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COVID-19 vaccine decision-making: The story of a career woman in Kenya


Final Mile concluded its formative research to understand the COVID-19 context, vaccine decision mental models, decision drivers and barriers to the COVID-19 vaccine uptake through end user in-depth interviews and context mapping. This has been conducted in four countries, Burkina Faso, Ivory Coast, Kenya, and Pakistan. Intriguing stories have been shared by individuals in their unique journeys towards COVID-19 vaccination, with unpredictable final outcomes.

During the 2 years that Wafula* (not real name) has worked at a health facility in Bungano, she's seen numerous patients and colleagues succumb to COVID-19. She, too, has come down with mysterious headaches, chills, fever and respiratory symptoms associated with the virus. A few months ago, on experiencing flu like symptoms she went to the doctor.

When the doctor at the hospital informed her on the positive diagnosis for COVID-19, it felt as though her conscious brain had been jolted awake. Thoughts about death and the possibility of not getting pregnant immediately illuminated in her radar. She was devastated to say the least. Besides, this was during the peak of the COVID-19 pandemic and she had already witnessed way too many deaths in the hospital. Stories she heard from patients experiencing severe COVID-19 symptoms haunted her.

Prior to testing positive Wafula had felt she carried the virus with her. With visitations limited to one person in the hospital, she dutifully engaged COVID-19 patients in conversations as she perceived many to be slipping into mentally depressive states. Let alone the trumped up nursing duties with limited personal protective equipment. The hospital was overwhelmed on all fronts, what used to be a maternity ward had been extended to fit COVID-19 patients. After all, the old lady she nursed before knocking off, might not be there the next morning when she comes for her shift. However, Wafula had been extra careful- wearing three masks at work, soaking her clothes in hot water every day and wearing the protective gear that was provided by the government. She wanted to quit the job and this was the second time she had thought about it. The first time she wanted to quit her job was when the government had made it mandatory for frontline workers to get vaccinated. The thought of throwing away years spent in education and in securing the job made her rubbish the decision. Rumours that the COVID-19 vaccines cause infertility in women were the chief the reason behind her decision to quit the job.

Wafula is not the only one to have faced such conundrums.

Also interviewed during the Final Mile behavioural inquiry into vaccine hesitancy was a newly wedded mother of one who works as a registration officer at a clinic. Before getting that post, she was a merchandiser at a local store but lost the job after getting pregnant. She is part of the women who have not been vaccinated but lives in constant fear that at some point she will be asked to produce the vaccine certificate. She too admits that when the time comes, despite her fears, she might take the risk and take the jab. Similar sentiments were passed by a mother of three who had to get vaccinated in order to travel and pursue her entrepreneurial adventures. The decision did not come easy. She had to relocate more than two times because she could not afford to stay in the city.

Amid a fluctuating unemployment rate, Kenya's legion of workers - most of them women – expressed fears of losing their ability of giving birth when they get vaccinated against COVID-19 but have since done it anyway due to work mandates.

These stories demonstrate the complexity of psycho-behavioral factors that inform the decision to vaccinate against COVID-19. While it can be a rational and acceptable decision, the inability to cope with the perceived risks of the vaccines, despite perceived rewards of vaccination can lead to inaction. A review of the responses shows that women regarded having completed an educational level, holding a job and having a stable income and good housing as important factors that are to be juxtaposed with the possible consequences of not being able to give birth due to the COVID-19 vaccine. Their choice emerges out of a woman’s psycho-social and economic trade-offs. A wide range of demographic, psycho-social, and behavioural factors influence women's individual decisions in-favour of the relevant trade-offs. Their hunger for information is insatiable but hours of browsing online sites often leads to fear and confusion. As we observed, many vaccine-hesitant women expressed that they would rather procrastinate COVID-19 vaccination while observing if the infertility claims are true.

In the African context, womanhood can be proven through being fecund and fertile, by actually getting pregnant. A pregnant woman can conjure respect from their partner, in-law relatives and family members. Children are given spiritual and social value, as they are perceived to be a gift from God or ancestral spirits, and hence pregnancy is respected. It is important to note that participants did not ascribe these beliefs as contributing to hesitancy. But as bevahioural architects we understand the immense power of subconscious views of how the world works and the beliefs cannot be looked in isolation.

Young women appear to be a vulnerable cohort constantly fighting COVID-19 for its uncertain and perceived high socio-economical costs more than its direct health benefits. The stories from the field provide us with valuable insights to design compatible incentives catering to the perceived risks and benefits of target population such as young women in this case.

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