Individual and social determinants of COVID-19 vaccine hesitancy and uptake in Northwest Syria.
COVID-19
Health
Hesitancy
Syria
Vaccine
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
01 Mar 2024
01 Mar 2024
Historique:
received:
13
05
2023
accepted:
19
02
2024
medline:
2
3
2024
pubmed:
2
3
2024
entrez:
1
3
2024
Statut:
epublish
Résumé
The COVID-19 outbreak devastated the fragmented health system in Syria, a war-torn country, and exaggerated the demands for humanitarian assistance. COVID-19 vaccination was rolled out in Northwest Syria, an area out of government control, in May 2021. However, vaccine acceptance rates are still minimal, which is reflected in the meager percentage of vaccinated people. The study aims to investigate the effectiveness of the humanitarian actors' plans to address the COVID-19 vaccine hesitancy and conclude practical strategies for boosting vaccine uptake in Northwest Syria. Two questionnaires were developed to collect data from humanitarian organizations involved in the COVID-19 vaccination campaign and people from northwest Syria. Data analysis was performed using SPSS 22 data analysis program. According to the findings, 55.5% of people refused the COVID-19 vaccine. The results showed a knowledge gap and lack of evidence regarding humanitarian actors' strategies to address the vaccine's low uptake. Besides, it was found that doctors and medical workers were reliable sources of information about the vaccine. However, they were not systematically engaged in community mobilization and risk communication to promote people's perspectives on the vaccine. Risk communication and community engagement programs were not significantly associated with increasing the COVID-19 acceptance rate. Humanitarian actors must reconsider their strategies to address vaccine hesitancy in Northwest Syria. These strategies should engage medical professionals through dialogue sessions on the realities of the pandemic and vaccine development mechanism based on a compelling and evidence-based approach.
Identifiants
pubmed: 38429739
doi: 10.1186/s12913-024-10756-z
pii: 10.1186/s12913-024-10756-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
265Informations de copyright
© 2024. The Author(s).
Références
Sosnowski M, Hamadeh N. The right to have rights: legal identity documentation in the Syrian civil war. Focus| MIDDLE EAST. 2021;4:10.
Beaujouan J. The Covid-19 pandemic and alternative Governance systems in Idlib. IDS Bull. 2022;53:39–52.
doi: 10.19088/1968-2022.116
Ghawji H, AlYousfi MN, Satyanarayana S, Wilson N, Tomeh L, Alkhellov H, et al. Feasibility, Uptake, and results of COVID-19 Antigen Rapid Diagnostic tests among refugees and migrants in a Pilot Project in North-West Syria. Trop Med Infect Dis. 2023;8:281.
pubmed: 37235329
pmcid: 10222732
doi: 10.3390/tropicalmed8050281
Chadwick S, Townes DA, Perrone LA. Utility of point of Care and Rapid Diagnostics in Humanitarian emergencies. J Appl Lab Med. 2021;6:236–46.
pubmed: 33247297
doi: 10.1093/jalm/jfaa180
Sida L, Trombetta L, Panero V. Evaluation of OCHA response to the Syria crisis. 2016.
Abdullah SF, Baker LS. Experiences of the ‘Whole of Syria’ coordination for nutrition. Emerg Nutr Netw 2017; Field Exch 56:79.
Will T, Cross-border, Aid. Covid-19, and U.S. Decisions in Syria on JSTOR. 2020.
Kallström A, Häkkinen M, Al-Abdulla O, Juusola H, Kauhanen J. Caught in crossfire: health care workers’ experiences of violence in Syria. Med Confl Surviv. 2021;37:34–54.
pubmed: 33641561
doi: 10.1080/13623699.2021.1889654
saghir A. How Syria Crisis affects the Potable Water System Efficiency in Non-state Armed Group controlled areas. Turkish J Water Sci Manag. 2018;2:20–39.
doi: 10.31807/tjwsm.385727
Yang L, Liu S, Liu J, Zhang Z, Wan X, Huang B, et al. COVID-19: immunopathogenesis and immunotherapeutics. Signal Transduct Target Ther. 2020;5:1–8.
pubmed: 32296011
pmcid: 6946647
Seidi PAM, Ardebil MD, Jaff D. COVID-19 pandemic: New challenge to securing mental well-being in conflict settings. Asian J Psychiatr. 2020;51.
Mohamad O, Zamlout A, AlKhoury N, Mazloum AA, Alsalkini M, Shaaban R. Factors associated with the intention of Syrian adult population to accept COVID19 vaccination: a cross-sectional study. BMC Public Health. 2021;21:1–10.
doi: 10.1186/s12889-021-11361-z
OCHA. COVID-19 Monthly Update Northwest Syria (July 2023). COVID-19. 2023. https://reliefweb.int/report/syrian-arab-republic/covid-19-monthly-update-northwest-syria-july-2023 . Accessed 20 Jan 2024.
Fawcett L. The Middle East and COVID-19: time for collective action. Globalization Health. 2021;17:1–9.
doi: 10.1186/s12992-021-00786-1
Douedari Y, Alhaffar M, Al-Twaish M, Mkhallalati H, Alwany R, Ibrahim NBM, et al. Ten years of war! You expect people to fear a ‘germ’? A qualitative study of initial perceptions and responses to the COVID-19 pandemic among displaced communities in opposition-controlled northwest Syria. J Migr Heal. 2020;1–2:100021.
doi: 10.1016/j.jmh.2020.100021
Fouad FM, Soares L, Diab JL, Abouzeid A. The political economy of health in conflict: lessons learned from three states in the Eastern Mediterranean Region during COVID-19. J Glob Health. 2022;12:7001.
doi: 10.7189/jogh.12.07001
Al-Abdulla O, Kallström A, Kauhanen J, Valderrama C. Simulation of the progression of the COVID-19 Disease in Northwest Syria using Basic and adjusted SIR Model. Zoonotic Dis 2022. 2021;2:44–58.
Marzouk M, Alhiraki OA, Aguas R, Gao B, Clapham H, Obaid W, et al. SARS-CoV-2 transmission in opposition-controlled Northwest Syria: modeling pandemic responses during political conflict. Int J Infect Dis. 2022;117:103–15.
pubmed: 35123027
pmcid: 8808433
doi: 10.1016/j.ijid.2022.01.062
Qaddour A, Fallon K. Covid-19: Compounding 10 Years of Health Crises in Syria. Washington, DC; 2021.
Kasem RA, Kassab F. The challenges of COVID-19 vaccination in a war-torn country– Syria. Int J Infect Control. 2022;18.
Al-Abdulla O, Alaref M. Navigating the Aftermath: the Complex Landscape of COVID-19 in Northwest Syria. J Heal Syst Policies. 2023;:153–63.
Al-Abdulla O, Kallström A. Community engagement and adherence to COVID-19 prevention measures in Northwest Syria: a systematic review. Med Confl Surviv. 2023;:1–18.
Swed S, Baroudi I, Ezzdean W, Sawaf B, Bohsas H, Patwary MM. COVID-19 vaccine hesitancy among people in Syria: an incipient crisis. Ann Med Surg. 2022;75:103324.
Patwary MM, Alam MA, Bardhan M, Disha AS, Haque MZ, Billah SM, et al. COVID-19 Vaccine Acceptance among low-and Lower-Middle-Income countries: a Rapid systematic review and Meta-analysis. Vaccines. 2022;10:427.
pubmed: 35335059
pmcid: 8950670
doi: 10.3390/vaccines10030427
Shakeel CS, Mujeeb AA, Mirza MS, Chaudhry B, Khan SJ. Global COVID-19 Vaccine Acceptance: a systematic review of Associated Social and behavioral factors. Vaccines. 2022;10:110.
pubmed: 35062771
pmcid: 8779795
doi: 10.3390/vaccines10010110
Acharya KP, Ghimire TR, Subramanya SH. Access to and equitable distribution of COVID-19 vaccine in low-income countries. npj Vaccines. 2021;6:1–3.
doi: 10.1038/s41541-021-00323-6
Shibani M, Alzabibi MA, Mouhandes AEF, Alsuliman T, Mouki A, Ismail H, et al. COVID-19 vaccination acceptance among Syrian population: a nationwide cross-sectional study. BMC Public Health. 2021;21:1–12.
doi: 10.1186/s12889-021-12186-6
World Health Organization. COVID-19 Response Tracking Dashboard Northwest Syria. World Health Organization. 2023. https://app.powerbi.com/view?r=eyJrIjoiMmRiMGMxODMtNThkMi00NzA2LTk0MWUtYzc5YTgyNThlYWEyIiwidCI6ImY2MTBjMGI3LWJkMjQtNGIzOS04MTBiLTNkYzI4MGFmYjU5MCIsImMiOjh9&pageName=ReportSectionb57388c4c756b1036a93. Accessed 7 May 2023.
Karaca B, Çelik B. Evaluation of the opinions of patients applying to the emergency department in the north of Syria about COVID-19 vaccine. Arch Curr Med Res. 2022;3:199–207.
doi: 10.47482/acmr.1101137
Forman R, Ciancaglini L, Garces PSJ, Neli M, Mossialos E. Another crisis in the sorrowland: COVID-19 in northeast Syria. J Glob Health. 2022;12:03033.
pubmed: 36039849
pmcid: 9425426
doi: 10.7189/jogh.12.03033
Corace K, Garber G. When knowledge is not enough: changing behavior to change vaccination results. Hum Vaccines Immunother. 2014;10:2623–4.
doi: 10.4161/21645515.2014.970076
Loulergue P, Moulin F, Vidal-Trecan G, Absi Z, Demontpion C, Menager C, et al. Knowledge, attitudes and vaccination coverage of healthcare workers regarding occupational vaccinations. Vaccine. 2009;27:4240–3.
pubmed: 19481314
doi: 10.1016/j.vaccine.2009.03.039
Childress JF, Faden RR, Gaare RD, Gostin LO, Kahn J, Bonnie RJ, et al. Public health ethics: mapping the terrain. Journal of Law, Medicine and Ethics. Cambridge University Press; 2002. pp. 170–8.
Gostin LO. Jacobson v Massachusetts at 100 years: police power and civil liberties in tension. Am J Public Health. 2005;95:576–81.
pubmed: 15798112
pmcid: 1449223
doi: 10.2105/AJPH.2004.055152
Williamson L, Glaab H. Addressing vaccine hesitancy requires an ethically consistent health strategy. BMC Med Ethics. 2018;19:1–8.
doi: 10.1186/s12910-018-0322-1
Rezza G. Mandatory vaccination for infants and children: the Italian experience. Pathogens Global Health. 2019;113:291–6.
pubmed: 31868571
pmcid: 7006725
doi: 10.1080/20477724.2019.1705021
MacDonald NE, Harmon S, Dube E, Steenbeek A, Crowcroft N, Opel DJ, et al. Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps. Vaccine. 2018;36:5811–8.
pubmed: 30143274
doi: 10.1016/j.vaccine.2018.08.042
Williamson JA. Using humanitarian aid to ‘win hearts and minds’: a costly failure? Int Rev Red Cross. 2011;93:1035–61.
doi: 10.1017/S1816383112000380
Macklin R. The paradoxical case of payment as benefit to research subjects. IRB; Rev Hum Subj Res. 1989;11:1–3.
Savulescu J. Good reasons to vaccinate: mandatory or payment for risk? J Med Ethics. 2021;47:78–85.
pubmed: 33154088
doi: 10.1136/medethics-2020-106821
Greenberg J, Dubé E, Driedger M. Vaccine hesitancy: in search of the Risk Communication Comfort Zone. PLoS Curr. 2017;9.
Gilkey MB, Grabert BK, Malo TL, Hall ME, Brewer NT. Physicians’ rhetorical strategies for motivating HPV vaccination. Soc Sci Med. 2020;266:113441.
pubmed: 33069959
pmcid: 7550258
doi: 10.1016/j.socscimed.2020.113441
Braun C, O’Leary ST. Recent advances in addressing vaccine hesitancy. Curr Opin Pediatr. 2020;32:601–9.
pubmed: 32692056
doi: 10.1097/MOP.0000000000000929
Nihlén Fahlquist J. Vaccine hesitancy and trust. Ethical aspects of risk communication. Scand J Public Health. 2018;46:182–8.
pubmed: 28847220
doi: 10.1177/1403494817727162
McGee LU, Suh J. Communication strategies to address vaccine hesitancy in Healthcare settings and on Social Media. J Appl Res Child. 2019;10.
Nyhan B, Reifler J, Richey S, Freed GL. Effective messages in vaccine promotion: a randomized trial. Pediatrics. 2014;133:e835–42.
pubmed: 24590751
doi: 10.1542/peds.2013-2365
Edwards KM, Hackell JM, Byington CL, Maldonado YA, Barnett Md ED, Davies HD et al. Countering vaccine hesitancy. Pediatrics. 2016;138.
Coleman MC. The role of patience in arguments about Vaccine Science. West J Commun. 2018;82:513–28.
doi: 10.1080/10570314.2017.1294708
Kempe A, Daley MF, McCauley MM, Crane LA, Suh CA, Kennedy AM, et al. Prevalence of parental concerns about childhood vaccines: the experience of primary care physicians. Am J Prev Med. 2011;40:548–55.
pubmed: 21496754
doi: 10.1016/j.amepre.2010.12.025
Make J, Lauver A. Increasing trust and vaccine uptake: Offering invitational rhetoric as an alternative to persuasion in pediatric visits with vaccine-hesitant parents (VHPs). Vaccine X. 2022;10:100129.
pubmed: 34934941
doi: 10.1016/j.jvacx.2021.100129
Dubé E, Gagnon D, MacDonald NE, Eskola J, Liang X, Chaudhuri M, et al. Strategies intended to address vaccine hesitancy: review of published reviews. Vaccine. 2015;33:4191–203.
pubmed: 25896385
doi: 10.1016/j.vaccine.2015.04.041
Jarrett C, Wilson R, O’Leary M, Eckersberger E, Larson HJ, Eskola J, et al. Strategies for addressing vaccine hesitancy - A systematic review. Vaccine. 2015;33:4180–90.
pubmed: 25896377
doi: 10.1016/j.vaccine.2015.04.040
Olson O, Berry C, Kumar N. Addressing parental vaccine hesitancy towards childhood vaccines in the United States: a systematic literature review of communication interventions and strategies. Vaccines. 2020;8:1–25.
doi: 10.3390/vaccines8040590
Noushad M, Al-Awar MS, Al-Saqqaf IS, Nassani MZ, Alrubaiee GG, Rastam S. Lack of Access to Coronavirus Disease 2019 vaccines could be a Greater threat than vaccine hesitancy in low-income and conflict nations: the case of Yemen. Clin Infect Dis. 2022;75:1827–33.
pubmed: 35134160
doi: 10.1093/cid/ciac088
Alkhalil M, Alaref M, Mkhallalati H, Alzoubi Z, Ekzayez A. An analysis of humanitarian and health aid alignment over a decade (2011–2019) of the Syrian conflict. Confl Health. 2022;16:57.
pubmed: 36352438
pmcid: 9644630
doi: 10.1186/s13031-022-00495-5
OCHA. Türkiye Cross-Border Health Cluster Bulletin, June 2023. Health Cluster Bulletin. 2023. https://reliefweb.int/report/syrian-arab-republic/turkiye-cross-border-health-cluster-bulletin-june-2023 . Accessed 20 Jan 2024.
Abdulah DM. Prevalence and correlates of COVID-19 vaccine hesitancy in the general public in Iraqi Kurdistan: a cross-sectional study. J Med Virol. 2021;93:6722–31.
pubmed: 34347294
pmcid: 8427006
doi: 10.1002/jmv.27255
Abdulkader MA, Aghali Merza M. The evaluation of COVID-19 vaccination program in Duhok Province, Iraqi Kurdistan: challenges and solutions. J Res Heal. 2022;12:219–26.
doi: 10.32598/JRH.12.4.2008.1
Dal A, Tokdemir E. Social-psychology of Vaccine intentions: the mediating role of Institutional Trust in the fight against Covid-19. Polit Behav. 2022;44:1459–81.
doi: 10.1007/s11109-022-09793-3
Al-Abdulla O, Alaref M. The forgotten threat of cholera in Syria. J Water Health. 2022;20:1755–60.
pubmed: 36573678
doi: 10.2166/wh.2022.262
Alwaday H. Critical discourse analysis of COVID-19 conspiracy theory videos.: a study of popular videos in arabic media. Malmö University; 2022.
Elbarazi I, Yacoub M, Reyad OA, Abdou MS, Elhadi YAM, Kheirallah KA, et al. Exploring enablers and barriers toward COVID-19 vaccine acceptance among arabs: a qualitative study. Int J Disaster Risk Reduct. 2022;82:103304.
pubmed: 36193257
pmcid: 9519527
doi: 10.1016/j.ijdrr.2022.103304
Limaye RJ, Balgobin K, Michel A, Schulz G, Erchick DJ. What message appeal and messenger are most persuasive for COVID-19 vaccine uptake: results from a 5-country survey in India, Indonesia, Kenya, Nigeria, and Ukraine. PLoS ONE. 2022;17:e0274966.
pubmed: 36129894
pmcid: 9491563
doi: 10.1371/journal.pone.0274966
Zewude B, Habtegiorgis T, Hizkeal A, Dela T, Siraw G. Perceptions and experiences of COVID-19 vaccine side-effects among Healthcare Workers in Southern Ethiopia: a cross-sectional study. Pragmatic Obs Res. 2021;12:131–45.
doi: 10.2147/POR.S344848
Bsoul EA, Loomer PM. COVID-19 vaccination experience among United States dental professionals and students: Safety, confidence, concerns, and side effects. PLoS ONE. 2022;17(2):e0264323.
pubmed: 35192657
pmcid: 8863258
doi: 10.1371/journal.pone.0264323
Douedari Y, Howard N. Perspectives on rebuilding Health System Governance in Opposition-Controlled Syria: a qualitative study. Int J Heal Policy Manag. 2019;8:233–44.
doi: 10.15171/ijhpm.2018.132
Bdaiwi Y, Rayes D, Sabouni A, Murad L, Fouad F, Zakaria W, et al. Challenges of providing healthcare worker education and training in protracted conflict: a focus on non-government controlled areas in North West Syria. Confl Health. 2020;14:1–13.
doi: 10.1186/s13031-020-00287-9
Ekzayez A, Alhaj Ahmad Y, Alhaleb H, Checchi F. The impact of armed conflict on utilisation of health services in north-west Syria: an observational study. Confl Health. 2021;15:1–10.
doi: 10.1186/s13031-021-00429-7