Coverage of COVID-19 vaccines in Somalia remains low, including among health workers. This study aimed to identify factors associated with COVID-19 vaccine hesitancy among health workers. In this cross-sectional, questionnaire-based study, 1476 health workers in government and private health facilities in Somalia’s federal member states were interviewed face-to-face about their perceptions of and attitudes toward COVID-19 vaccines. Both vaccinated and unvaccinated health workers were included. Factors associated with vaccine hesitancy were evaluated in a multivariable logistic regression analysis. Participants were evenly distributed by sex, and their mean age was 34 (standard deviation 11.8) years. The overall prevalence of vaccine hesitancy was 38.2%. Of the 564 unvaccinated participants, 39.0% remained hesitant. The factors associated with vaccine hesitancy were: being a primary health care worker (adjusted odds ratio (aOR) = 2.37, 95% confidence interval (CI): 1.15–4.90) or a nurse (aOR = 2.12, 95% CI: 1.05–4.25); having a master’s degree (aOR = 5.32, 95% CI: 1.28–22.23); living in Hirshabelle State (aOR = 3.23, 95% CI: 1.68–6.20); not having had COVID-19 (aOR = 1.96, 95% CI: 1.15–3.32); and having received no training on COVID-19 (aOR = 1.54, 95% CI: 1.02–2.32). Despite the availability of COVID-19 vaccines in Somalia, a large proportion of unvaccinated health workers remain hesitant about being vaccinated, potentially influencing the public’s willingness to take the vaccine. This study provides vital information to inform future vaccination strategies to achieve optimal coverage.

By 31 December 2021, only 5.5% (861 879/15 670 530) of the Somali population had been fully vaccinated against coronavirus disease 2019 (COVID-19). To rapidly increase COVID-19 vaccine coverage in 2022, the health ministry and its partners (World Health Organization and United Nations Children’s Fund) adopted a more responsive strategy. This strategy included careful microplanning, better targeting of populations and providing people-centred vaccination services close to their homes. These services were combined with childhood vaccination and basic health-care provision using the existing polio network and community health workers. Additionally, a digital tool for recording COVID-19 vaccination data and a mobile phone-based electronic registration system were introduced. Somalia, a fragile and conflict-affected state, faced challenges when implementing COVID-19 vaccination, including inexperience in managing mass adult vaccination, inadequate infrastructure and health workforce. Furthermore, insecurity in some areas and severe drought resulted in large-scale displacement of people. The implementation of a more context-specific strategy helped Somalia reach substantially more people with COVID-19 vaccination and 42.1% coverage by 31 December 2022. Additionally, 84 600 zero-dose children received their first childhood vaccine during the integrated campaigns. The increased coverage has led to public health benefits that outweigh the investment in the COVID-19 vaccination campaigns. Successful roll-out of adult vaccination is achievable even in a fragile and conflict-affected setting through implementation of a tailored contextualized approach. Key factors include good microplanning, use of digital tools, better population-targeting, bundling vaccines together and delivering vaccination services close to people’s homes.

Background: Vaccination against coronavirus disease 2019 (COVID-19) began in Somalia on 16 March 2021 with the Covishield (ChAdOx1 nCoV-19) vaccine. However, by the end of 2021, only a small percentage of the population had been fully vaccinated. As side effects play an important role in determining public confidence in vaccines and their uptake, this study aimed to examine reported adverse events following immunization (AEFIs) of vaccine recipients.Methods: This cross-sectional-survey-based study was conducted between March and October 2021 in Somalia. Vaccine recipients who were eligible to receive the first dose of the Covishield vaccine in the first phase of COVID-19 vaccination were eligible for study inclusion. P < 0.05 was considered to indicate significance.Results: Of the 149,985 respondents who had received the first dose of the Covishield vaccine, 378 reported side effects. This represented a reported AEFI rate of 2.5 per 1000 population. Amongst those who reported adverse events, males (2.8 per 1000; P < 0.001), respondents aged 35-49 years (3.3 per 1000; P = 0.001) and teachers (3.5 per 1000; P = 0.000) had higher rates of adverse events compared with females, other age groups and other occupations. Amongst population settlement types, a higher rate of AEFIs was observed amongst refugees (23.9 per 1000; P = 0.000) and internally displaced populations (19 per 1000; P = 0.000). Nearly half of the vaccine recipients who reported side effects (48%) reported one local symptom, and most symptoms were mild in nature. The probability of having acute and severe side effects was found to be 66% lower among males compared with females [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.26-0.73; P = 0.002]. Respondents aged > 60 years (OR 1.52, 95% CI 0.64-3.62; P = 0.34) were more likely to develop acute and severe AEFIs. None of the study population reported any severe life-threatening symptoms or death.Conclusion: Some variables (sex, profession, age) put recipients at higher odds of acute and severe AEFIs, but the Covishield vaccine generally produced mild side effects in a small proportion of the vaccinated population in Somalia. This study confirms that COVID-19 vaccines are safe, and their benefits clearly outweigh any associated risk.