AUTHOR=Khankeh Hamidreza , Pourebrahimi Mohammad , Hosseinabadi-Farahani Mohammadjavad , Farrokhi Mehrdad , Khanjani Mohammad Saeed , Shojafard Javad , Hamedanchi Arya , Ranjbar Maryam , Jenabi Ghods Mariye , Ahmadi Shokoufeh , Ghanaatpisheh Elham , Saatchi Mohammad 

TITLE=Comparison of vaccine hesitancy during the low and high points of COVID-19 in a population under international sanctions: A longitudinal mixed-methods study in Iran

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.958899

DOI=10.3389/fpubh.2022.958899

ISSN=2296-2565

ABSTRACT=Along with the challenges of Covid-19 vaccine supply in low-income countries, vaccine hesitancy was another problem for the health system. The aim of this study was to deeply understand the challenges of vaccine acceptance, the vaccination process, and to compare the factors affecting vaccine acceptance in the high and low points of the epidemic in Iran. In the qualitative part of this mixed-methods study, content analysis was used to investigate experiences and perceptions about COVID-19 vaccination in four groups. In the quantitative study, in March 2021 (low point), and on August 1, 2021 (high point), two population-based cross-sectional studies were performed in Tehran and its rural, with sample sizes of 1200 and 1872 people aged over 18 years, respectively. Multinomial (polytomous) logistic regression was used to determine the factors affecting hesitation and unwillingness to receive the vaccine. Disbelief in vaccine safety, vaccine distrust, ignorance and confusion, and inadequate facilities were the common reasons extracted in the two qualitative studies. At the low and high points of the epidemic, vaccine acceptance was 83.6% (95% CI: 81.3-85.9) and 65.8% (95% CI: 65.8-71.0), respectively. Residence in rural areas, (Odds Ratio: 0.44, p-value = 0.001), being a student (Odds Ratio: 0.41, p-value =0.011), housewives (Odds Ratio: 0.63, p-value =0.033), illiteracy (Odds Ratio: 4.44, p-value =0.001), and having an underlying disease (Odds Ratio: 4.44, p-value =0.001) were factors affecting on vaccine acceptance. Counter-intuitively, acceptance did not increase at the peak of epidemic. The presence of obstacles, such as increased distrust in the effectiveness of vaccines due to the occurrence of multiple peaks in different vaccinated countries, as well as the influence of the media, anti-vaccine campaigns, and lack of proper communication about risks caused more hesitation. More investigation to understand how people accept or reject vaccine and its long term consequences is recommended.