A high rate of COVID-19 vaccine hesitancy in a large-scale survey on Arabs
- Faculty of Pharmacy, Jerash University, Jordan
- Department of Computer Science, Lakehead University, Canada
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Jordan
- Department of Paediatrics, University of Jordan, Jordan
- Department of Paediatrics and Cancer Care Informatics Program, King Hussein Cancer Center, Jordan
Figures
Figure 1
COVID-19 vaccination attitudes among 36,220 participants.
(A) Vaccine acceptance in the per-country in the Arab region, (B) vaccination attitudes reported by participants from the Arab countries and territories, (C) vaccination attitudes reported by participants from countries other than Arab countries and territories, (D) vaccination attitudes reported by participants per Arab country/territory, and (E) vaccination attitudes reported by participants from countries other than Arab countries and territories clustered by residency region.
Figure 2
Differences in COVID-19 vaccination attitudes among participants according to (A) country of residence, (B) age, (C) level of academic education, (D) being a health care worker, (E) having a chronic illness, (F) knowing the vaccine type available in participant’s country, (G) having a previous COVID-19 infection, (H) age, and (I) receiving annual influenza vaccine.
Figure 3
Multivariate analysis results of COVID-19 vaccine acceptance/hesitancy stratified according to different factors; odds ratio (OR) and 95% confidence intervals (CI) are shown; the size of the box represents the number of participants in each level.
Figure 4 with 1 supplement
Barplot showing percentages of participants (N = 36,220) who selected the shown barriers.
Figure 4—figure supplement 1
Barriers to COVID-19 vaccine acceptance chosen by survey participants with percentage of selection for each barrier (out of a total of 36,220 participants) stratified according to (A) gender and (B) residence in or out of the Arab countries.
Figure 5
Participants’ attitudes toward COVID-19 vaccination in regards to (A) national health policies and (B) selecting individuals who should be vaccinated.
Appendix 1—figure 1
The burden of COVID-19 outbreak on Arab countries with panels representing (A) the daily cases per million in different countries, (B) cumulative cases per million in each country, (C) total daily cases and deaths in all Arab countries, (D) cumulative number of confirmed cases and deaths in all Arab countries, and (E) a map showing the differences in total cumulative confirmed cases per million capita.
Appendix 1—figure 2
A bar plot and a pie chart showing distribution of participants according to country of residence and gender.
Appendix 1—figure 3
Scatter plots showing correlation between vaccine acceptance in 36,220 survey participants and (A) the total number of confirmed COVID-19 cases per million and (B) the total COVID-19-related deaths per million in Arab countries.
Tables
Table 1
Characteristics of participants with distribution of COVID-19 vaccine willingness.
| Variables | Levels | No | Not sure | Will wait for others | Depending on type | Yes | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| N | % | N | % | N | % | N | % | N | % | ||
| Age | Below 29 | 5871 | 37.2 | 3607 | 22.9 | 3591 | 22.8 | 899 | 5.7 | 1803 | 11.4 |
| 30–39 | 4939 | 42.7 | 2484 | 21.5 | 2225 | 19.2 | 463 | 4.0 | 1454 | 12.6 | |
| 40–49 | 2563 | 43.3 | 1213 | 20.5 | 1156 | 19.5 | 160 | 2.7 | 827 | 14.0 | |
| 50–59 | 1009 | 43.9 | 429 | 18.6 | 455 | 19.8 | 72 | 3.1 | 336 | 14.6 | |
| Over 60 | 267 | 40.2 | 123 | 18.5 | 125 | 18.8 | 21 | 3.2 | 128 | 19.3 | |
| Chronic Diseases | No | 12,390 | 40.8 | 6614 | 21.8 | 6292 | 20.7 | 1368 | 4.5 | 3717 | 12.2 |
| Yes | 2259 | 38.7 | 1242 | 21.3 | 1260 | 21.6 | 247 | 4.2 | 831 | 14.2 | |
| Country | Arab countries | 12,534 | 41.5 | 6414 | 21.2 | 6220 | 20.6 | 1464 | 4.8 | 3568 | 11.8 |
| Other countries | 2115 | 35.1 | 1442 | 24.0 | 1332 | 22.1 | 151 | 2.5 | 980 | 16.3 | |
| Academic Education | Higher education | 9128 | 41.1 | 4752 | 21.4 | 4277 | 19.2 | 1027 | 4.6 | 3052 | 13.7 |
| Lower education | 5521 | 39.5 | 3104 | 22.2 | 3275 | 23.4 | 588 | 4.2 | 1496 | 10.7 | |
| Had Covid | No | 7147 | 39.4 | 3885 | 21.4 | 3703 | 20.4 | 780 | 4.3 | 2610 | 14.4 |
| Not sure | 4445 | 38.8 | 2628 | 22.9 | 2642 | 23.1 | 548 | 4.8 | 1195 | 10.4 | |
| Yes | 3057 | 46.1 | 1343 | 20.2 | 1207 | 18.2 | 287 | 4.3 | 743 | 11.2 | |
| Job | HCW | 1886 | 33.0 | 1266 | 22.2 | 1034 | 18.1 | 432 | 7.6 | 1090 | 19.1 |
| Not HCW | 12,763 | 41.8 | 6590 | 21.6 | 6518 | 21.4 | 1183 | 3.9 | 3458 | 11.3 | |
| Gender | Male | 8152 | 37.0 | 4625 | 21.0 | 4776 | 21.7 | 1152 | 5.2 | 3335 | 15.1 |
| Female | 6497 | 45.8 | 3231 | 22.8 | 2776 | 19.6 | 463 | 3.3 | 1213 | 8.6 | |
| Influenza vaccine | Yearly | 166 | 18.3 | 159 | 17.5 | 170 | 18.7 | 62 | 6.8 | 351 | 38.7 |
| Some years | 687 | 23.6 | 627 | 21.5 | 678 | 23.3 | 180 | 6.2 | 739 | 25.4 | |
| Rarely | 1324 | 30.4 | 1019 | 23.4 | 1117 | 25.6 | 228 | 5.2 | 673 | 15.4 | |
| Never | 12,472 | 44.5 | 6051 | 21.6 | 5587 | 19.9 | 1145 | 4.1 | 2785 | 9.9 | |
| Vaccine type unknown | No | 7937 | 37.5 | 4356 | 20.6 | 4364 | 20.6 | 1141 | 5.4 | 3365 | 15.9 |
| Yes | 6712 | 44.6 | 3500 | 23.2 | 3188 | 21.2 | 474 | 3.1 | 1183 | 7.9 | |
Table 2
List of surveyed countries and the frequency (%) of participants COVID-19 vaccination choices.
| Country | No | Not sure | Will wait for others | Depending on type | Yes | Total | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| N | % | N | % | N | % | N | % | N | % | ||
| Algeria | 1675 | 61.9 | 509 | 18.8 | 343 | 12.7 | 81 | 3.0 | 98 | 3.6 | 2706 (7.5) |
| Bahrain | 40 | 34.8 | 22 | 19.1 | 28 | 24.3 | 6 | 5.2 | 19 | 16.5 | 115 (0.3) |
| Egypt | 1949 | 36.5 | 1166 | 21.8 | 1315 | 24.6 | 480 | 9.0 | 429 | 8.0 | 5339 (14.7) |
| Europe | 1139 | 36.4 | 749 | 23.9 | 677 | 21.6 | 61 | 1.9 | 504 | 16.1 | 586 (1.6) |
| Iraq | 204 | 34.8 | 113 | 19.3 | 163 | 27.8 | 28 | 4.8 | 78 | 13.3 | 7020 (19.4) |
| Jordan | 3032 | 43.2 | 1283 | 18.3 | 1407 | 20.0 | 369 | 5.3 | 929 | 13.2 | 529 (1.5) |
| Kuwait | 168 | 31.8 | 115 | 21.7 | 122 | 23.1 | 7 | 1.3 | 117 | 22.1 | 492 (1.4) |
| Lebanon | 205 | 41.7 | 104 | 21.1 | 110 | 22.4 | 14 | 2.8 | 59 | 12.0 | 229 (0.6) |
| Libya | 65 | 28.4 | 64 | 27.9 | 51 | 22.3 | 11 | 4.8 | 38 | 16.6 | 99 (0.3) |
| Mauritania | 39 | 39.4 | 32 | 32.3 | 17 | 17.2 | 3 | 3.0 | 8 | 8.1 | 3775 (10.4) |
| Morocco | 1750 | 46.4 | 961 | 25.5 | 631 | 16.7 | 135 | 3.6 | 298 | 7.9 | 187 (0.5) |
| North America | 259 | 34.6 | 170 | 22.7 | 142 | 19.0 | 10 | 1.3 | 167 | 22.3 | 53 (0.1) |
| Oman | 66 | 35.3 | 40 | 21.4 | 36 | 19.3 | 7 | 3.7 | 38 | 20.3 | 1624 (4.5) |
| Other Arabs | 18 | 34.0 | 15 | 28.3 | 14 | 26.4 | 3 | 5.7 | 3 | 5.7 | 443 (1.2) |
| Others | 183 | 35.7 | 137 | 26.8 | 103 | 20.1 | 15 | 2.9 | 74 | 14.5 | 3588 (9.9) |
| Palestine | 568 | 35.0 | 392 | 24.1 | 336 | 20.7 | 77 | 4.7 | 251 | 15.5 | 313 (0.9) |
| Qatar | 114 | 25.7 | 113 | 25.5 | 89 | 20.1 | 7 | 1.6 | 120 | 27.1 | 1232 (3.4) |
| Saudi Arabia | 1240 | 34.6 | 761 | 21.2 | 822 | 22.9 | 74 | 2.1 | 691 | 19.3 | 665 (1.8) |
| Sudan | 136 | 43.5 | 60 | 19.2 | 50 | 16.0 | 19 | 6.1 | 48 | 15.3 | 979 (2.7) |
| Syria | 504 | 40.9 | 266 | 21.6 | 279 | 22.6 | 51 | 4.1 | 132 | 10.7 | 226 (0.6) |
| Tunisia | 358 | 53.8 | 120 | 18.0 | 125 | 18.8 | 19 | 2.9 | 43 | 6.5 | 3130 (8.6) |
| Turkey | 534 | 32.8 | 386 | 23.7 | 410 | 25.2 | 65 | 4.0 | 235 | 14.4 | 748 (2.1) |
| UAE | 280 | 28.6 | 245 | 25.0 | 246 | 25.1 | 60 | 6.1 | 148 | 15.1 | 1630 (4.5) |
| Yemen | 123 | 54.4 | 33 | 14.6 | 36 | 15.9 | 13 | 5.8 | 21 | 9.3 | 512 (1.4) |
Table 3
Predictors of vaccine hesitancy tested by univariate and multivariate binary logistic regression.
| Variable | Levels | Acceptance | Hesitance | Univariate | Multivariate |
|---|---|---|---|---|---|
| N (%) | N (%) | OR (95% CI) | OR (95% CI) | ||
| Age | Below 29 | 2702 (17.1) | 13,069 (82.9) | – | – |
| 30–39 | 1917 (16.6) | 9648 (83.4) | 1.04 (0.98–1.11) | 1.18 (1.10–1.26) | |
| 40–49 | 987 (16.7) | 4932 (83.3) | 1.03 (0.95–1.12) | 1.14 (1.05–1.24) | |
| 50–59 | 408 (17.7) | 1893 (82.3) | 0.96 (0.86–1.08) | 1.03 (0.91–1.17) | |
| Over 60 | 149 (22.4) | 515 (77.6) | 0.71 (0.59–0.86) | 0.89 (0.73–1.09) | |
| Chronic diseases | No | 5085 (16.7) | 25,296 (83.3) | – | – |
| Yes | 1078 (18.5) | 4761 (81.5) | 0.89 (0.83–0.96) | 0.91 (0.84–0.99) | |
| Country | Arab countries | 5032 (16.7) | 25,168 (83.3) | – | – |
| Other countries | 1131 (18.8) | 4889 (81.2) | 0.86 (0.80–0.93) | 0.90 (0.84–0.98) | |
| Academic education | Higher education | 4079 (18.3) | 18,157 (81.7) | – | – |
| Lower education | 2084 (14.9) | 11,900 (85.1) | 1.28 (1.21–1.36) | 1.18 (1.11–1.26) | |
| Had COVID | No | 3390 (18.7) | 14,735 (81.3) | – | – |
| Not sure | 1743 (15.2) | 9715 (84.8) | 1.28 (1.20–1.37) | 1.30 (1.22–1.39) | |
| Yes | 1030 (15.5) | 5607 (84.5) | 1.25 (1.16–1.35) | 1.32 (1.22–1.43) | |
| Job | HCW | 1522 (26.7) | 4186 (73.3) | – | – |
| Not HCW | 4641 (15.2) | 25,871 (84.8) | 2.03 (1.90–2.17) | 1.82 (1.70–1.96) | |
| Gender | Male | 4487 (20.4) | 17,553 (79.6) | – | – |
| Female | 1676 (11.8) | 12,504 (88.2) | 1.91 (1.80–2.03) | 1.90 (1.79–2.03) | |
| Vaccine type unknown | No | 4506 (21.3) | 16,657 (78.7) | – | – |
| Yes | 1657 (11.0) | 13,400 (89.0) | 2.19 (2.06–2.33) | 1.93 (1.81–2.06) | |
| Annual influenza vaccine | Yearly | 413 (45.5) | 495 (54.5) | – | – |
| Some years | 919 (31.6) | 1992 (68.4) | 1.81 (1.55–2.11) | 1.57 (1.34–1.83) | |
| Rarely | 901 (20.7) | 3460 (79.3) | 3.20 (2.76–3.72) | 2.70 (2.31–3.15) | |
| Never | 3930 (14.0) | 24,110 (86.0) | 5.12 (4.47–5.86) | 4.08 (3.54–4.70) |
Additional files
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Supplementary file 1
Survey of the attitudes of Arabs towards COVID-19 vaccines .
- https://cdn.elifesciences.org/articles/68038/elife-68038-supp1-v2.pdf
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Supplementary file 2
Differences in barriers for acceptance according to country of residence, gender and academic achievement, compared using chi-square test.
- https://cdn.elifesciences.org/articles/68038/elife-68038-supp2-v2.pdf
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Reporting standard 1
Checklist of items that should be included in reports of cross-sectional studies.
- https://cdn.elifesciences.org/articles/68038/elife-68038-repstand1-v2.docx
-
Transparent reporting form
- https://cdn.elifesciences.org/articles/68038/elife-68038-transrepform-v2.pdf
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A high rate of COVID-19 vaccine hesitancy in a large-scale survey on Arabs
eLife 10:e68038.
https://doi.org/10.7554/eLife.68038
