Much ado about COVID -19 vaccine[s]: understanding perceptions and experiences of vaccines among healthcare workers in three hospitals in Eswatini.

Abstract

The COVID‑19 pandemic has been widely narrated through biomedical framings and global statistics, yet such accounts often obscure the lived realities and perceptions of healthcare workers in fragile health systems. In Eswatini, nurses occupied a dual role as frontline caregivers and trusted community communicators, navigating systemic shortages, cultural expectations, and contested narratives around vaccination. This study interrogates how nurses perceived, experienced, and communicated about COVID‑19 vaccines, situating their voices within broader debates on health communication, cultural identity, and systemic fragility. Methodologically, the research makes a distinctive contribution by employing Interpretative Phenomenological Analysis (IPA) in combination with in‑depth interviews and focus group discussions. This design captured both individual narratives and collective negotiations of meaning, enabling a nuanced understanding of how nurses interpreted vaccination within contexts of trauma, stigma, and resilience. By explicitly foregrounding perception alongside experience, the study demonstrates how IPA can be extended to interrogate communicative practices in under‑resourced, culturally complex health systems. Nurses at Raleigh Fitkin Memorial, Mbabane Government, and Hlatikulu Government Hospitals were purposefully selected because they were the first recipients of vaccines and simultaneously key intermediaries between state messaging and community realities, making their perspectives critical for understanding how trust and authority were negotiated in practice. Findings reveal that nurses’ perceptions of vaccination were shaped by trauma, stigma, and resilience. Trauma extended beyond clinical encounters to encompass psychological strain and uncertainty; stigma manifested in how nurses were perceived as potential carriers of infection; resilience was expressed through improvisation, peer support, and faith commitments, yet often masked systemic vulnerabilities. Importantly, nurses contested reductive framings of “hesitancy,” articulating concerns rooted in cultural identity, professional responsibility, and inequitable resource distribution. Their accounts demonstrate that vaccine communication cannot be reduced to compliance or behavioural deficit but must be understood as a negotiation of trust across biomedical and cultural domains, particularly in a context where the government of Eswatini did not impose vaccine mandates yet expected citizen; including nurses, to be vaccinated. This study contributes to scholarship by addressing three critical gaps: the limited attention to healthcare workers’ communicative roles in under‑resourced contexts; the dominance of biomedical framings that marginalise cultural identity and systemic fragility; and the lack of methodological approaches that capture perception as well as experience. Its methodological innovation; using IPA to foreground nurses’ meaning‑making through interviews and focus groups, marks its most significant contribution, offering a model for future research that seeks to capture the complexity of frontline health communication. These insights are vital for strengthening pandemic preparedness and designing strategies that resonate with communities in Eswatini and comparable settings.