Coronavirus Disease 2019 Vaccine Hesitancy in the Kurdistan Region: A Cross-Sectional National Survey

Archives of Razi Institute, Vol. 76, No. 4 (2021) 751-759 Copyright © 2021 by Razi Vaccine & Serum Research Institute DOI: 10.22092/ari.2021.355737.1714 Original Article Coronavirus Disease 2019 Vaccine Hesitancy in the Kurdistan Region: A Cross-Sectional National Survey Ahmad Khidir, K1 * 1. Animal Resource Department, College of Agricultural Engineering Sciences, University of Raparin, 46016 Qaladze, Kurdistan Region, Iraq Received 2 August 2021; Accepted 1 September 2021 Corresponding Author: Abstract It has been a few months since the first batch of Coronavirus Disease 2019 (COVID-19) vaccines arrived in the Kurdistan region, and the priority was given to health workers at the forefront of the treatment of COVID-19 patients. The rollout is slow, and there is little evidence to suggest that the whole Kurdistan region is vaccinated anytime soon. This comprehensive and national survey was conducted to investigate the perception of the people of the Kurdistan region towards COVID-19 vaccine hesitancy. An adjusted valid and dependable questionnaire was deployed via social media platforms (Facebook and Viber) to invite participants aged 18 and over from the residents of the four provinces of the Kurdistan region. A total of 450 individuals participated in this study. The majority of the participants were male (54.4%) who were aged 26-40 years with bachelor's degrees (44.3%). Moreover, they were full-time employees (37.8%) with a household income of 0-$5,000 (53.3%). They were the residence of urban regions (81.9%) and Sulaymaniyah province (87.7%). On the probability of getting a COVID-19 vaccine shot, the responses were very likely (26.7%), somewhat likely (24.9%), not likely (20%), and definitely not (28.4%). The vaccine hesitancy prevalence was high among individuals aged 26-40, students with low incomes, unemployed, and those from the suburban areas, while respondents with the least perceived threat to get infected with the COVID-19 in the next year had the highest level of vaccine hesitancy. It is evident that vaccine hesitancy is high, and multiple strategies across the Kurdistan region needed to be implemented to encourage people to get vaccinated; therefore, scientific communication is necessary with the help of mass media. Keywords: COVID-19 vaccine, Vaccine hesitancy, Kurdistan region, Nationwide assessment 1. Introduction Coronavirus disease 2019 (COVID-19) first appeared in Wuhan China in December 2019. The disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread globally to almost all countries of the world. By April 27, 2021, the virus has infected over 162 million people across the globe and has caused more than 3,374,052 deaths (1). Subsequently, the world health organization (WHO) in March 2020 declared that COVID-19was a pandemic disease, and many countries worldwide implemented a variety of precautionary measures to curb the spread of the virus, such as lockdowns, social distancing, mandating wearing masks, and quarantines (2). Despite implementing various measures to prevent the spread of the disease, in the autumn of 2020, the second wave of the coronavirus hit the European countries, which required restoring the measures eased earlier in the summer of 2020 (2). The Kurdistan region implemented the same preventative measures to tackle the virus. However, it was hit by the second wave of the coronavirus in March 2021, which made the 752 Ahmad Khidir / Archives of Razi Institute, Vol. 76, No. 4 (2021) 751-759 government and ministry of health order curfews and other previous preventive measures. It is expected that these strategies continue until herd immunity is achieved either by vaccination or the SARS-CoV-2 infection since COVID-19 transmission can be reduced to a minimum level by social distancing; accordingly, herd immunity can only be achieved by mass vaccination (2). To achieve this and eradicate the disease, many countries have begun to develop vaccines for the COVD-19, and several vaccines have been given emergency use by the WHO, such as the Pfizer/BioNTech, the SII/Covishield and AstraZeneca/AZD1222, the Janssen./Ad26.COV 2.S, the Moderna COVID-19 vaccine (mRNA 1273), and most recently Sinopharm COVID-19 (1). Two of the COVID-19 vaccines, namely Moderna (mRNA-1273) and Pfizer (BNT162b2), developed by American pharmaceutical companies have shown 90%-95% effectiveness (3, 4). In the Kurdistan region, the ministry of health launched a campaign for COVID-19 vaccination via a website and an application named "KURDVAC"on March 4, 2021 (5). The ministry of health aims to vaccine all citizens and has categorized the target population into three groups. The first group who received the vaccine included health practitioners, people aged 65 and over, essential workers, obese people, those with body mass index over 40, and individuals with immunodeficiencies. The second phase of the rollout target group was people aged over 50 and individuals with chronic diseases, and the third target group will be the public (6). There have been several studies to know the public's view towards COVID-19 vaccination, as well as vaccine hesitancy (7). Vaccine hesitancy concerns are growing worldwide (8), and it can be defined as the refusal of vaccination or reluctance to get vaccinated against a disease, regardless of the safety and effectiveness of the vaccine (9). A global survey was conducted in 19 countries to assess the acceptance of the COVID-19 vaccine. The results showed that 71.5% of the participants would be either very likely or somewhat likely to get the vaccine, while 48.1% of the cases responded that they would receive the vaccine if their employer asked them to do so (8). In other nationwide studies, vaccine hesitancy has shown different outcomes. Indonesia has shown high levels of acceptance for free vaccinations (10), and in China, the majority of participants intended to accept the COVID19 vaccine (11); however, in France and Russia, there has been a high rate of vaccine hesitancy. The vaccine efficacy and safety were cited as the top reasons for the hesitancy, followed by the lack of information regarding eligibility, possible side effects, inconvenience, and lack of time (7). There is no data about COVID-19 vaccine hesitancy in the Kurdistan region, and since the rollout of the vaccine, adverse effects experienced by few people who received the COVID-19 vaccines; moreover, misinformation is spread on social media, and conspiracy theories globally have drawn the attention of the people (12), including Kurdistan people. In addition, rapid vaccine development further heightened vaccine hesitancy (13), and other factors can determine vaccine hesitancy, such as socioeconomic status, gender, cultural factors, and religion (14). Considering all of these factors, to address vaccine hesitancy in the Kurdistan region, the government, public health practitioners, and the media must work and encourage vaccination. (...truncated)