COVID-19 Vaccination and Vaccine Hesitancy in the Gaza Strip from a Cross-Sectional Survey in 2023: Prevalence, Risk Factors, and Associations with Health System Interventions

Preventing COVID-19 in Gaza is crucial due to the devastation of advanced health services infrastructure by war. Despite the high protection offered by COVID-19 vaccines against severe disease, a 2021 survey in Gaza found only half of the population vaccinated and one-third vaccine hesitant. This follow-up study conducted in March 2023 aimed to re-evaluate vaccination levels, hesitancy, exposure to vaccine promotion efforts, and other risk factors in Gaza. A community-based cross-sectional survey with multistage stratified sampling was used. Associations of primary exposures and other determinants with vaccine status and hesitancy were quantified using bivariate and multivariate logistic regression. In 2023, 63.5% of adults received at least one vaccine dose compared to 49.1% in 2021. Vaccine hesitancy prevalence was 31.7% in 2023 versus 34.1% in 2021 (p=0.395). Adjusted odds of vaccination were 4.2 times higher among those referred by health workers compared to those not referred. Adjusted odds of vaccine hesitancy among those who received information on the vaccine from health workers were 0.3 times that of people who did not receive information. Results suggest health workers could play a crucial role in future vaccination strategies, as their vaccine promotion efforts were linked to better vaccine outcomes. Investing in the skills development of community health workers to contribute to these efforts is recommended.