 infections, and 39.8% thought vaccines could worsen any pre-existing medical conditions. 21% of HCWs still do not believe that getting vaccinated is an excellent way to protect their friends and families.

This raises serious concerns since it suggests that HCWs are both uninformed and unconvinced about the safety of COVID-19 vaccinations. Although the cause of this widespread misunderstanding is unknown, Cameroonian public health organizations may need to step up their efforts to enlighten HCWs about the security of these vaccines. Study limitations, including bias, may have impacted the outcome of our study. HCWs may have overreported positive attitudes and impressions and anticipated vaccine uptake due to social desirability bias, which occurs when respondents answer questions in a way that others would see favourably. Furthermore, due to the study’s methodology, causal conclusions cannot be taken from it.

Healthcare professionals in Yaounde, Cameroon, showed a moderately high level of readiness to receive the COVID-19 vaccine. The most important reasons for refusing immunisations were negative attitudes and perceptions of HCWs concerning COVID-19 vaccines. HCWs are tasked with administering vaccines to the population and are among the first to get vaccines. Thus, it is imperative that critical aspects of their decision-making process, such as information and attitudes regarding vaccine safety, are addressed as soon as possible. Our findings may assist health administrators and planners in creating pertinent interventions encouraging Cameroonian healthcare workers to receive vaccines during the pandemic. The high percentage of HCWs who believed that immunisations could exacerbate any existing medical issues or lead to COVID-19, in particular, is highly troubling because it appears that HCWs are both uninformed and unconvinced about the safety of immunisations. The Ministry of Public Health and other Cameroonian public health organisations must address these problems immediately. Raising attitudes and perceptions of COVID-19 vaccines may be possible by working on behavioural change, communication, and social mobilisation using culturally appropriate methods. This would increase the rate of COVID-19 immunisation. We also recommend studies in urban and rural communities to investigate the religious conspiracy about COVID-19 vaccines that may increase the vaccination rate of COVID-19.

The information on attitudes and perceptions about the refusal of the COVID-19 vaccine among HCWs can inform policymakers and administrators about opportunities and constraints in distributing vaccines among HCWs in Yaoundé and other cities in Cameroon. The findings may thus contribute to developing a strategy for controlling the pandemic by addressing factors significantly affecting vaccination uptake.

In this study, we could not identify the fully or partially vaccinated status of confirmed COVID-19 cases.

We gratefully acknowledge the University of Buea for providing the ethical clearance letter that allowed us to do this study. We also thank the Yaoundé Regional Delegation of Public Health for permitting us to conduct this study. We also acknowledge the managers of the public and private healthcare facilities in Yaoundé for their permission to conduct this study and for the information we received when needed. We thank the data collectors and supervisors for their assistance and all study participant’s participation and valuable information.

Ethics approval and consent to participate Ethical approval were obtained from the Institutional Ethical Review Committee of the Faculty of Health Sciences at the University of Buea. Informed written consent was obtained from study participants after the purpose of the study was explained to them, and they were assured that their information would not be used for purposes other than scientific research. Confidentiality was ensured by using code numbers rather than names. All the methods used comply with the principles and ethical standards of the declaration of the University of Buea. Moreover, no personal pieces of information have been disclosed in the presentation of results, thus ensuring the confidentiality of all participants.

This study did not receive any funding from public or private entities.

Data curation, Formal analysis, Investigation, Conceptualization, Methodology, Project administration, Resources, Software, Writing an original draft, Writing a review, and editing were done by TKA. Supervision, Validation Visualization, Project administration, and editing done by Prof. LN, NSA (PhD) and ES (PhD).

There was no conflict of interest between the authors.

Kinsley Aka, T., Ndeso Atanga, S., Nkie Esemu, S. and Ayamba Ndip, L.M. (2024) Attitudes, and Perceptions of COVID-19 Vaccines and Acceptance to Receive COVID-19 Vaccine among Healthcare Workers in Yaounde, Cameroon. Open Access Library Journal, 11: e11483. https://doi.org/10.4236/oalib.1111483

AOR: Adjusted Odds Ratio;

CI: Confidence Interval;

COR: Crude Odds Ratio;

HCWs: Healthcare Workers.