Characteristics of Study Participants.

The COVID-19 pandemic negatively impacted routine immunizations worldwide, decreasing confidence in vaccination programs. We used mixed methods to examine changes in vaccine confidence from before to during the pandemic in HBV-negative adults in Kinshasa who were exposed to HBV in the household, and eligible for HBV vaccination. We measured changes in routine HBV vaccine confidence with a previously validated Shift in Vaccine Confidence (SVC) self-report measure that was verbally administered in Lingala (local language). We compared vaccination confidence before versus during the pandemic using Chi-square tests. We also interviewed participants and coded open-ended responses to the SVC scale to explore context-specific perceptions. From April 2022 to February 2023, we administered the SVC tool to a purposive sample of 41 participants: 7 vaccinees, 23 willing to receive HBV vaccine, and 11 refusers. Participants had a median age of 32 years, were predominantly affiliated with Revivalist churches, and most reported unemployment and no education beyond secondary school. We observed statistically significant declines across all five vaccine confidence domains when comparing responses before and during the pandemic (p < 0.01): vaccines prevent diseases (85.4%-68.3%), are safe (80.5%-46.3%), important for a child’s health (92.7%-87.8%) and one’s own health (87.8%-68.3%), and new vaccines carry no more risk than routine vaccines (78.1%-63.5%). Qualitative analysis identified four themes impacting uptake decisions: vaccine confidence, knowledge, risks, and external influences. Rising uncertainty about efficacy, safety, and distrust in the COVID-19 vaccine undermined vaccine confidence among our participants. Factors such as distrust in manufacturers and government, fear of side effects, perceived low illness risk, and inconvenient healthcare access contributed to low vaccine uptake. These insights underscore the pandemic’s impact on routine immunization and emphasize the need for consideration in future vaccination campaigns.