COVID-19 VACCINE COVERAGE AND ACCEPTABILITY AMONG WOMEN ATTENDING FIRST ANTENATAL CARE VISITS IN 3 DISTRICTS OF ZAMBIA, DECEMBER 2021-JUNE 2022

INTRO: COVID-19 vaccines are safe and effective at reducing risk of severe COVID-19 among pregnant women, a group at higher risk of severe disease. However, vaccine uptake has been slow among people in Zambia. We sought to describe vaccine uptake among pregnant women in Zambia. METHODS: We conducted serial cross-sectional surveys among pregnant women attending first antenatal care visits in one rural and two urban districts of Zambia from December 2021 through June 2022. Ten health facilities per district were randomly selected and a convenience sample of 20 women per facility per month were recruited. Consenting participants were administered an electronic questionnaire asking about offers and receipt of COVID-19 vaccines. FINDINGS: In total, 3,652 women were recruited from December 2021 to June 2022, and 82.4% had not received a COVID-19 vaccine. Vaccine coverage among participants rose from 10.5% in December 2021 to 28.7% in June 2022 (p<0.01). During the same period, the proportion of women who reported being offered a vaccine rose significantly from 22.4% to 52.5% (p<0.01), with a non-significant increase in the proportion of women who were unvaccinated but willing to accept a vaccine (58.0% to 65.8%, p=0.59). Among 785 women who were unvaccinated and not willing to accept a vaccine, 42.3% were concerned about the safety of vaccination during pregnancy. CONCLUSION: Vaccine coverage among pregnant women in Zambia remains low and safety concerns during pregnancy are high. Door-to-door vaccination campaigns and individual vaccination consultations at all healthcare encounters may increase the number of women being offered a vaccine. Focused safety messaging for pregnant women may help to alleviate fears and increase COVID-19 vaccine uptake.