Community perspectives on COVID-19 vaccine allocation ethical principles in Uganda: a cross-sectional study

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Background: The scarcity of COVID-19 vaccines raised tough questions about who should get them first. While global guidelines stress fairness, they may overlook local realities and community voices. Without understanding these perspectives, efforts to ensure equity and build trust risk falling short. Therefore, this study aimed to assess the multifaceted perceptions, knowledge, and attitudes of community influencers in Uganda regarding COVID-19 vaccination. Methods: This study adopted a mixed-methods cross-sectional descriptive design. The study participants were identified through community-based organizations (CBOs) to get a broad representation of the various community members and practical community entry points. Quantitative data were analyzed using the Statistical Package for Social Sciences (SPSS). Qualitative data were analyzed using thematic content analysis with NVivo 12.0 software. Results: > 0.05). Ninety percent (90%) supported guiding principles. Only few of the participants 31% agreed that they were very likely to contract COVID-19 after vaccination, 81% favored equal treatment but low trust in equity across classes or tribes. From the qualitative data, five themes which included, gender/power imbalances, economic divides, social norms, herbal alternatives, and tribalism. Global equity skepticism was high (57% no trust in LMIC/HIC quality parity); 86% endorsed national equity, but doubts persisted on at-risk prioritization and fair distribution. Conclusion: While awareness of guidelines is relatively high, it is overshadowed by pervasive skepticism regarding vaccine efficacy, profound distrust in the fairness and integrity of distribution processes, and a feeling of exclusion from decision-making at global and national levels. Therefore, addressing these challenges requires a multi-pronged approach that goes beyond simply disseminating information about COVID-19 vaccination. With the strong support for ethical principles in COVID-19 vaccination, addressing equity gaps through culturally attuned strategies is essential for equitable distribution and sustained public trust in Uganda.

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