Assessment of COVID-19 vaccination among healthcare workers in Iraq; adverse effects and hesitancy

PLOS ONE RESEARCH ARTICLE Assessment of COVID-19 vaccination among healthcare workers in Iraq; adverse effects and hesitancy Omeed Darweesh1,2,3*, Nasir Khatab ID1, Ramiar Kheder4,5, Thulfiqar Mohammed6, Tola Faraj5,7, Sabah Ali3, Muath Ameen8, Azad Kamal-Aldin3, Mohammed Alswes9, Naif AlJomah ID10* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 College of Pharmacy, Al-Kitab University, Kirkuk, Iraq, 2 Department of Molecular and Cell Biology, University of Leicester, Leicester, United Kingdom, 3 Department of Public Health, Kirkuk Health Directorate, Ministry of Health, Kirkuk, Iraq, 4 Medical Laboratory Science Department, College of Science, University of Raparin, Sulaymaniyah, Iraq, 5 Department of Medical Analysis, Faculty of Applied Science, Tishk International University, Erbil, Iraq, 6 National Institute of Technology, Sulaymaniyah, Iraq, 7 Department of Basic Sciences, College of Medicine, Hawler Medical University, Erbil, Iraq, 8 College of Pharmacy, Knowledge University, Erbil, Iraq, 9 Department of Family Medicine and Policlinics, Research Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, 10 Molecular Oncology Department, Research Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia * (OD); (NAJ) Abstract OPEN ACCESS Citation: Darweesh O, Khatab N, Kheder R, Mohammed T, Faraj T, Ali S, et al. (2022) Assessment of COVID-19 vaccination among healthcare workers in Iraq; adverse effects and hesitancy. PLoS ONE 17(11): e0274526. https:// doi.org/10.1371/journal.pone.0274526 Editor: Vijayaprakash Suppiah, University of South Australia, AUSTRALIA Received: May 6, 2022 Accepted: August 28, 2022 Published: November 18, 2022 Copyright: © 2022 Darweesh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the article. Funding: The authors acknowledged that they received no funding in support of this study. Several messenger ribonucleic acid (mRNA) and inactivated COVID-19 vaccines are available to the global population as of 2022. The acceptance of the COVID-19 vaccine will play a key role in combating the worldwide pandemic. Public confidence in this vaccine is largely based on its safety and effectiveness. This study was designed to provide independent evidence of the adverse effects associated with COVID-19 vaccines among healthcare workers in Iraq and to identify the attitudes of healthcare workers who rejected the vaccination. We conducted a cross-sectional study to collect data on the adverse effects of the Pfizer, AstraZeneca, and Sinopharm vaccines. Data were collected between October 2021 and February 2022. A total of 2,202 participants were enrolled in the study: (89.97%) received injections of the COVID-19 vaccines and (10.03%) were hesitant to receive the vaccination. Participants received either the Pfizer vaccine (62.9%), AstraZeneca vaccine (23.5%) or Sinopharm vaccine (13.6%). Most adverse effects were significantly less prevalent in the second dose than in the first dose. Notably, the adverse effects associated with the Pfizer vaccine were significantly more prevalent in females than in males. Following the first dose, the participants experienced more adverse effects with the AstraZeneca vaccine. Following the second dose, more adverse effects were associated with the Pfizer vaccine. Interestingly, the prevalence of COVID-19 infection in participants who received two doses of the Pfizer vaccine was significantly reduced compared to those who received two doses of either the AstraZeneca or Sinopharm vaccines. According to vaccine-hesitated participants, insufficient knowledge (29.9%), expeditious development (27.6%) and lack of trust in the vaccines (27.1%) were the three major reasons for refusing the vaccines. The results of our study indicated that these adverse effects do not present a significant problem and should not prevent successful control of the COVID-19 pandemic. Competing interests: The following authors have no competing interests. PLOS ONE | https://doi.org/10.1371/journal.pone.0274526 November 18, 2022 1 / 18 PLOS ONE Assessment of COVID-19 in Iraq Introduction As there is no approved antiviral treatment for COVID-19 infection, vaccination is the most effective intervention for combating the disease [1]. Vaccination prevents symptomatic COVID-19 infection and minimizes the risks of severe illness, by stimulating the immune system to produce antibodies [2–4]. Trials to develop vaccines were immediately initiated in the hope of controlling this pandemic. The first vaccines approved by global health authorities were the Pfizer-BioNTech mRNA vaccine (BNT162b2) and the Oxford-AstraZeneca vaccine (ChAdOx1 nCoV-19), followed by Sinopharm (BBIBP-CorV) [5]. BNT162b2 is a vaccine based on mRNA coding for SARS-CoV-2 spike protein that has demonstrated 95% efficacy against symptomatic COVID-19 infection [6]. AstraZeneca developed ChAdOx1 nCoV-19, a replication-deficient chimpanzee adenovirus particle expressing the full length of the spike protein. The AstraZeneca vaccine was authorized to be used in the age group of 18 years and older and showed 66% efficacy against COVID-19 infection [7]. In contrast, China developed the Sinopharm vaccine, which consists of an inactivated strain of SARS-CoV-2 HB02 with an efficacy of 79% [5]. There is no vaccine that is completely free of adverse effects. Vaccination confers immunity against COVID-19, regardless of whether adverse effects occur or not [8]. Potential postvaccine adverse effects are thought to be the primary reason for vaccine hesitancy. Improving vaccine acceptance requires increasing public awareness of vaccine efficacy and being honest about adverse effects [9, 10]. Vaccine adverse effects depend on the type of vaccine: for example, mRNA vaccines are associated with higher postvaccination adverse effects than other vaccines [11, 12]. A large-scale study indicates that pain at the injection site (58%) presented alongside fatigue (46%), headache (45%), fever (39%), joint pain (38%) dizziness (28%) and chills (28%) are the most common side effects after COVID-19 vaccines [12]. The COVID-19 vaccine is more likely to be given to adults. Moreover, healthcare workers are more cautious about getting vaccinated because of the nature of their work and their exposure to COVID-19 patients [7]. Based on the medical and scientific background of the study sample, a major strength of this study is that it was based on healthcare professionals who were expected to provide accurate and transparent information. Although the epidemiology and outcome of COVID-19 have been progressively studied [13–15], there is a lack of knowledge about COVID-19 vaccines efficacy and adverse effect (...truncated)