Attitudes toward Receiving COVID-19 Booster Dose in the Middle East and North Africa (MENA) Region: A Cross-Sectional Study of 3041 Fully Vaccinated Participants

Abstract

COVID-19 vaccines are crucial to control the pandemic and avoid COVID-19 severe infections. The rapid evolution of COVID-19 variants such as B.1.1.529 is alarming, especially with the gradual decrease in serum antibody levels in vaccinated individuals. Middle Eastern countries were less likely to accept the initial doses of vaccines. This study was directed to determine COVID-19 vaccine booster acceptance and its associated factors in the general population in the MENA region to attain public herd immunity. We conducted an online survey in five countries (Egypt, Iraq, Palestine, Saudi Arabia, and Sudan) in November and December 2021. The questionnaire included self-reported information about the vaccine type, side effects, fear level, and several demographic factors. Kruskal–Wallis ANOVA was used to associate the fear level with the type of COVID-19 vaccine. Logistic regression was performed to confirm the results and reported as odds ratios (ORs) and 95% confidence intervals. The final analysis included 3041 fully vaccinated participants. Overall, 60.2% of the respondents reported willingness to receive the COVID-19 booster dose, while 20.4% were hesitant. Safety uncertainties and opinions that the booster dose is not necessary were the primary reasons for refusing the booster dose. The willingness to receive the booster dose was in a triangular relationship with the side effects of first and second doses and the fear (p < 0.0001). Females, individuals with normal body mass index, history of COVID-19 infection, and influenza-unvaccinated individuals were significantly associated with declining the booster dose. Higher fear levels were observed in females, rural citizens, and chronic and immunosuppressed patients. Our results suggest that vaccine hesitancy and fear in several highlighted groups continue to be challenges for healthcare providers, necessitating public health intervention, prioritizing the need for targeted awareness campaigns, and facilitating the spread of evidence-based scientific communication.

Why Some People Are Hesitant to Receive COVID-19 Boosters: A Systematic Review

“…Gender predicted CBVH in 10 studies (23.8%). Several studies indicated that females are more likely to be hesitant to receive a COVID-19 booster vaccine than males [ 5 , 8 , 26 , 35 , 37 , 39 ]. On the contrary, Bendezu-Quispe et al [ 12 ] found that females are associated with lower booster hesitancy.…”

“…Geographical factors such as country, region, and residency were also associated with CBVH. Higher COVID-19 booster vaccine hesitancy was found among residents of Saudi Arabia [ 26 ], rural areas [ 12 , 28 , 31 , 39 ], and the southern U.S. [ 51 ]. Two studies reported greater CBVH among residents of towns than cities [ 12 , 25 ].…”

“…Vaccine-associated adverse events were the most frequently reported predictor of CBVH in 27 studies (64.29%). The main drivers for CBVH were fear about the side effects of booster vaccines [ 4 , 21 , 30 , 45 , 47 , 50 ], the severity of side effects associated with previous COVID-19 vaccines [ 26 , 29 , 31 , 34 ], concerns about adverse reactions to booster vaccines [ 6 , 52 ], adverse reactions experienced personally or among friends and family following previous COVID-19 vaccinations [ 5 , 7 , 30 , 52 ], and receipt of medical care following the COVID-19 vaccine primary doses [ 37 ]. Other studies reported uncertainty, risk, and safety concerns associated with booster doses [ 5 , 13 , 20 , 26 , 43 , 44 , 49 , 53 ].…”

Willingness to accept a second COVID-19 vaccination booster dose among healthcare workers in Italy

“…in Saudi Arabia (55.3%) (22), Czechia (71.3%) (23), and China (87%) (24). A surprising finding was that this value was also considerably lower than those in the general population in India (59.1%) (25), the Middle East and North Africa Region (60.2%) (26), China (91.1%) (27), Japan (97.8%) (28), university students and staff in Italy (85.7%) (15), and the United States (96.2%) (29). The finding of the present study is of great concern because HCWs have a higher risk of infection with SARS-CoV-2 than the general population; in Italy, since the beginning of the pandemic as of September 2021, there have been 3,970 deaths among HCWs out of a total of 124,000 (30).…”

Assessing COVID-19 Vaccine Booster Hesitancy Using the Modified 5C Scale in Zhejiang Province, China: A Cross-Sectional Study

“…It is urgent for policymakers to explore the obstructions and underlying concerns of the booster, so as to encourage timely interventions to promote acceptance. Although previous studies [ 23 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ] conducted similar surveys on booster hesitancy, the influential factors varied with different policy background, COVID-19 prevalence and predominant variants, COVID-19 vaccine type and supply capacity, public awareness of vaccine literacy and non-pharmaceutical interventions (NPIs), as well as investigation periods and religious beliefs.…”