COVID-19 Vaccine Hesitancy, Adverse Events Following Immunization, and Associated Factors among Ethiopian General Population During Early Phase of COVID-19 Vaccination Program
Authors: Tadesse Tamrat Assefa , Endale Sisay , Amare Firehiwot , Gebregeorgise Dawit Teshome , Negash Zenebe , Abiye Alfoalem Araba , Hussen Shemsu Umer , Yishak Amanuel , Tamiru Melaku Tileku 
Published: December 2022

Abstract
Aim: This study aimed at assessing COVID-19 vaccine hesitancy, adverse events after immunization, and associated factors among the general population during the early phase of the COVID-19 vaccination program in Ethiopia.
Subjects and Methods: We conducted a national online survey among 853 Ethiopian general population between June 19 and July 31, 2021, in three languages that included Amharic, Afan Oromo and English. Responses obtained from Google Forms were downloaded in excel formats, filtered, coded, exported, and analyzed using Statistical Package for Social Science (SPSS) version 26. Binary logistic regression was employed to identify factors associated with the outcome variables and p<0.05 was used as the cut-off point to declare the significance of the association. This study was approved by the Ethical Review Committee of the School of Pharmacy, College of Health Sciences, Addis Ababa University (ERB/290/13/2021).
Results: Of the 853 study participants, the majority of the participants were male (57.4%) and their mean (±SD)age was 32.0 (±13.57) years. More than half (61.0% (95% CI; 57.1%-64.8) of the participants were hesitant to take the COVID-19 vaccine. Fear of side effects (21.3%) and doubt about its effectiveness (16.9%) were their main reasons for not receiving the vaccine. Of the 214 participants, who received the first dose of the COVID-19 vaccine, 34.6% showed hesitation to take the second dose. The overall mean score (±SD) of the attitude of the participants toward COVID-19 and its vaccine was 31.21(±3.21) from an overall score of 45 and 53.6% scored below the mean (had a poor attitude) toward COVID-19. Of the 145 (67.8%) participants that experienced adverse events following immunization (AEFI) with the COVID-19 vaccine, the most common were pain at the injection site (52.4%), headache (40.7%), and fatigue (35.2%). The odds of vaccine hesitancy were reduced by 57% and 93% among participants with good attitudes toward the COVID-19 vaccine (AOR: 0.43, 95% CI: (0.29-0.65) and who recommended the vaccine to other people (AOR: 0.07, 95% CI: (0.04-0.12), respectively. The odds of COVID-19 vaccine side effects were reduced by 57% and 69% among participants in the age group of 30-39 years (AOR: 0.43, 95% CI: (0.19-0.98) and 40-49 years (AOR: 0.31, 95% CI: (0.12-0.86), respectively when compared to those in the age group of 18-29 years.
Conclusion: Hesitancy to first and second doses of the COVID-19 vaccine was high among the general population in Ethiopia. Fear of adverse effects and doubt about its effectiveness were the most frequent reasons for not receiving the COVID-19 vaccine. More than half of the participants had a poor attitude toward COVID-19 and its vaccine. More than two third of vaccinated participants experienced one or more AEFI COVID-19 vaccine administrations.