Perceptions of, and Obstacles to, SARS-CoV-2 Vaccination Among Adults in Lebanon: Cross-sectional Online Survey

  1. Nadeem Elias Abou-Arraj
  2. Diana Maddah
  3. Vanessa Buhamdan
  4. Roua Abbas
  5. Nadine Kamel Jawad
  6. Fatima Karaki
  7. Nael H Alami
  8. Pascal Geldsetzer

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

The COVID-19 pandemic is an additional burden on Lebanon’s fragmented health care system and adds to its ongoing political, economic, and refugee crises. Vaccination is an important means of reducing the impact of the pandemic.

Objective

Our study’s aims were to (1) assess the prevalences of intention to vaccinate and vaccine hesitancy in Lebanon; (2) determine how vaccine hesitancy in Lebanon varies by sociodemographic, economic, and geographic characteristics; and (3) understand individuals’ motivations for vaccinating as well as concerns and obstacles to vaccination.

Methods

We performed a cross-sectional study from January 29, 2021, to March 11, 2021, using an online questionnaire of open- and closed-ended questions in Arabic via convenience “snowball” sampling to assess the perceptions of adults residing in Lebanon.

Results

Of the 1185 adults who participated in the survey, 46.1% (95% CI: 43.2%-49.0%) intended to receive the SARS-CoV-2 vaccine when available to them, 19.0% (95% CI 16.8%-21.4%) indicated they would not, and 34.0% (95% CI 31.3%-36.8%) were unsure (with an additional 0.9% skipping this question). The most common reasons for hesitancy were concerns about safety, limited testing, side effects, and efficacy. Top motivations for vaccinating were to protect oneself, protect one’s family and the public, and end the pandemic. Despite financial hardships in Lebanon, barriers to vaccine access were not frequently described as concerns. Established health care facilities, rather than new temporary vaccination centers, were most frequently selected as preferred vaccination sites.

Conclusions

Vaccine hesitancy appears to be high in Lebanon. Disseminating clear, consistent, evidence-based safety and efficacy information on vaccines may help reduce vaccine hesitancy, especially among the large proportion of adults who appear to be unsure about (rather than opposed to) vaccination.

Article activity feed

  1. Version published to 10.2196/36827
  2. ScreenIT

    SciScore for 10.1101/2021.05.21.21257613: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: The survey consisted of 31 multiple-choice and free-response questions (depending on branch points, participants were not asked each question), divided into an introduction with the informed consent document, followed by questions about screening, demographics, questions experience with COVID-19, and perceptions of SARS-CoV-2 vaccination.
    Sex as a biological variablenot detected.
    RandomizationWe originally intended to distribute it to randomly selected Lebanese phone numbers to obtain an unbiased nationally representative sample, but during piloting, this method needed to be aborted because of exceedingly low response rates (less than 1%), thought to be due to mistrust of messages and links received from an unknown phone number.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data Analysis: Data were downloaded from Qualtrics as a .csv file and translated into English using Microsoft Excel [27].
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)
    Data cleaning and statistical analysis were performed in R computer software and focused on description rather than identifying causal links [28].
    R computer
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are several important limitations of our study. First and foremost, our sample is unlikely to be representative of the general population because of the sampling strategy. While we attempted to mitigate this by collecting and describing important demographic and experiential characteristics, the bias remains, and several important demographic groups were underrepresented, most notably the elderly, members of Shi’a and Sunni religions, residents outside of Beirut and Mount Lebanon, non-Lebanese citizens, and those who identify as refugees. Small sample sizes of subgroups limited analysis of associations with certain variables, especially governorate and citizenship. Second, participation required literacy in Arabic, access to the internet, and digital literacy, potentially excluding some populations (though it is noteworthy that >80% of refugees in Lebanon have access to mobile technology like WhatsApp) [40]. Third, some participants did not answer all questions, possibly leading to non-response bias. Finally, vaccine hesitancy, perceptions, and concerns may be changing rapidly over time; our results should be interpreted as pertaining to the time period during which the survey was conducted.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.05.21.21257613v1 on medRxiv