Variations in COVID-19 Vaccine Attitudes and Acceptance among Refugees and Lebanese Nationals Pre- and Post-Vaccine Rollout in Lebanon

Abstract

Vaccine hesitancy among displaced populations is associated with inequitable access to services and mistrust of authorities, among other factors. This study evaluated variations in attitudes toward COVID-19 vaccines and factors associated with vaccine acceptance among refugees and Lebanese nationals accessing 60 International Medical Corps-supported health facilities through two cross-sectional surveys pre- (n = 3927; Survey 1) and post- (n = 4174; Survey 2) vaccine rollout. Logistic regression was used to assess predictors of vaccine acceptance using the health beliefs model. Refugees comprised 52.9% (Survey 1) and 54.2% (Survey 2) of respondents. Vaccine acceptance was low among both groups in Survey 1 (25.9% refugees vs. 23.1% Lebanese nationals), but higher in Survey 2 in Lebanese (57.6%) versus refugees (32.9%). Participants reported greater perceived benefits of vaccination, higher perceived COVID-19 susceptibility, and lower perceived vaccination barriers in Survey 2 versus Survey 1. Post-vaccine rollout, refugees had lower odds of vaccine acceptance compared to Lebanese (OR 0.50, 95%CI 0.41–0.60), while older age (OR 1.37, 95%CI 1.06–1.78, ≥51 years vs. 18–30 years) was associated with greater vaccine acceptance. Health beliefs model variables were associated with vaccine acceptance in both surveys. Tailored strategies to respond dynamically to changes in vaccine attitudes among vulnerable groups in Lebanon are essential for equitable vaccine uptake.

Predictors of COVID-19 Vaccine Acceptability Among Refugees and Other Migrant Populations: A Systematic Scoping Review

“…Most common sociodemographic factors associated with COVID-19 acceptance were gender, age, level of education, and marital status (Table 4). Female gender (11-21), younger age (14, 15, 17, 22-29), lower level of education (12, 16, 17, 19, 20, 22, 26, 30-32), and being single (11, 13, 26) were associated with lower vaccine acceptance in most studies.…”

“…Being concerned about vaccine development was positively associated with vaccine hesitancy in all three studies evaluating this association. Additionally, six studies examined the participants’ knowledge/attitude scores towards COVID-19 vaccines (15, 22, 24, 34, 36, 38). Two studies showed that people with greater knowledge of COVID-19 vaccines had higher intention to get vaccinated (15, 22).…”

Vaccine Uptake and COVID-19 Frequency in Pregnant Syrian Immigrant Women

“…In a community-based study in Turkey, 45.3% of the participants were hesitant about receiving the COVID-19 vaccine [ 35 ]. In a recent study, the intentions for COVID-19 vaccination among immigrants were found to be lower than the local population [ 36 ]. In the same study, nearly half of the participants thought that the COVID-19 vaccine could not be received by pregnant women.…”

Perception of the Lebanese Adults about Vaccination: A Survey

“…A survey conducted on 1012 adults in the United States before the COVID-19 vaccine was available showed that 68% agreed to get the vaccine for themselves and 65% would vaccinate the adults under their care [ 16 ]. However, in a study carried out among refugees and Lebanese nationals pre and post-COVID-19 vaccination [ 17 ], the vaccine acceptance was very low in both groups in the pre-vaccination survey (around 25%); and the acceptance rate was higher after the vaccination [ 17 ]. The Lebanese nationals had significantly higher vaccine acceptance compared to the refugees [ 17 ].…”

“…However, in a study carried out among refugees and Lebanese nationals pre and post-COVID-19 vaccination [ 17 ], the vaccine acceptance was very low in both groups in the pre-vaccination survey (around 25%); and the acceptance rate was higher after the vaccination [ 17 ]. The Lebanese nationals had significantly higher vaccine acceptance compared to the refugees [ 17 ].…”