Zambians Favor New TB Vaccines, Study Shows

Tuberculosis remains a major global health challenge, and new vaccines for adults and adolescents are seen as essential to meeting control targets. Recognizing that several vaccine candidates could be ready within five years, researchers led by Andrew D. Kerkhoff set out to understand whether people in Zambia would accept such vaccines and what would influence their decisions. The study focused on Lusaka, a capital city where vaccine attitudes can shape wider rollout efforts, and it looked both at ordinary community members and the health workers who would be asked to deliver and promote any new vaccine. The goal was practical: to gather early, real-world information that could inform readiness activities and make a future introduction more likely to succeed. By combining structured surveys with in-depth conversations, the team aimed to capture both the numbers—how many people would say they intended to get a vaccine—and the reasons behind those numbers. This mixed approach was designed to highlight not only broad acceptance or hesitancy, but also specific concerns, delivery preferences, and ways to build trust before a vaccine arrives.

The study used a convergent mixed-methods design in Lusaka, Zambia. Adult community members were enrolled from randomly selected households in four communities chosen for historically low COVID-19 vaccine coverage, and healthcare workers (HCWs) were recruited from 10 public facilities representing different levels of care. In total, 499 people completed structured surveys (395 community members and 104 HCWs). The qualitative component included 25 in-depth interviews (IDIs) and nine focus group discussions (FGDs), with 63 additional participants, and findings from both strands were analyzed together. Researchers used mixed-effects Poisson regression to estimate the marginal probability that a participant intended to get a new TB vaccine. On the survey, 77% of community members and 83% of HCWs said they intended to be vaccinated. The only factors that significantly predicted vaccine intention were perceived personal risk of TB and how serious people thought the disease was. Participants generally accepted the World Health Organization’s minimum vaccine specifications—50% efficacy, a two-dose schedule, transient mild side effects, and protection lasting at least two years—though HCWs said they would prefer higher efficacy because of their occupational exposure. For delivery, people recommended early community engagement (three to six months before rollout), multiple delivery sites—facility-based and community venues for adults, schools for adolescents, and door-to-door campaigns—and clear, transparent communication using trusted sources to counter COVID-19-related skepticism.

These findings point to practical steps that could make a new TB vaccine roll out successfully in Zambia. High expressed intention among both community members and health workers suggests a strong starting point, but the study also makes clear that intention alone won’t guarantee uptake. Perceived risk and severity were the main motivators, so messaging that explains who is at risk and why vaccination matters will be important. Health workers’ desire for higher efficacy highlights the need to communicate clinical benefits clearly and to consider occupational vaccination policies. The acceptance of modest WHO minimums shows pragmatism among participants, but implementers should aim for higher performance where possible and be ready to explain trade-offs. The emphasis on early engagement, multiple delivery channels, and trusted messengers offers a road map: start outreach months ahead, use schools and community sites as well as clinics, consider door-to-door options for people who can’t reach facilities, and address lingering COVID-19 skepticism with transparent information. Taken together, these actionable recommendations can guide readiness activities so that when viable adult and adolescent TB vaccines become available, Zambia is prepared to protect more people efficiently and equitably.