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 Table of Contents  
ORIGINAL ARTICLE
Year : 2023  |  Volume : 2  |  Issue : 1  |  Page : 36-44

Evaluating the acceptance of COVID-19 vaccine among the adult population in the United Arab Emirates


1 College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
2 
3 Department of Family and Community Medicine and Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates

Date of Submission14-Jun-2022
Date of Decision03-Sep-2022
Date of Acceptance04-Sep-2022
Date of Web Publication17-Oct-2022

Correspondence Address:
Ahmed Khaled Mahmoud Abdelhamid Aboeldahab
College of Medicine, University of Sharjah, Sharjah
United Arab Emirates
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/abhs.abhs_39_22

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  Abstract 


Background: Ever since the emergence of coronavirus disease-2019 (COVID-19) infection in the UAE, the government had taken several preventive measures against the disease, including vaccination. Acceptance of the vaccine among the population played a crucial role in determining whether the pandemic could be successfully controlled.
This study aimed to assess the acceptance, knowledge, and perception of the COVID-19 vaccine among the adult population of the UAE.
Methods: A cross-sectional study was conducted using a snowball sampling method among UAE residents above 18 years of age. Data were collected using an online questionnaire consisting of 33 close-ended questions divided into three sections.
Results: A total of 825 adults (males = 18.4% and females = 81.6%) participated in the study. Males were 3.3 times more likely to get vaccinated than females (95% confidence interval [CI]: 1.9–5.7). Those participants who took the flu vaccine before were 1.4 times more likely to get vaccinated (95% CI: 1.003–1.897). Employed participants were three times more likely to take the vaccine as compared with students and those who were unemployed (95% CI: 2.078–4.577). Likewise, those who were over 40 years old and those who believed in the efficacy and safety of vaccines were more willing to get vaccinated.
Conclusion: The acceptance of the COVID-19 vaccine was overall high, especially among males and employees. Our findings may help identify vulnerable groups in order to expand vaccination coverage and help raise awareness among UAE residents.

Keywords: COVID-19, immunization, UAE, vaccine


How to cite this article:
Ahmed Hassan RA, Yaser YM, Abdelhamid Aboeldahab AK, O. Alqallaf MO, Al Hamadi AA, Hussein A. Evaluating the acceptance of COVID-19 vaccine among the adult population in the United Arab Emirates. Adv Biomed Health Sci 2023;2:36-44

How to cite this URL:
Ahmed Hassan RA, Yaser YM, Abdelhamid Aboeldahab AK, O. Alqallaf MO, Al Hamadi AA, Hussein A. Evaluating the acceptance of COVID-19 vaccine among the adult population in the United Arab Emirates. Adv Biomed Health Sci [serial online] 2023 [cited 2023 Feb 6];2:36-44. Available from: http://www.abhsjournal.net/text.asp?2023/2/1/36/358783




  Background Top


As the coronavirus disease-2019 (COVID-19) infection was first being introduced to the public, the scientific community across the globe was eager to assist in any sort or form to control the situation. Once the genetic sequence was discovered in January 2020, intense efforts were made to develop vaccines against the virus [1,2]. Traditionally, several components are required to develop a vaccine. However, COVID-19 vaccine development was done at an unprecedented pace, as it was in March 2020 that the first COVID-19 vaccine candidate entered human clinical testing with safety criteria remaining a priority throughout the process [1-6]. Several countries, such as China, India, and Kazakhstan, took the traditional route of developing a vaccine made up of an inactivated virus [7]. Meanwhile, a new approach was also introduced: RNA vaccines. Although extensively researched, this approach was not previously approved for use. Despite the COVID-19 vaccines made by Pfizer/BioNTech being the first mRNA vaccine to complete all clinical trial stages and be licensed for use, scientists had, in fact, been examining and studying mRNA vaccines for decades [7-9]. Previous research on mRNA vaccines for the flu, Zika, rabies, and cytomegalovirus was performed [10]. Because these vaccines might be created in a laboratory using components that are easily accessible, interest in them has increased. This implies that vaccinations can be created and developed in larger quantities in a relatively shorter time in comparison with other approaches [9].

COVID-19 is known to be a contagious disease caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The majority of those infected with COVID-19 encountered very few to a moderate degree of respiratory symptoms such as fever, coughing, difficulty in breathing, tiredness, loss of taste and/or smell, sore throat, muscle ache, and gastrointestinal symptoms [11]. Nevertheless, all symptoms seemed to cease completely within few weeks without the need for special treatment and/or clinical intervention [12]. On the contrary, some did become severely ill and required immediate medical attention, which involved them being on a ventilator. As the transmission of the disease was discovered to be short-range airborne, it was crucial to take certain preventative measures to help limit the spread of the disease [11,13]. For instance, sneezing and coughing should be done in a flexed arm.

According to the Ministry of Health and Prevention (MOHAP) in the UAE, the first ever person reported to be infected with COVID-19 in the UAE was a member of a family arriving from the Chinese city of Wuhan [14]. Since then, more than 179 million COVID polymerase chain reaction (PCR) tests were conducted across the country. In fact, the total number of cases in the UAE was 999,637, whereas total recoveries stood at 978,503 as of August 8, 2022. The death toll reported as of the same day stood at 2337. As a matter of fact, as of June 2022, over 99% of UAE's population received at least one dose of the COVID-19 vaccine, whereas approximately 99% of the total population had been considered fully vaccinated (received at least two doses of one of the accepted vaccines) [15]. Indisputably, the UAE had done a great job at handling the COVID-19 pandemic through setting various travel restrictions, COVID-19 guidelines, as well as a set of rules to keep the entire community safe and healthy [16].

Since the vaccination process commenced, there had been multiple oppositions due to varying reasons and beliefs. Some were concerned with the safety criteria. Others were concerned that the development of the vaccines was unprecedentedly rapid [17]. The source of information about the COVID-19 vaccine was also an issue, as there was a lot of speculation on social media platforms, claiming numerous conspiracy theories regarding the vaccines. Furthermore, recognizing certain vaccination manufacturer names was also influential in a way or another owing to some being more favored than others. COVID-19 vaccination perception among the population of the UAE had been poorly characterized and, therefore, there was a need to investigate the potential factors driving reluctance to vaccination. We aim to fill this gap by conducting this study to evaluate the acceptance of the COVID-19 vaccine among the adult population in the UAE. We hypothesize that the awareness about the safety and efficacy of vaccination is not adequate in the UAE. This hypothesis will be tested by conducting an online survey among the UAE residents.


  Materials and methods Top


Study design and participants

The study design was cross-sectional in nature. The survey had two versions: one in Arabic and the other in English. Both versions of the questionnaire were pilot tested on a group of subjects who were similar to the target population. Overall, feedback from the selected participants did not imply the need to perform any further changes. Due to the COVID-19 pandemic, data collection was conducted online during the period of February to March 2021. The sampling strategy was of a snowball type. This involved the research members conveying the questionnaire links across different social media platforms such as WhatsApp and Instagram. Respondents were also requested to forward the links to their friends and/or family members. Participants filled out the questionnaire using Google Forms and data were collected using a Google spreadsheet. Instructions for filling out the questionnaire were provided on the first page of the Google Forms platform. Any adult, male or female, aged 18 years and above was able to participate in the study. Anyone who did not speak both the Arabic and English languages was not able to take part in the research. Likewise, those with a degenerative brain disease or with no access to the internet could not participate in the study.

Participation in the study was completely voluntary and participant's consent was implied by filling out the online questionnaire. This study was conducted in accordance with the Declaration of Helsinki [16].

Data analysis

Data were analyzed by using the Statistical Package for Social Sciences (SPSS) software program, version 28.0, in which descriptive statistics were carried out. The chi-square test was used to examine the association between categorical variables in the bivariate analysis. A value of P ≤ 0.05 indicated statistical significance [18].


  Results Top


Social and demographic data

After data cleaning, a total of 825 valid responses were recorded. Of the 825 responses gathered, female participants constituted 81.6% of the study sample. Approximately 54.7% of the participants were young––in the 18–29-year-old age group. Participants aged 30–39 years made the lowest contribution to sample size. In addition, 82.1% of the participants had a university degree and 16.5% of the participants had long-standing illnesses. Most (94.7%) of our respondents were Arab, whereas only 5.3% were non-Arab. As for the marital status of respondents, 43.9% were married, whereas the rest were not married. Moreover, 42.8% had children in comparison with 57.2% without children. Those employed made up 40.4% of the total number of respondents, whereas 36.7% were students and 22.9% were unemployed. In addition, 80.5% had health insurance. Furthermore, 83.5% of participants claimed they are free of comorbidities. [Figure 1] shows the prevalence of the different comorbidities amongst the participants.
Figure 1: Prevalence of different comorbidities

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COVID-19 status

The “COVID-19 status” section of the questionnaire included questions about current and previous infections with COVID-19, previous positive PCR test results, and whether relatives/friends had previously contacted COVID-19. As shown in [Figure 2]A, 47.6% of participants believed that it is impossible to become infected with COVID-19, which could be due to their lack of knowledge concerning the transmission of the COVID-19 infection.
Figure 2: Participants' perceptions regarding COVID-19 infection likelihood (A), and different aspects of COVID-19 vaccines (B–D)

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COVID-19 vaccine acceptance

In order to boost immunization across the UAE population, it was vital to highlight the promoting factors as well as the barriers for taking the COVID-19 vaccine. As shown in [Figure 3], 75.3% of the participants were willing to get vaccinated or had already taken the vaccine.
Figure 3: COVID-19 vaccines acceptance and hesitancy of the participants

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Factors associated with vaccine acceptance

Factors that are positively impacting COVID-19 vaccination rates could be further emphasized by the government to encourage those concerned and/or hesitant about getting vaccinated. Approximately 27.4% of the study participants had lost relatives or friends due to COVID-19. Hence, it was not surprising to discover that the majority (61.8%) of the participants were interested in getting vaccinated to protect their family members and community, as shown in [Figure 4].
Figure 4: Reasons for, and against, taking COVID-19 vaccine

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On top of what was shown in [Figure 4], there were several additional factors associated with an increased willingness to get vaccinated. Although most of the study participants were females, males were found to be 3.3 times more likely to get vaccinated. Those currently employed were particularly more likely to get vaccinated than students. This might have been due to many students currently undergoing an online learning system. Working individuals might have had a higher likelihood of getting vaccinated as a protective measure during work, as they are exposed to multiple people. Taking the flu vaccine was associated with an increased likelihood of getting the COVID-19 vaccine (P < 0.05). Participants' perceptions about different aspects of COVID-19 vaccine were also significantly associated with getting vaccinated. Such aspects included effectiveness and safety of vaccines, as well as their importance in fighting the pandemic. [Figure 2]B, [Figure 2]c, [Figure 2]D show the perceptions of COVID-19 vaccines with respect to their effectiveness, safety profiles, and as an important tool in controlling the pandemic, respectively. In all three graphs, most of the participants had adequate knowledge about the vaccines, with 43.6% believing that COVID-19 vaccines are effective, 50.2% believing they are safe, and 60.5% opting for vaccines as one of the essential tools in fighting the pandemic. Other associated factors included recommending COVID-19 vaccine to friends and family members, possibility of taking the vaccine in the future, and the type of vaccine.

Factors associated with vaccine hesitancy

In order to achieve herd immunity, everyone shall be well informed about the vaccines and feel assured about their safety profiles. Being aware of the community's perception about COVID-19 vaccination safety could assist in interpreting the causes of hesitancy. Lack of information about the vaccines (9.9%) and believing that vaccines did not undergo adequate testing (9.8%) were the main causes behind COVID-19 vaccination hesitancy, as shown in [Figure 4]. By educating the community about the different vaccines used and how they work to stop the spread of the infection, vaccine-related stress could be significantly reduced.

As for the barriers for vaccination, presence of some comorbidities and being a student were clear causative factors. Those aged 18–29 years had the lowest likelihood and willingness to get vaccinated. Those in the 30–39 and 40+ age groups had a, respectively, 78.9% and 84.1% higher chance of getting vaccinated. [Table 1], [Table 2], [Table 3] show the cross-tabulation results, associating several factors with vaccine acceptance.
Table 1: Logistic regression analysis (bivariate analysis) of COVID-19 vaccine knowledge and perception in participants enrolled in the study, and their association with COVID-19 vaccine acceptance.

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Table 2: Perception about the vaccine.

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Table 3: Recommendation, time, and type of the vaccine.

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  Discussion Top


This study provided a detailed examination of various factors expected to influence COVID-19 vaccination acceptance, particularly education level, presence of comorbidities, employment status, source of information, as well as the community's own perception of the vaccine, in terms of importance, effectiveness, and safety. Elements including reasons behind taking or refusing to take the vaccine and whether to recommend it to family and friends were likewise included.

Other attributes such as side effects and vaccination type were also included. Moreover, knowledge about herd immunity and the flu vaccine was evaluated.

The study showed that 75.3% of the participants were willing to get vaccinated. This level of acceptability was within the average estimated––that is, 67% among countries [19]. Therefore, further information and details should be released to public in order to increase the acceptance rate of the COVID-19 vaccination.

The data suggested that opting to receive the COVID-19 vaccinations remained complex, considering few factors that play a role in the population's decision-making. In this study, factors that played a role in decision-making included gender, history of flu vaccination, ethnicity, age, educational level, source of information about the vaccine, recommendation of the vaccine to someone else, and importance, safety, and effectiveness of the vaccine. It should be noted that the decision to accept the vaccine was done under the presumption that the vaccine is freely provided by the government.

This study concluded that males were more likely to accept vaccination in comparison to females. This finding came in consistency with other studies [20-22]. This may be due to some females expecting a child or willing to become pregnant in the near future, as some families may perceive the vaccine as a threat to the newborns' health. Another possible explanation for this finding was that men in the UAE, especially non-Emiratis, were the ones responsible for the health insurance of their families and, thus, accustomed to make health decisions for themselves and their families. This might have influenced more males to get vaccinated in order to keep themselves and their families safe during the pandemic. This only supported another finding of ours linking employment status with COVID-19 vaccination acceptance, as it was observed that those currently employed were more likely to get vaccinated.

The study also found that having a history of taking the flu vaccine played a role in accepting the COVID-19 vaccine, which was understandable, as these individuals were more likely to have less misconceptions about vaccinations in general. Therefore, they were encouraged to accept the COVID-19 vaccine. Those taking the flu vaccine typically believe in the safety, significance, and effectiveness of vaccinations, and therefore, would in most cases undoubtedly get vaccinated. This also came in consistent with another study [23-25].

Moreover, results showed that non-Arabs were more supportive of the decision of taking the vaccine than Arabs, even though the percentage of non-Arab participants was minimal compared to Arabs. This finding was supported by other studies [26,27]. This might be particularly due to the difference in the level of education, religious factors, or other cultural aspects. Non-Arabs may additionally find it more essential, as it became necessary for travel purposes throughout the pandemic, assuming their countries have set certain travel restrictions and limitations. Nevertheless, having such a difference in the acceptability of the vaccine among different demographics should be addressed by the medical field and public health.

In addition, the acceptability of the vaccine was shown to increase with age, as subjects aged 30 years and above showed more willingness to get vaccinated than younger respondents aged 18–29 years, which was similar to other findings [21],[24],[28],[29]. In contrast, other studies showed that the acceptability decreased with increasing age [29-31]. One possible explanation for these conflicting results was that perception of and beliefs about the vaccination varied in different age groups. Not to mention that once again, exposure tended to be higher as older populations were in contact with other individuals at work and other social events. One more reason worth mentioning could be the lack of serious comorbidities among the youth and those below the age of 30. Therefore, public health should address the younger generations, as even though they were at a lower risk of suffering from severe complications themselves, they still can be potential carriers for the infection and transmit it to other vulnerable groups in the society. That could involve providing several classes and lectures in schools and universities to help raise awareness among those age groups. Health authorities could also explore various methods to perhaps spread accurate information on social media platforms such as Twitter, Facebook, and Instagram, which are all often used by young adults.

Another important finding was that the source of information highly impacted the decision of whether to vaccinate, as shown in [Table 4]. Those who did not receive information from social media were more likely to accept the vaccine than those who did. This finding was supported by other studies [24],[25],[32]. This was displayed in the results, as 81.7% of those who did not utilize social media to seek information about the COVID-19 vaccine received or were willing to receive the vaccine, in comparison with 72.9% of those who depended on social media to seek information about the vaccine. This relationship was likewise seen with those who received their information from friends and relatives.
Table 4: Sources of information for COVID-19 vaccines and their association with COVID-19 vaccine acceptance.

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Regarding the reluctance toward the COVID-19 vaccination, the main concerns revolved around the safety and effectiveness of the COVID-19 vaccine. This came in similar findings with other studies [21],[28],[30],[31],[33],[34],[35]. The study showed that those who refused or were hesitant to accept the vaccine were more likely to express these concerns than those who did not. It was also not surprising to discover that those who believed the COVID-19 vaccine is effective and safe were up to 12 and 19 times more likely to get vaccinated compared to those who doubted its effectiveness and safety. Therefore, it goes without saying that it is remarkably essential to address such concerns in specific to increase the acceptability of the vaccine, as they seem to play a considerable role in decision-making. This could involve the government addressing false theories and misinformation through online and public campaigns. In addition, stress should be emphasized on why vaccinations are essential. Illustrating how and of what constituents vaccines are made could additionally intensify the authenticity of the COVID-19 vaccine.

Evidence collected from this study and other similar research may assist in promoting vaccination rates in the UAE and other countries, as well as an aid toward understanding how and why certain elements influence individuals' choice to vaccinate. This can also improve vaccination programs for different infections and diseases. Not only that, but such studies can also aid in tackling misled perceptions about vaccines present in the community.

[TAG:2]Conclusion[/TAG:2]

The acceptance of the COVID-19 vaccine in the UAE was influenced by several factors, including the source of information about the COVID-19 vaccine, educational level of the participants, and most importantly, safety and effectiveness of the vaccine. Other aspects of the study provided potential influencing factors and opportunities for further research. Promotion of the COVID-19 vaccine could be done through emphasis on effectiveness and safety. Outlining the effectiveness by providing evidence in simple language or through the aid of diagrams could positively influence the acceptance of the vaccine across the community.

In addition, explaining the COVID-19 vaccine-related side effects and showing its safety can help diminish fears and concerns regarding the vaccine. Information from trusted medical authorities about the COVID-19 vaccine is to also be disclosed to the public in order to address their concerns and perhaps spread assurance and reliance. Awareness could likewise be spread through utilizing all means of social media, informative brochures, and establishing reliable websites where one could learn all there is to know about the vaccination. Future studies could additionally explore other factors.

Study limitations

The generalizability of the results was limited by a potential selection bias, since in order to answer the questionnaire, a smartphone, computer, or tablet was required. Moreover, the study was done at a time when the vaccines were still under development, and information was yet to be provided to the public. Another potential limitation of this study was that it necessarily only offered a snapshot in time, which happened to be before vaccination approval and release. There were also no obligations or regulations done by the government yet to increase the vaccinated population at the time of the study. Therefore, respondents could change their stance about the acceptability of the vaccine later. Moreover, the psychological impact of the vaccine and the COVID-19 pandemic was beyond the scope of this study. Nonetheless, the study addressed a wide variety of factors and concerns that can contribute to the hesitancy or acceptability of the COVID-19 vaccine, in hopes to address these concerns by the public health to ensure wide acceptability of the COVID-19 vaccine.

Authors' contributions

RA, YM, AK, MO, and AA conceived the research concept. RA, YM, AK, MO, and AA worked on data acquisition and analysis. RA, YM, AK, MO, and AA searched for literature. RA, YM, AK, MO, and AA came up with the methodology. RA, YM, AK, MO, and AA were responsible for project administration and manuscript preparation. AH supervised the research study. All authors worked on writing and editing the manuscript. All authors are responsible for the contents and integrity of this manuscript.

Ethical statement

The study's ethical consideration was obtained from the Research Ethics Committee (REC), reference number REC-21-02-10-06-S, at the University of Sharjah. Participation in the study was completely voluntary and participant's consent was implied by filling out the online questionnaire.

Financial support and sponsorship

Not applicable.

Conflict of interests

No conflict of interests declared.

Data availability statement

All data supporting the results reported in this article can be found in [Table 1], [Table 2]4 and [Figure 1], [Figure 2], [Figure 3], [Figure 4].



 
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