COVID-19 Vaccine Hesitancy and Attitudes in Qatar: A National Cross-Sectional Survey of a Migrant-Majority Population

"States and healthcare authorities need to recognize the massive trust deficit around the vaccine and use the popular media used by people to share credible and reliable information."

Research conducted to date suggests that hesitancy to COVID-19 vaccination varies globally, with emerging evidence suggesting that the rates of hesitancy are relatively higher in high-income countries. Although Qatar is a high-income country, 90% of its population are economic migrants from low- to medium-income countries (LMICs). The degree and determinants of hesitancy among this population - and in the wider Middle East and North Africa (MENA) region - are not yet known. Thus, these researchers carried out a national cross-sectional survey of adults in Qatar to measure attitudes toward COVID-19 vaccination using the Vaccine Attitudes Examination Scale (VAX).

The study was carried out via an online survey from October 15 2020 to November 15 2020 among 7,821 adults, 87.5% of whom had completed childhood vaccinations, with 46.6% of them having received the influenza vaccine at least once in the last three years. Of respondents, 3.6% reported they had had COVID-19, and another 9.8% reported that a family member had had COVID-19.

In response to the question, "Will you take the COVID-19 vaccine when it becomes available?", 44.7% and 15.8% said they would "definitely" or "probably" accept the vaccine, respectively. 19.8% were unsure, 8.7% would "probably not" accept the vaccine, and 11.5% would "definitely not" take the vaccine. Very similar proportions were observed in response to a question on whether they would recommend the vaccine to elderly family members or relatives with chronic conditions, or whether they would get their children vaccinated for COVID-19. Defining vaccine hesitators as those who would "definitely" or "probably" not going accept a COVID-19 vaccine, the researchers found that citizens and women were more likely to be hesitators than immigrants and men, respectively. (For example, the overall vaccine hesitancy among the local Qataris of working age was 42.57% compared to 16.71% for the immigrant population.)

In terms of worries, 53.8% of the respondents expressed concerns about vaccine safety because of COVID-19 being a new disease, and 47.9% expressed concerns about longer-term safety of vaccines in general. Vaccine hesitancy was significantly associated with the beliefs: that there has been insufficient testing of COVID-19 vaccines, that authorities are motivated by financial gain rather than health of people, and that natural exposure to germs and viruses gives the safest protection.

Of those who were unsure and showed vaccine hesitancy, 36.1% and 43.4%, respectively, reported that their own understanding of the disease and vaccine was the main reason that would make them more confident to accept the vaccine. The figures for healthcare workers for the same variables were 37.7% and 49.7%, respectively. Overall, nearly two-thirds of those surveyed reported they trusted their own research to arrive at decision-making for accepting the vaccine, in preference to endorsement by healthcare professionals; this finding cut across demographic, socioeconomic, and educational variables.

In examining the findings, the researchers observe that the local Qatari population have significantly higher hesitancy rates comparable to high-income countries, whereas the economic migrants have significantly lower hesitancy rates - giving an overall hesitancy rate that is somewhat lower than the global aggregate rates. Among the factors: The migrant group likely sees vaccination as a means to return to full economic activity.

In the researchers' assessment, the study's finding about people's penchant to rely on personal research to make the vaccination decision reflects the availability of instant online information and warrants attention to the role of the media and, in particular, social media in shaping public opinion around the COVID-19 disease and the vaccine. This is a matter of concern due to the "immense potential for propagation of unverified and unvetted information. Further, algorithms within social media platforms allow users to follow content that agrees with their views and reject contrasting views leading to development of distinct communities that subscribe to specific opinions and ideologies....This has been shown to be associated with increasing negative attitudes to the COVID-19 and the vaccination."

In conclusion, this research "underlines the importance of developing trust in the safety of this vaccine. States and healthcare authorities need to recognize the power and influence of social media and devise innovative awareness and information dissemination strategies to increase vaccine uptake. [This] study identifies the specific subgroups that these campaigns should be focused upon and the content of such campaigns."