COVID-19 Vaccine Acceptance and Hesitancy among Pregnant Women: A Knowledge, Attitude, and Perceived Risks Survey in Lusaka, Zambia

Introduction: The coronavirus disease 2019 (COVID-19) is an infectious disease of the respiratory tract caused by SARS-CoV-2. Since its emergence, there have been increased rates of transmission and spread, morbidity and mortality which led to the development of COVID-19 vaccines to address the pandemic. This study assessed acceptance, knowledge, attitude, and perceived risks regarding COVID-19 vaccines among pregnant women attending antenatal care at two First-Level Hospitals in Lusaka, Zambia. Materials and Methods: This was a cross-sectional study that was conducted among 241 pregnant women using a questionnaire from August 2023 to October 2023 in two First-Level Hospitals in Lusaka district, Zambia. The collected data were analyzed using IBM Statistical Package for Social Sciences (SPSS) version 22.0. Statistical analysis was performed using a Chi-square test. The statistical significance was set at a 95% confidence level. Results: Of the 241 participants, 107 (42.7%) were aged between 24 and 34 years. Overall, 64.3% accepted the COVID-19 vaccines, of which 122 (50.6%) were already vaccinated. Further, 203 (84.6%) of the pregnant women had good knowledge, and 199 (82.6%) had positive attitudes towards COVID-19 vaccines. However, 58.5% thought COVID-19 vaccines were not safe and could cause infertility. Alongside this, 70.1% thought that COVID-19 vaccines were harmful during pregnancy. Having good knowledge of COVID-19 vaccines was associated with age (p = 0.049), education status (p = 0.001), and employment status (p = 0.001). Having a positive attitude towards COVID-19 vaccines was associated with education status (p = 0.001) and employment status (p = 0.001). Conclusion: This study found that most pregnant women had good knowledge, and positive attitudes, and the majority accepted the COVID-19 vaccine. Encouragingly, most of the pregnant women who accepted the COVID-19 vaccines were already vaccinated. Most pregnant women thought that COVID-19 vaccines had side effects, were not safe, and could be harmful during pregnancy. Consequently, this could have contributed to the hesitancy to receive a vaccine among some participants. The findings of this study demonstrate the need to provide pregnant women with continuous educational programs on the benefits of vaccinations for themselves and their children.

Inequity in the global distribution of monkeypox vaccines

Monkeypox(mpox)has been a public health emergency of international concern that emerged in mid-2022 and has spread to 110 countries.The clinical findings of the disease vary according to the seriousness of the cases.Although its case fatality risk has not been high,a significant percentage of patients require hospitalization.In this context,local initiatives were taken to extend the limited supply of vaccines against the disease;however,such measures have not been sufficient to contain the spread of cases and ensure an equitable distribution of health resources.As a result,endemic regions of low-income countries continue to have insufficient access to mpox vaccination.Despite this and considering the global scope of the disease,there is still little discussion in the literature about the difficulties in achieving adequate vaccination coverage rates for the target population of interest.In this article,we briefly discussed general aspects of the disease,including its surveillance,the current global context of challenges for mpox vaccination,and issues on global allocation of health resources as well as proposed related recommendations.

Vaccine Hesitancy—A Persistant Pandemic and Continued Threat to Global Health

Last time the world faced a deadly pandemic was the H1N1 Spanish flu in 1918, which affected almost one third of the world’s population (500 million people). Since then, almost 100 years later, we are now facing another pandemic of the SARS-CoV2 virus (Covid-19), which is still endemic to this day. As technology evolved during those 100 years, an effective vaccine for Covid-19 was produced within only a year, a huge feat. But, unfortunately, due to its fast development, another force would arise limiting the impact of the vaccine: Vacccine hesitancy and anti-vaxxers, which John Hopkins and the World Health Organization call the biggest current threat to global health. From politics to social media, it is clear that there has been a rapid spread of misinformation, resulting in hesitancy, especially from sociopolitically motivated people popularly referred to as antivaccers. However, a second group of vaccine-hesitant people have also emerged, who are uneducated and remain undecided about vaccination mostly due to safety concerns. They come under the massive influence of anti-vaxxers and anti-vaccine propaganda through social media and politicians, which often make bold claims and huge headlines. To combat vaccine hesitancy, it is crucial that we debunk these conspiracy theories and misinformation that so many believe in, with factual, data-based information. Actively spreading correct information about the vaccines, such as disclosing the rigorous developmental processes and validation of safety data by the FDA, assurance for unlikeliness of getting a lethal side effect along with tremendous health benefits, will encourage people to safe vaccination against Covid-19 and other potentially infectious diseases in future. This article discusses the role of anti-vaxxers and vaccine hesitancy groups, electronic social media, and politics in vaccine hesitancy among people. It describes the strategies to combat the roadblocks in the vaccination programs and health benefits, offered by recent advances in scientific and technological developments.

COVID-19 Vaccine Rejection among Muslims in Turkey: Religiosity and Fear of Death

This study aimed to examine the relationship between COVID-19 vaccine refusal and religiosity and fear of death among Muslims living in Turkey. This cross-sectional study was conducted online with 1046 adults aged 18 and older. The Ok-Religious Attitude Scale (Islam) (ORASI) (8 items) and Thorson-Powell Death Anxiety Scale (TPDAS) (20 items) were used as data collection instruments. The data were analyzed using the Pearson chi-square test, Student’s t-test, and binary logistic regression. A p-value of 0.05). In binary logistic regression analysis, vaccine rejection was 7.19 times higher among single people, 50.55 times higher among workers and tradesmen, and 3.36 times higher among people who did not have COVID-19. As religiosity increased, the risk of vaccine refusal decreased 1.037-fold.

Effectiveness and safety of COVID-19 vaccines in patients with diabetes as a factor for vaccine hesitancy

Diabetes mellitus is one of the most common comorbid conditions encountered in patients with severe acute respiratory syndrome coronavirus 2 infection accompanied by significantly increased mortality,prolonged hospital stay,and requirement of invasive mechanical ventilation.This review aims to present the effectiveness and safety profile of available coronavirus disease 2019(COVID-19)vaccines in people with diabetes as a potential cause of hesitancy for vaccination.Data from published research proves a robust immune response following immunization for COVID-19 in diabetic patients with substantial production of virus-neutralizing antibodies;however,the observed immune response was unequivocally weaker than that in individuals without diabetes.This observation was further enhanced by the findings that worse glycemic control was associated with more suppressed antibody production.In contrast,individuals with optimal glycemic control performed similarly to healthy controls.In addition to the need for strict glucose monitoring and adequate diabetes treatment,those findings reinforce the concept of diabetes-induced secondary immune deficiency and necessitate the application of booster doses to diabetic patients with priority.Nevertheless,after vaccination,reported adverse events were not different from those in the general population.No increase in severe adverse events was documented.While single case reports detected transient increases in blood glucose post-vaccination,more extensive trials could not replicate such a relationship.

Reasons of Vaccine Hesitancy among Pakistanis with Available COVID-19 Vaccine: The Next Challenge in the Fight against COVID-19

The government of Pakistan started vaccination campaign for the frontline healthcare pro-viders, as they are more likely to be exposed to COVID-19 patients. In the next step, it ex-tended the free vaccination campaign to include people above 60 and 50 years of age re-spectively. The drive is now open to all citizens >18 years of age. There is a significant re-luctance to get vaccinated even though the government has provided it free of cost. The project uses self-reporting method to assess reasons of vaccine hesitancy among Pakistanis and possible solutions to overcome this problem. Concern for serious side effects was the most common issue 154 (48.42%) reported among all groups of people, including the healthcare workers. The major sources of COVID-19 related information were television 117 (36.8%) and healthcare professionals 105 (33%). The participants reported that they can be convinced to get vaccinated if more published data related to vaccine efficacy and safety is available 118 (37.1%), they observe no side effect among vaccine recipients 90 (28.3%) or higher government officials get the same vaccine 39 (12.3%). Vigorous analysis and publication of data generated is paramount to increase the percentage of people being vaccinated. The healthcare professionals should share evidence-based knowledge related to vaccine efficacy and safety through television and social media to increase acceptance rates and hence, decrease mortality and morbidity from COVID-19 in Pakistan.

Predictors and willingness to take COVID-19 vaccine in Nigeria

Background:Coronavirus Disease 2019 constitutes a major threat worldwide with which the whole globe is confronted.Notwithstanding the urgent requirement for an effective vaccine,there is as yet an extensive lack of concern and hesitancy in accepting vaccines in Nigeria.Methods:Online survey conducted from January to December 2020 with 5,114 grown-ups,arbitrarily scrutinized to coordinate with the populace for age,and sexual orientation.The survey instrument assessed the willingness to accept COVID-19 approved vaccine,using a published scale of 15 items vaccine hesitancy scale.Results:About 3,667(71.7%)participants indicated a willingness to be vaccinated,while 598(11.7%)were unwilling and 849(16.6%)were indeterminate.Clarifying 32%of difference featured two higher-request logical variables:'unnecessary question'(r=0.51),including connivance belief,negative perspectives on specialists,and need for turmoil and'positive clinical benefits experiences'(r=−0.48),including solid expert correspondences and incredible National Health Insurance care.Hesitancy was found to be associated with lower adherence to isolating social principles.Conclusion:Hesitating to take the COVID-19 vaccine is spreading moderately across the general population.Public data on a vaccine that highlights prosocial benefits may be especially convincing.However,elements,such as subversion beliefs and taboos that develop a question and disintegrate social association will hinder vaccine take-up.

Zambia’s Response to the COVID-19 Pandemic: Exploring Lessons, Challenges and Implications for Future Policies and Strategies

The coronavirus disease 2019 (COVID-19) pandemic is a global public health problem that has affected the globe in different ways. There is little information published on the challenges and lessons learnt in responding to the COVID-19 epidemic in Zambia. Objective: To establish Zambia’s response, lessons and the challenges experienced in the fight against COVID-19. Results: Since the emergence of COVID-19, Zambia has experienced three waves, with the third wave being the most severe. The Zambian government responded positively and effectively to all three pandemics with the help of cooperating partners. Zambia adopted the World Health Organization (WHO) recommended prevention methods such as hand hygiene, masking up in public, physical distancing, avoiding crowded areas and staying at home to prevent the further spread of the disease. Additionally, surveillance of COVID-19 was strengthened, which led to the early detection of cases. Besides, there has been a strong call for all Zambian adults to receive the COVID-19 vaccine as a way of controlling the epidemic. However, since the launch of the COVID-19 vaccination programs, there has been a high level of vaccine hesitancy, causing Zambia to fall below the 10% of the adult population required to be vaccinated. Conclusion: The Zambian government put in place effective strategies in the fight against COVID-19. However, a lack of resources, misinformation, myths and vaccine hesitancy posed challenges in the fight against COVID-19 in Zambia. There is a need for continuous public education and sensitization on COVID-19 and the importance of vaccinations.

Awareness about transmission and preventive measures of COVID-19 from mother to child: A cross-sectional study among pregnant women

Objective:To study the knowledge,attitude,and practice of pregnant women regarding transmission and preventive measures of COVID-19 from mother to child and to determine the reasons for vaccine hesitancy.Methods:This observational cross-sectional knowledge,attitude,and practice study was conducted among pregnant women of any trimester,attending the antenatal care out-patient department of a tertiary care hospital in Lucknow from October 2020 to March 2021.All the participants were interviewed using a pretested semi-structured questionnaire for desired information.Reasons for vaccine hesitancy were also asked to assess their unwillingness to get vaccinated.Results:Totally 652 pregnant women were included and 91.3%were aware that COVID-19 spread through contact with an infected person and 85.3%knew that COVID-19 spread by respiratory droplets.Of pregnant women,95.7%perceived that social distancing and wearing a proper mask were effective ways to prevent SARS-CoV-2 infection and 96.8%of the pregnant women wore masks regularly when going out.Of pregnant women,79.0%were hesitant to get vaccinated.The most common reason was that COVID-19 vaccine can harm the developing fetus(77.5%)and was not very safe in pregnancy(75.0%).Conclusions:Of the pregnant women,22.92%have unsatisfactory knowledge regarding COVID-19,35.63%have negative attitude and 19.93%have poor practices,indicating that there are still gaps in awareness,and majority of them are unwilling to get vaccinated.Good awareness will help prevent the occurrence of future COVID-19 waves in India.

The global COVID-19 vaccine surplus:tackling expiring stockpiles

Background A global surplus of coronavirus disease 2019(COVID-19)vaccines exists as a result of difficulties in aligning the demand and supply for vaccine manufacturing and delivery.World leaders have accelerated vaccine development,approval,production and distribution as a pragmatic approach to addressing the immediate public health challenges of the first two and a half years of the pandemic.Main body The currently predominant,highly transmissible Omicron variant of severe acute respiratory syndrome coronavirus 2 has brought us closer to the threshold required to achieve herd immunity by greatly increasing rates of natural infection.Paradoxically,in parallel with rising vaccination levels in industrialized nations,this indirectly reduces the need for mass vaccine campaigns.Principal concerns that contribute to low vaccination rates which persist in several other countries,particularly of the Global South,are vaccine hesitancy and unequal access to vaccination.Social uncertainty fueled by fake news,misinformation,unfounded lay opinions and conspiracy theories has inevitably led to an erosion of public trust in vaccination.Conclusion To address the current mismatch between supply and demand of COVID-19 vaccines,there should be a focus on three principles:decelerating vaccine production,increasing distribution across communities,and optimizing cost-effectiveness of distribution logistics.Slowing down and switching from large-scale production to effectively‘made to order’is a feasible option,which should be commensurate with management capacity.Transparent and evidence-based data should be widely and freely disseminated to the public through multimedia channels to mitigate miscommunication and conspiracy theories.Use of soon-to-expire stockpiles should be prioritized not only to enhance booster dose rollouts in adults but to expand immunization campaigns to children(especially those aged 5–11 years),subject to national approval.Future research should ideally aim to develop vaccines that only require basic,affordable storage and maintenance procedures as opposed to sophisticated and expensive protocols.

Hesitant adopters:COVID-19 vaccine hesitancy among diverse vaccinated adults in the United States

Background:Despite the United States(US)having an abundant supply of COVID-19 vaccines,vaccination rates lag behind other high-income countries,suggesting that vaccine hesitancy and attitudes play a greater role in public health measures than pure supply and access.With the acknowledgment that vaccination attitudes and status may or may not be correlated,this study examined COVID-19 vaccine hesitancy among vaccinated US adults by asking:(1)What is the prevalence of COVID-19 vaccine hesitancy among the vaccinated?(2)Does COVID-19 vaccine hesitancy vary across sociodemographic characteristics?(3)Does COVID-19 vaccine hesitancy vary by healthcare access and influenza vaccination over the past 5 years?Methods:Data were collected through an online survey of 2022 US adults with a final analytic sample of 1383 vaccinated respondents.Results:Overall,48.8%of vaccinated adults reported some level of hesitancy,while a slight majority reported they were“not at all hesitant”.Younger respondents,women,and Black and American Indian or Alaska Native participants had greater adjusted odds of being more hesitant towards receiving the COVID-19 vaccine.Respon-dents who had a primary care physician had greater adjusted odds than those who did not have a primary care physician of being more hesitant towards receiving the COVID-19 vaccine.Conclusions:This is the first population-based national sample study examining COVID-19 vaccine hesitancy among vaccinated individuals from subgroups of distinctive backgrounds in order to inform targeted strategies for reducing vaccine hesitancy.Findings can assist in efforts to increase vaccination rates and also decrease vaccine hesitancy at the national level.

Knowledge about, attitude and acceptance towards, and predictors of intention to receive the COVID-19 vaccine among cancer patients in Eastern China: A cross-sectional survey

Objective: The coronavirus disease 2019(COVID-19) pandemic has had a serious impact on health all over the world. Cancer patient, whose immunity is often compromised, faces a huge challenge.Currently, some COVID-19 vaccines are being developed and applied on general population;however,whether cancer patients should take COVID-19 vaccine remains unknown. Our study aimed to explore the knowledge, attitude, acceptance, and predictors of intention to receive the COVID-19 vaccine among cancer patients in Eastern China.Methods: A cross-sectional study was conducted in Eastern China from June 17 th to September 3 rd, 2021.Patients were selected using a convenience sampling method. A self-report questionnaire was developed to assess knowledge about the COVID-19 vaccine, attitude towards the vaccine and acceptance of the vaccine;following a review of similar studies previously published in the scientific literature, multivariate logistic regression analysis was used to determine the predictors associated with COVID-19 vaccine acceptance.Results: A total of 2158 cancer patients were enrolled in this study. The rate of vaccine hesitancy was 24.05%(519/2158);further, among the participants of vaccine acceptance, 767 had taken COVID-19 vaccine(35.54%), and 872 were willing to get vaccinated(40.01%). A total of 24 variables including demographic characteristics, clinical status of cancer, impact of COVID-19 pandemic on study participants,patients’ knowledge about the COVID-19 vaccine, and attitude towards the vaccine, had significant differences between the ‘‘vaccine hesitancy" population and ‘‘vaccine acceptance" population.Multivariate logistic regression analysis indicated that parameters including alcohol consumption(odds ratio [OR] = 1.849;95% confidence interval [CI]: 1.375–2.488;P-reference [P-Ref] < 0.001 vs nondrinkers), income impacted by COVID-19 pandemic(OR = 1.930, 2.037 and 2.688 for mild, moderate,and severe impact, respectively;all P-Ref < 0.01 vs no impact), knowledge of how the vaccine was developed(OR = 1.616;95% CI: 1.126–2.318;P-Ref = 0.009 vs unknown), believing in the safety of the vaccine(OR = 1.502;95% CI: 1.024–2.203;P-Ref = 0.038 vs denying the safety of vaccine), willingness to pay for the vaccine(OR = 3.042;95% CI: 2.376–3.894;P-Ref < 0.001 vs unwilling), and willingness to recommend families and friends to get vaccinated(OR = 2.744;95% CI: 1.759–4.280;P-Ref < 0.001 vs do not recommend) were contributors to vaccine acceptance. While such as being retired(OR = 0.586;95% CI: 0.438–0.784;P-Ref < 0.001 vs unemployed), undergoing multiple therapies of cancer(OR = 0.408;95% CI: 0.221–0.753;P-Ref = 0.004 vs no ongoing treatment), and worrying that the vaccine might deteriorate the prognosis of cancer(OR = 0.393;95% CI: 0.307–0.504;P-Ref < 0.001 vs might not) were contributors to vaccine hesitancy.Conclusion: This study provided preliminary estimates of the rates of vaccine acceptance and vaccine hesitancy among cancer patients in Eastern China. The intention to receive the COVID-19 vaccine was impacted by factors such as patient occupation, alcohol consumption, and some parts of knowledge about and attitude towards COVID-19 vaccine. It is recommended to develop individualized vaccination plans that meet the healthcare needs of cancer patients.

The COVID‐19 vaccine: Attitudes and vaccination in patients with autoimmune inflammatory rheumatic diseases

Background:We examined attitudes toward the COVID‐19 vaccine,potential factors underlying these attitudes,and ways to increase vaccination willingness in autoimmune inflammatory rheumatic diseases(AIIRD)patients.Methods:A multicenter,web‐based,observational survey using an online questionnaire was conducted among AIIRD patients aged≥18 years from May 24,2021,to June 3,2021.Participants were 3104 AIIRD patients(2921 unvaccinated and 183 vaccinated).Results:Of the unvaccinated patients,32.9%were willing to receive the COVID‐19 vaccine,45.0%were uncertain,and 14.8%were unwilling.When vaccination was recommended by physicians,patients'willingness increased to 93.8%.Participants'main concerns were that the vaccine may aggravate AIIRD disease(63.0%)and may cause vaccine‐related adverse events(19.9%).Female patients were less likely to be vaccinated.However,patients who had children aged≤18 years were more willing to be vaccinated.In addition,vaccination willingness was higher in patients with trust in the safety and efficacy of the COVID‐19 vaccine.Notably,183(5.9%)patients were vaccinated.The major vaccination side effects were injection reaction,myalgia,and fatigue.At a median follow‐up of 88(38,131)days,patients'disease activities were stable.Conclusions:The findings show that AIIRD patients were unwilling to receive the COVID‐19 vaccine because of fears of potential disease exacerbation and additional adverse events.Sociodemographic characteristics and concerns about COVID‐19 disease and vaccines had a significant effect on vaccination willingness.

Social media study of public opinions on potential COVID-19 vaccines: informing dissent, disparities, and dissemination

Background The current development of vaccines for severe acute respiratory syndrome coronavirus 2(SARSCoV-2)is unprecedented.Little is known,however,about the nuanced public opinions on the vaccines on social media.Methods We adopted a human-guided machine learning framework using more than six million tweets from almost two million unique Twitter users to capture public opinions on the vaccines for SARS-CoV-2,classifying them into three groups:pro-vaccine,vaccine-hesitant,and anti-vaccine.After feature inference and opinion mining,10,945 unique Twitter users were included in the study population.Multinomial logistic regression and counterfactual analysis were conducted.Results Socioeconomically disadvantaged groups were more likely to hold polarized opinions on coronavirus disease 2019(COVID-19)vaccines,either pro-vaccine(B=0.40,SE=0.08,P<0.001,OR=1.49;95%CI=1.26-1.75)or anti-vaccine(B=0.52,SE=0.06,P<0.001,OR=1.69;95%CI=1.49-1.91).People who have the worst personal pandemic experience were more likely to hold the anti-vaccine opinion(B=−0.18,SE=0.04,P<0.001,OR=0.84;95%CI=0.77-0.90).The United States public is most concerned about the safety,effectiveness,and political issues regarding vaccines for COVID-19,and improving personal pandemic experience increases the vaccine acceptance level.

Forecast Hesitancy: Why are People Reluctant to Believe, Accept, or Respond to Various Weather, Water, and Climate Hazard-Related Forecasts?

Current discussions of the social phenomenon of“vaccine hesitancy”with regard to Covid-19 provide an opportunity to use hesitancy as a means to shift thinking about untimely and delayed responses to forecasts of hydrometeorological hazards.Hesitancy,that is,provides a paradigm through which such regrettably delayed responses to hydromet hazards might be better understood and effectively addressed.Without exaggeration,just about every hydromet event provides an example of how hesitancy hinders individual,community,and national government risk-reducing preventive and mitigative responses to forecasts of foreseeable,relatively near-term climate,water,or weather hazards.Reasons for such hesitancy(for vaccine and forecast use alike)include—among others—lack of trust in the science,lack of confidence in government,and persistent concern about the uncertainties that surround forecasting—both meteorological and public health.As such,a better understanding of the causes that lead to individual and group hesitancy can better inform hydromet forecasters and affected communities about ways in which beneficial actions in response to timely forecasts are often delayed.This better understanding will facilitate,where necessary,targeted interventions to enhance the societal value of forecasting by reducing this long-observed challenge of“forecast hesitancy.”First,this article focuses on incidents of“vaccine hesitancy”that,for various reasons,people around the world are even now experiencing with regard to several now-available,and confirmed efficacious,Covid-19 vaccines.Reports of such incidents of indecisiveness first increased dramatically over the first few months of 2021,despite the strong scientific confidence that vaccination would significantly lower personal risk of contracting as well as spreading the virus.After,the notion of forecast hesitancy with regard to hydrometeorological hazards is discussed.

Experiences and perceptions of COVID‑19 infection and vaccination among Palestinian refugees in Jerash camp and Jordanian citizens:a comparative cross‑sectional study by face‑to‑face interviews

Background:During the COVID-19 vaccination,the access to vaccines has been unequal among countries and indi‑viduals,for example low-income countries displayed signifcant low levels of vaccination.Furthermore,most refugees are living in developing low-income countries which struggling to access the essential health-care services including vaccination.Thus,the objective of this study was to assess the experiences and perceptions of COVID-19 infection and vaccination among Palestine refugees in Jerash camp compared to resident Jordanian citizens.Methods:A face-to-face interview-based comparative cross-sectional study was carried out among Palestine refu‑gees in Jerash camp located in northern Jordan and Jordanian citizens from diferent cities in Jordan from October,2021 to March,2022.A Chi-square test was used to determine the diferences in the experiences and perceptions of COVID-19 infection and vaccination between Palestinian refugees and resident Jordanian citizens.Logistic regres‑sion analysis was performed to predict factors associated with the beliefs,barriers and hesitancy towards COVID-19 vaccines.Results:The total number of participants was 992,with 501(50.5%)Palestinian refugees and 491(49.5%)Jordanian citizens.Most participants(64.1%)who have never been tested for COVID-19 were from the refugees(P<0.001),whereas about 80.3%of the participants tested for COVID-19 at private healthcare institutions were citizens(P<0.001).While 70.0%of the participants who tested positive for COVID-19(n=303)were from the refugees(P<0.001).Com‑pared to the citizens,the refugees had signifcantly lower levels of beliefs about the safety(P=0.008)and efciency(P<0.001)of COVID-19 vaccines.They also had lower rates of vaccine hesitancy(P=0.002)and vaccine uptake(P<0.001),and a higher rate of facing difculties during registration for COVID-19 vaccination(P<0.001).Furthermore,refugees have more negative attitudes toward the importance and implementation of COVID-19 precautionary activi‑ties,including wearing face masks,practicing social distancing and following proper prevention hygiene compared to citizens(P<0.001).The regression analysis showed that gender(P<0.001),age(P<0.001)and level of education(P=0.001)were signifcantly associated with COVID-19 vaccine hesitancy.Also,being a refugee(P<0.001)and being a male(P=0.012)were signifcantly associated with facing more difculties upon the registration to receive a COVID19 vaccine.Conclusions:This study showed that,compared to citizens,refugees had lower attitudes and practices toward COVID-19 infection and vaccination.They also had and a lower rate of COVID-19 vaccine hesitancy and uptake with limited access to vaccines.Government sectors and non-government organizations should implement policies and regulations to raise the awareness of refugees towards COVID-19 infection,testing,preventive measures,and the safety and efcacy of vaccines.