{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:07:31Z","timestamp":1785420451707,"version":"3.56.0"},"reference-count":42,"publisher":"AOSIS","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0The coronavirus disease 2019 (COVID-19) pandemic posed unprecedented global health challenges, necessitating accelerated COVID-19 vaccine development. However, vaccine and booster hesitancy among healthcare workers (HCWs) presented a barrier globally and in South Africa (SA).\nAim:\u00a0This study aimed to determine the level of vaccine and booster acceptance among HCWs in public, private and public-private sectors in KwaZulu-Natal (KZN), SA, and to identify the key reasons of vaccine and booster acceptance and refusal.\nSetting:\u00a0This study was conducted across KZN.\nMethods:\u00a0A quantitative, descriptive, cross-sectional survey was conducted from October 2024 to April 2025 among doctors, nurses and pharmacists using an online questionnaire. Three hundred and thirty-one HCWs participated in this study with a reliable and standardised questionnaire. Data analysis included descriptive and inferential statistics. Relevant ethics committees and participants provided ethical approval.\nResults:\u00a0Average vaccine acceptance rate for vaccine and booster was 92.4% (n\u00a0= 306) and 73.7% (n\u00a0= 244), respectively. Public-private recorded the highest acceptance rates for vaccine (96.3%) and booster (85.1%). Primary reasons for vaccine refusal included vaccine-related illness in family (52.4%,\u00a0n\u00a0= 11) and rapid development and safety concerns (64%,\u00a0n\u00a0= 16), predominantly among private sector. Main booster refusal reasons included safety of multiple booster doses (50%,\u00a0n\u00a0= 32) and antibodies from previous COVID-19 infection, mostly in the public sector.\nConclusion:\u00a0Addressing complex determinants of vaccine hesitancy across healthcare sectors necessitates an integrated and sustained approach reinforced by multidisciplinary stakeholder engagement.\nContribution:\u00a0This study contributes to future pandemic preparedness and vaccination programmes by elucidating reasons influencing vaccine acceptance and refusal among HCWs.<\/jats:p>","DOI":"10.4102\/hsag.v31i0.3331","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:17:55Z","timestamp":1783073875000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative analysis of COVID-19 vaccine and booster acceptance among healthcare workers in public and private sectors in KwaZulu-Natal, South Africa"],"prefix":"10.4102","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0710-5093","authenticated-orcid":false,"given":"Viloshini K.","family":"Manickum","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4739-8944","authenticated-orcid":false,"given":"Lehlohonolo J.","family":"Mathibe","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Ackah, B.B.B., Woo, M., Stallwood, L., Fazal, Z.A., Okpani, A., Ukah, U.V. et al., 2022, \u2018COVID-19 vaccine hesitancy in Africa: A scoping review\u2019, Global Health Research and Policy 7(1), 21. https:\/\/doi.org\/10.1186\/s41256-022-00255-1","DOI":"10.1186\/s41256-022-00255-1"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Adeniyi, O.V., Stead, D., Singata-Madliki, M., Batting, J., Wright, M., Jelliman, E. et al., 2021, \u2018Acceptance of COVID-19 vaccine among the healthcare workers in the Eastern Cape, South Africa: A cross-sectional study\u2019, Vaccines 9(6), 666. https:\/\/doi.org\/10.3390\/vaccines9060666","DOI":"10.3390\/vaccines9060666"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Adhikari, B., Yeong Cheah, P. & Von Seidlein, L., 2022, \u2018Trust is the common denominator for COVID-19 vaccine acceptance: A literature review\u2019, Vaccine X 12, 100213. https:\/\/doi.org\/10.1016\/j.jvacx.2022.100213","DOI":"10.1016\/j.jvacx.2022.100213"},{"key":"ref3","unstructured":"Baspakova, A. & Sartayeva, A., 2023, \u2018The epidemiology of vaccine hesitancy: A global challenge to 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