Abstract
Background: COVID-19 vaccine acceptance among refugees in the Arab region remains low. This study aimed to examine the prevalence, reasons and predictors of COVID-19 vaccine refusal among older Syrian refugees in Lebanon.
Methods: A nested cross-sectional study within a longitudinal study among older Syrian refugees in Lebanon. The sampling frame was a complete listing of beneficiary households of a humanitarian organization with an adult aged 50 years or older. Telephone surveys were completed at months 1 starting September 2020 (wave 1), months 2 (wave 2), months 5 (wave 3), months 6 (wave 4) and month 17 (wave 5) in March 2022. Logistic regression models were
used to identify predictors of COVID-19 vaccine refusal. Models were internally validated using bootstrap methods and the models’ calibration and discrimination were presented.
Findings: Of 3,167 Syrian refugees, 61% intended to receive the COVID-19 vaccine, 31% refused, and 7% were undecided. Reasons for vaccine refusal were: preference to follow preventive measures (27%) and belief that the vaccine is not essential (21%). Furthermore, 57% of participants registered to take the COVID-19 vaccine in wave 5. Irrespective of vaccination intention, reasons for not registering included: not wanting to receive the vaccine, and being unsure whether to take it. Predictors of COVID-19 vaccine refusal included: sex (female), older age, education, living outside informal tented settlements, perceiving COVID-19 as not severe and vaccines as not safe or effective, and using social media for information on COVID-19. After adjusting for optimization, the final model showed moderate discrimination (C-statistic:
0.65 (95% CI:(0.63-0.67)) and good calibration (C-Slope: 0.93 (95% CI:0.82-1.06)).
Conclusions: This study developed a predictive model for vaccination intention with a moderate discriminative ability and good calibration. Prediction models in humanitarian settings can help to identify refugees at higher risk of not intending to receive the COVID-19 vaccine for public health targeting.
Methods: A nested cross-sectional study within a longitudinal study among older Syrian refugees in Lebanon. The sampling frame was a complete listing of beneficiary households of a humanitarian organization with an adult aged 50 years or older. Telephone surveys were completed at months 1 starting September 2020 (wave 1), months 2 (wave 2), months 5 (wave 3), months 6 (wave 4) and month 17 (wave 5) in March 2022. Logistic regression models were
used to identify predictors of COVID-19 vaccine refusal. Models were internally validated using bootstrap methods and the models’ calibration and discrimination were presented.
Findings: Of 3,167 Syrian refugees, 61% intended to receive the COVID-19 vaccine, 31% refused, and 7% were undecided. Reasons for vaccine refusal were: preference to follow preventive measures (27%) and belief that the vaccine is not essential (21%). Furthermore, 57% of participants registered to take the COVID-19 vaccine in wave 5. Irrespective of vaccination intention, reasons for not registering included: not wanting to receive the vaccine, and being unsure whether to take it. Predictors of COVID-19 vaccine refusal included: sex (female), older age, education, living outside informal tented settlements, perceiving COVID-19 as not severe and vaccines as not safe or effective, and using social media for information on COVID-19. After adjusting for optimization, the final model showed moderate discrimination (C-statistic:
0.65 (95% CI:(0.63-0.67)) and good calibration (C-Slope: 0.93 (95% CI:0.82-1.06)).
Conclusions: This study developed a predictive model for vaccination intention with a moderate discriminative ability and good calibration. Prediction models in humanitarian settings can help to identify refugees at higher risk of not intending to receive the COVID-19 vaccine for public health targeting.
| Original language | English |
|---|---|
| Journal | Vaccine |
| Publication status | Accepted/In press - 18 Feb 2024 |
Bibliographical note
Funding SourceThis work was supported by ELRHA’s Research for Health in Humanitarian Crisis (R2HC) Programme, which aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. R2HC is funded by the UK Foreign, Commonwealth and Development Office (FCDO), Wellcome, and the UK National Institute for Health Research (NIHR). The views expressed herein should not be taken, in any way, to reflect the official opinion of the NRC or ELRHA. The funding agency was not involved in the data collection, analysis or interpretation.
Keywords
- COVID-19
- Vaccine acceptance
- refugees
- older adults
