A high rate of COVID-19 vaccine hesitancy in a large-scale survey on Arabs

  1. Eyad A Qunaibi  Is a corresponding author
  2. Mohamed Helmy
  3. Iman Basheti
  4. Iyad Sultan
  1. Jerash University, Jordan
  2. Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), Singapore
  3. Faculty of Pharmacy, Applied Science Private University, Jordan
  4. King Hussein Cancer Center, Jordan


Background: Vaccine hesitancy can limit the benefits of available vaccines in halting the spread of COVID-19 pandemic. Previously published studies paid little attention to Arab countries, which has a population of over 440 million. In this study, we present the results of the first large-scale multinational study that measures vaccine hesitancy among Arab-speaking subjects.

Methods: An online survey in Arabic was conducted from 14-Jan-2021 to 29-Jan-2021. It consisted of 17 questions capturing demographic data, acceptance of COVID-19 vaccine, attitudes towards the need for COVID-19 vaccination and associated health policies, and reasons for vaccination hesitancy. R software- v.4.0.2 was used for data analysis and visualization.

Results: The survey recruited 36,220 eligible participants (61.1% males, 38.9% females, mean age 32.6±10.8 years) from all the 23 Arab countries and territories (83.4%) and 122 other countries (16.6%). Our analysis shows a significant rate of vaccine hesitancy among Arabs in and outside the Arab region (83% and 81%, respectively). The most cited reasons for hesitancy are concerns about side effects and distrust in healthcare policies, vaccine expedited production, published studies and vaccine producing companies. We also found that female participants, participants 30-59 year-old, those with no chronic diseases, those with lower-level of academic education, and those who do not know the type of vaccine authorized in their countries are more hesitant to receive COVID-19 vaccination. On the other hand, participants who regularly receive the influenza vaccine, health care workers, and those from countries with higher rates of COVID-19 infections showed more vaccination willingness. Interactive representation of our results is posted on our project website at https://mainapp.shinyapps.io/CVHAA.

Conclusion: Our results show higher vaccine hesitancy and refusal among Arab subjects, related mainly to distrust and concerns about side effects. Health authorities and Arab scientific community have to transparently address these concerns to improve vaccine acceptance.

Funding: This study received no funding.

Data availability

All data are available at our study website: https://mainapp.shinyapps.io/CVHAA. All the project's data and code has been deposited on Github. E. Qunaibi (2021) COVID-Vaccine-Arab-Survey. GitHub. https://github.com/MoHelmy/COVID-Vaccine-Arab-Survey. 5d1a881

Article and author information

Author details

  1. Eyad A Qunaibi

    Pharmacy, Jerash University, Jerash, Jordan
    For correspondence
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-0648-0757
  2. Mohamed Helmy

    The Donnelly Centre, Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
    Competing interests
    The authors declare that no competing interests exist.
  3. Iman Basheti

    Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
    Competing interests
    The authors declare that no competing interests exist.
  4. Iyad Sultan

    Department of Paediatrics and Cancer Care Informatics Program, King Hussein Cancer Center, Amman, Jordan
    Competing interests
    The authors declare that no competing interests exist.


The authors declare that there was no funding for this work.


Human subjects: This study was approved by the institutional review board (IRB) at King Hussein Cancer center (Approval No. 21 KHCC 0.34).

Reviewing Editor

  1. Margaret Stanley, University of Cambridge, United Kingdom

Publication history

  1. Received: March 3, 2021
  2. Accepted: May 18, 2021
  3. Accepted Manuscript published: May 27, 2021 (version 1)
  4. Version of Record published: June 15, 2021 (version 2)
  5. Version of Record updated: December 7, 2021 (version 3)


© 2021, Qunaibi et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.


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  1. Eyad A Qunaibi
  2. Mohamed Helmy
  3. Iman Basheti
  4. Iyad Sultan
A high rate of COVID-19 vaccine hesitancy in a large-scale survey on Arabs
eLife 10:e68038.
  1. Further reading

Further reading

    1. Epidemiology and Global Health
    Nikkil Sudharsanan et al.
    Research Article


    Fear over side-effects is one of the main drivers of COVID-19 vaccine hesitancy. A large literature in the behavioral and communication sciences finds that how risks are framed and presented to individuals affects their judgments of its severity. However, it remains unknown whether such framing changes can affect COVID-19 vaccine behavior and be deployed as policy solutions to reduce hesitancy.


    We conducted a pre-registered randomized controlled trial among 8998 participants in the United States and the United Kingdom to examine the effects of different ways of framing and presenting vaccine side-effects on individuals’ willingness to get vaccinated and their perceptions of vaccine safety.


    Adding a descriptive risk label (‘very low risk’) next to the numerical side-effect and providing a comparison to motor-vehicle mortality increased participants’ willingness to take the COVID-19 vaccine by 3.0 percentage points (p=0.003) and 2.4 percentage points (p=0.049), respectively. These effects were independent and additive and combining both framing strategies increased willingness to receive the vaccine by 6.1 percentage points (p<0.001). Mechanistically, we find evidence that these framing effects operate by increasing individuals’ perceptions of how safe the vaccine is.


    Low-cost side-effect framing strategies can meaningfully affect vaccine intentions at a population level.


    Heidelberg Institute of Global Health.

    Clinical trial number:

    German Clinical Trials Registry (#DRKS00025551).

    1. Epidemiology and Global Health
    Wan Yang, Jeffrey L Shaman
    Research Article

    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) have been key drivers of new coronavirus disease 2019 (COVID-19) pandemic waves. To better understand variant epidemiologic characteristics, here we apply a model-inference system to reconstruct SARS-CoV-2 transmission dynamics in South Africa, a country that has experienced three VOC pandemic waves (i.e. Beta, Delta, and Omicron BA.1) by February 2022. We estimate key epidemiologic quantities in each of the nine South African provinces during March 2020 to February 2022, while accounting for changing detection rates, infection seasonality, nonpharmaceutical interventions, and vaccination. Model validation shows that estimated underlying infection rates and key parameters (e.g. infection-detection rate and infection-fatality risk) are in line with independent epidemiological data and investigations. In addition, retrospective predictions capture pandemic trajectories beyond the model training period. These detailed, validated model-inference estimates thus enable quantification of both the immune erosion potential and transmissibility of three major SARS-CoV-2 VOCs, that is, Beta, Delta, and Omicron BA.1. These findings help elucidate changing COVID-19 dynamics and inform future public health planning.