Hesitancy of Arab Healthcare Workers towards COVID-19 Vaccination: A Large-Scale Multinational Study

Abstract

Background: Health care workers (HCWs) are at increased risk of acquiring and transmitting COVID-19 infection. Moreover, they present role models for communities with regards to attitudes towards COVID-19 vaccination. Hence, hesitancy of HCWs towards vaccination can crucially affect the efforts aiming to contain the pandemic. Previously published studies paid little attention to HCWs in Arab countries, which have a population of over 440 million.

Objectives: To assess the rates of COVID-19 vaccine hesitancy in Arabic-speaking HCWs residing in and outside Arab countries, and their perceived barriers towards vaccination.

Methods: A cross-sectional study based on an online survey was conducted from 14-29 January 2021, targeting Arabic-speaking HCWs from all around the world.

Results: The survey recruited 5708 eligible participants (55.6% males, 44.4% females, age 30.6 ± 10 years) from 21 Arab countries (87.5%) and 54 other countries (12.5%). Our analysis showed a significant rate of vaccine hesitancy among Arabic-speaking HCWs residing in and outside of Arab countries (25.8% and 32.8%, respectively). The highest rates of hesitancy were among participants from the western regions of the Arab world (Egypt, Morocco, Tunisia, and Algeria). The most cited reasons for hesitancy were concerns about side effects and distrust of the expedited vaccine production and healthcare policies. Factors associated with higher hesitancy included age of 30-59, previous or current suspected or confirmed COVID-19, female gender, not knowing the vaccine type authorized in the participant's country, and not regularly receiving the influenza vaccine.

Conclusion: This is the first large-scale multinational post-vaccine-availability study on COVID-19 vaccine hesitancy among HCWs. It reveals high rates of hesitancy among Arab-speaking HCWs. Unless addressed properly, this hesitancy can impede the efforts for achieving widespread vaccination and collective immunity.

Keywords: COVID-19 vaccines.

Figure 1

COVID-19 vaccination attitudes among 5708 HCW participants. (A) Vaccine acceptance per country in the Arab region, (B) vaccination attitudes reported by HCWs from Arab countries and territories, (C) vaccination attitudes reported by HCWs from countries other than Arab countries and territories, (D) vaccination attitudes reported by HCWs per Arab country/territory, and(E) vaccination attitudes reported by HCWs from countries other than Arab countries and territories clustered by residency region.

Figure 2

Differences in COVID-19 Vaccination attitudes among HCWs according to: (A) country of residence, (B) gender, (C) level of academic education, (D) having a chronic illness, (E) knowing the vaccine type available in participant’s country, (F) having a previous or current COVID-19 infection, (G) age, and (H) 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

Bar plot showing percentage of participants (n = 5708) who selected the shown barriers.

Figure 5

Bar plot showing the barriers with more than 5% difference between HCWs and non-HCWs.

Figure 6

Participants’ attitudes towards COVID-19 vaccination with regards to (A) national health policies, and (B) selecting individuals who should be vaccinated.