Development of Prediction Models of COVID-19 Vaccine Uptake among Lebanese and Syrians in a district of Beirut, Lebanon: a population-based study
Authors: Ragi Marie-Elizabeth , Ghattas Hala , Shamas Hazar , DeJong Jocelyn , Melhem Nada M. , McCall Stephen J. ,   with the CAEP Study Group
Published: March 2024

Introduction

Vaccines are essential to prevent infection and reduce morbidity of infectious diseases. Previous evidence has shown that migrants and refugees are particularly vulnerable to exclusion and discrimination, and low COVID-19 vaccine intention and uptake were observed among refugees globally. This study aimed to develop and internally validate prediction models of COVID-19 vaccine uptake by nationality.

Methods

This is a nested prognostic population-based cross-sectional analysis. Data was collected between June and October 2022 in Sin-El-Fil, a district of Beirut, Lebanon. All Syrian adults and a random sample of adults from low-socioeconomic status neighborhoods were invited to participate in a telephone survey. The main outcome was uptake of COVID-19 vaccine. Predictors of COVID-19 vaccine uptake were assessed using LASSO regression for Lebanese and Syrian nationalities, respectively.

Results

Of 2,045 participants, 79% were Lebanese, 18% Syrians and 3% of other nationalities. COVID-19 vaccination uptake was higher among Lebanese (85% (95%CI:82-86) compared to Syrians (47% (95% CI:43-51)) (P<0.001); adjusted odds ratio (aOR) 6.8 (95%CI:5.5-8.4). Predictors of uptake of one or more vaccine dose for Lebanese were older age, presence of an older adult in the household, higher education, greater asset-based wealth index, private healthcare coverage, feeling susceptible to COVID-19, belief in the safety and efficacy of vaccines and previous receipt of flu vaccine. For Syrians they were older age, male, completing school or higher education, receipt of cash assistance, presence of comorbidities, belief in the safety and efficacy of vaccines, previous receipt of flu vaccine, and legal residency status in Lebanon.

Conclusions

These findings indicate barriers for vaccine uptake in Syrian migrants and refugees, including legal residency status. They call for urgent action to enable equitable access to vaccines by raising awareness about the importance of vaccination and the targeting of migrant and refugee populations through vaccination campaigns.

Key Messages

What is already known on this topic

Vaccines are essential to prevent infection and reduce morbidity of infectious diseases, and vulnerable populations may lack access to vaccination campaigns.

What this study adds

To the best of our knowledge, no studies have examined compared predictors of COVID-19 vaccine uptake and measured the rate of vaccination among between Syrian migrants and refugees and their Lebanese host communities. This study illustrates a clear difference in vaccine uptake between nationalities and developed prediction models among the Syrian and Lebanese that identified differential predictors of COVID-19 vaccine uptake for each population.

How this study might affect research, practice or policy

These findings indicate barriers for vaccine uptake in Syrian migrants and refugees, including legal status, and calls for urgent action to enable access to vaccines by raising awareness about the importance of vaccination against COVID-19 in vulnerable groups and targeting migrant and refugee populations through vaccination campaigns.