Exploring key informants’ perceptions of Covid-19 vaccine hesitancy in a low-SES urban community in Ireland: emergence of a ‘5Cs’ model

Abstract Aim: The aim of this study was to explore key informants’ views on and experiences with Covid-19 vaccine hesitancy in a Dublin community of low socioeconomic status (SES) and to identify feasible, community-centred solutions for improving vaccination acceptance and uptake.Methods: Qualitative, semi-structured interviews were carried out at a local community-centre and a central hair salon. Twelve key informants from the target community were selected based on their professional experience with vulnerable population groups: the unemployed, adults in recovery from addiction, the elderly, and Irish Travellers. Inductive thematic framework analysis was conducted to identify emergent themes and sub-themes. Results: Drivers of vaccine hesitancy identified by key informants largely fell under the WHO ‘3Cs’ model of hesitancy: lack of confidence in the vaccine and its providers, complacency towards the health risks of Covid-19, and inconvenient access conditions. Covid-19 Communications emerged as a fourth ‘C’ whereby unclear and negative messages, confusing public health measures, and unmet expectations of the vaccine’s effectiveness exacerbated anti-authority sentiments and vaccine scepticism during the pandemic. Community-specific recommendations involved the provision of accurate and accessible information, collaborating with community-based organizations to build trust in the vaccine through relationship building and ongoing dialogue, and ensuring acceptable access conditions.Conclusions: A Confidence, Complacency, Convenience, Communications, Community-centred Solutions (‘5Cs’) model of vaccine hesitancy emerged through inductive analysis of key informant interviews in a low-SES urban community. The model and in-depth key informants’ perspectives can be used to compliment equitable vaccination efforts currently underway by Health Services Executive Ireland and non-governmental organizations.