COVID-19 vaccine hesitancy among healthcare workers in Arab Countries: A systematic review and meta-analysis

PLOS ONE RESEARCH ARTICLE COVID-19 vaccine hesitancy among healthcare workers in Arab Countries: A systematic review and meta-analysis Mai Alalawi ID1,2*, Muath A. Alsalloum3, Yusuf M. Garwan3, Mya Abuzeid4, Hassan Alalawi5, Khalid Eljaaly4, Abrar K. Thabit ID4, Jimmy Jose6 1 Pharmaceutical Care Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia, 2 Department of Pharmaceutical Sciences, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia, 3 Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, 4 Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia, 5 Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia, 6 School of Pharmacy, University of Nizwa, Nizwa, Sultanate of Oman a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 * Abstract Background OPEN ACCESS Citation: Alalawi M, Alsalloum MA, Garwan YM, Abuzeid M, Alalawi H, Eljaaly K, et al. (2024) COVID-19 vaccine hesitancy among healthcare workers in Arab Countries: A systematic review and meta-analysis. PLoS ONE 19(1): e0296432. https://doi.org/10.1371/journal.pone.0296432 Editor: Fadi Aljamaan, King Saud University College of Medicine, SAUDI ARABIA Received: April 3, 2023 Accepted: December 13, 2023 Published: January 2, 2024 Copyright: © 2024 Alalawi 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 paper and its Supporting Information files. Funding: The author(s) received no specific funding for this work Competing interests: The authors have declared that no competing interests exist. Vaccine hesitancy is a major obstacle to the large efforts made by governments and health organizations toward achieving successful COVID-19 vaccination programs. Healthcare worker’s (HCWs) acceptance or refusal of the vaccine is an influencing factor to the attitudes of their patients and general population. This study aimed to report the acceptance rates for COVID-19 vaccines among HCWs in Arab countries and identify key factors driving the attitudes of HCWs in the Arab world toward vaccines. Methods This systematic review and meta-analysis followed the PRISMA guidelines. PubMed and Scopus databases were searched using pre-specified keywords. All cross-sectional studies that assessed COVID-19 vaccine hesitancy and/or acceptance among HCWs in Arab countries until July 2022, were included. The quality of the included studies and the risk of bias was assessed using the JBI critical appraisal tool. The pooled acceptance rate of the COVID-19 vaccine was assessed using a random-effects model with a 95% confidence interval. Results A total of 861 articles were identified, of which, 43 were included in the study. All the studies were cross-sectional and survey-based. The total sample size was 57,250 HCWs and the acceptance rate of the COVID-19 vaccine was 60.4% (95% CI, 53.8% to 66.6%; I2, 41.9%). In addition, the COVID-19 vaccine acceptance rate among males was 65.4% (95% CI, 55.9% to 73.9%; I2, 0%) while among females was 48.2% (95% CI, 37.8% to 58.6%; I2, 0%). The most frequently reported factors associated with COVID-19 vaccine acceptance were being male, higher risk perception of contracting COVID-19, positive attitude toward the PLOS ONE | https://doi.org/10.1371/journal.pone.0296432 January 2, 2024 1 / 26 PLOS ONE COVID-19 vaccines acceptance influenza vaccine, and higher educational level. Predictors of vaccine hesitancy most frequently included concerns about COVID-19 vaccine safety, living in rural areas, low monthly income, and fewer years of practice experience. Conclusion A moderate acceptance rate of COVID-19 vaccines was reported among HCWs in the Arab World. Considering potential future pandemics, regulatory bodies should raise awareness regarding vaccine safety and efficacy and tailor their efforts to target HCWs who would consequently influence the public with their attitude towards vaccines. Introduction The coronavirus disease of 2019 (COVID-19) pandemic has resulted in a huge negative impact on global health and the economy. Even though hygienic and behavioral control measures are effective in tackling pandemics, vaccines have been proposed as the single most important method to provide protection and control the spread of the virus [1]. The World Health Organization (WHO) estimates that vaccinations prevent between 3.5 and 5 million deaths every year [2]. Since the start of the pandemic and the spread of the virus, efforts to create vaccines have been accelerated to prevent and control the disease. Vaccine hesitancy has been considered by the WHO as a global health threat in 2019 as it is deemed a barrier to the success of vaccination programs [3]. Vaccine hesitancy has been defined by the Strategic Advisory Group of Experts on Immunization (SAGE) as “a delay in acceptance or refusal of vaccination despite the availability of vaccination services” [4]. There are multiple determinants that influence the attitude in relation to the acceptance of vaccination, including complacency, convenience, and confidence [4]. Multiple previous studies indicated that vaccine acceptance, in general, is declining globally, even though it has been proven that vaccines are safe and effective in controlling the spread and reducing mortality rates [5– 9]. The three most common reasons for vaccine hesitancy are risk vs. benefit concerns, lack of awareness and knowledge of vaccinations and their importance, and certain religious and cultural beliefs [7]. In terms of COVID-19, surveys conducted prior to the availability of COVID-19 vaccines in the United States showed that 70% of residents planned to receive the vaccine when available [10]. On the other hand, an international study that investigated the attitudes of healthcare workers (HCWs) toward COVID-19 vaccination found that the rates of high acceptance, moderate acceptance, and hesitancy to receive the vaccine were 48.6%, 23%, and 28.4%, respectively. In addition, 40.88% agreed that the concern about vaccine safety was the most prevalent factor for vaccine hesitancy [11]. Recent studies have demonstrated multiple predictors of COVID-19 vaccine acceptance and/ or hesitancy among HCWs. In a systematic review and meta-analysis, Ackah et. al. estimated Covid-19 vaccine acceptance in Africa among HCWs and the associated hesitancy predictors. The study reported a low acceptance rate of 46% that was associated with concerns about vaccines’ safety and efficacy, limited data, and expedited COVID-19 vaccine clinical trials [12]. Vaccine hesitancy and low acceptance rates are major obstacles to the large efforts made by governments and health organizations toward achieving s (...truncated)