Behavioural and social drivers of COVID-19 vaccination in Papua New Guinea: A cross-sectional study

Papua New Guinea (PNG) has one of the world's lowest COVID-19 vaccination rates, despite high awareness of the disease. Understanding the behavioural and social drivers of vaccine acceptance is essential for informing context-appropriate strategies to improve uptake. This study is the first in PNG to systematically apply the WHO Behavioural and Social Drivers (BeSD) framework to examine factors associated with COVID-19 vaccination status.

A cross-sectional, household-based survey was conducted between July 2023 and May 2024 in urban and rural areas of Eastern Highlands and Madang provinces. Stratified sampling ensured balanced representation by age, sex, and residence. Data were collected using a structured questionnaire aligned with the four BeSD domains: thinking and feeling, social processes, motivation, and practical issues. Survey-weighted logistic regressions were used to identify factors associated with self-reported vaccination.

Among 480 participants surveyed, only 9.7 % had received at least one COVID-19 vaccine dose. Vaccination status was significantly higher among urban residents, those with tertiary education, and higher income groups. Perceived vaccine safety was the strongest predictor of vaccination (adjusted odds ratio [aOR]: 16.3, 95 % CI: 3.0-88.0). Other significant predictors included support from friends or family (aOR: 3.0, 95 % CI: 1.2-7.4), trust in religious leaders (aOR: 2.9, 95 % CI: 1.1-7.9), willingness to be vaccinated (aOR: 2.4, 95 % CI: 1.1-5.5), and knowledge of where to access vaccine information (aOR: 2.3, 95 % CI: 1.0-5.6). Affordability concerns were not prominent barriers, suggesting that logistical and informational barriers may play a greater role.

COVID-19 vaccination status in PNG is shaped by a complex interplay of individual perceptions, social influences, and access-related factors. Addressing safety concerns, engaging trusted social and religious figures, and improving access to reliable vaccine information are key strategies to enhance vaccination status. These findings provide valuable insights to inform tailored communication and delivery strategies in PNG.