ABSTRACT
Refugees in the United States are believed to be at high risk of COVID-19. A cross-sectional study design was utilized to collect anonymous, online surveys from refugee communities in the United States during December 2020 to January 2021. We invited bilingual community leaders to share the survey link with other refugees aged ≥18 years. We identified factors associated with COVID-19 infection and measured the distribution of contact tracing among those who tested positive. Of 435 refugees who completed the survey, 26.4% reported testing positive for COVID-19. COVID-19 infection was associated with having an infected family member and knowing people in one's immediate social environment who were infected. Among respondents who tested positive, 84.4% reported that they had been contacted for contact tracing. To prepare for future pandemics, public health authorities should continue partner with refugee community leaders and organizations to ensure efficient programs are inclusive of refugee communities.
ABSTRACT
BACKGROUND: The COVID-19 pandemic is an additional burden on Lebanon's stressed population, fragmented healthcare system, and political, economic, and refugee crises. Vaccination is an important means to overcoming the pandemic. OBJECTIVE: Our study's aims were to 1) assess rates of intention to vaccinate and vaccine hesitancy in Lebanon; 2) determine how vaccine hesitancy in Lebanon varies by sociodemographic, economic, and geographic characteristics; and 3) understand individuals' motivations for vaccinating and concerns and obstacles to vaccination. METHODS: We performed a cross-sectional study from 29 Jan 2021 to 11 Mar 2021 using an online questionnaire of open- and closed-ended questions in Arabic via convenience "snowball" sampling to assess the perceptions of adults residing in Lebanon. RESULTS: 1,185 adults participated in the survey. 46.1% [95% CI: 43.2%-49.0%] of survey participants intended to take the SARS-CoV-2 vaccine when available to them, 19.0% [16.8%-21.4%] indicated that they would not, and 34.0% [31.3%-36.8%] were unsure. The most common reasons for hesitancy were concerns about safety, limited testing, side effects, and efficacy. Top motivations for vaccinating were to protect oneself, to protect one's family and the public, and to end the pandemic. Despite financial hardships in Lebanon, barriers to vaccine access were not frequently described as concerns. Established healthcare facilities, rather than new temporary vaccination centers, were most frequently selected as preferred vaccination sites. CONCLUSIONS: Vaccine hesitancy appears to be high in Lebanon. Disseminating clear, consistent, evidence-based safety and efficacy information on vaccines may help reduce vaccine hesitancy, especially among the large proportion of adults who appear to be unsure about (rather than opposed to) vaccination.
ABSTRACT
OBJECTIVE: Little is known about COVID-19 vaccination intentions among refugee communities in the United States. The objective of this study was to measure COVID-19 vaccination intentions among a sample of refugees in the United States and the reasons for their vaccine acceptance or hesitancy. METHODS: From December 2020 through January 2021, we emailed or text messaged anonymous online surveys to 12 bilingual leaders in the Afghan, Bhutanese, Somali, South Sudanese, and Burmese refugee communities in the United States. We asked community leaders to complete the survey and share the link with community members who met the inclusion criteria (arrived in the United States as refugees, were aged ≥18, and currently lived in the United States). We compared the characteristics of respondents who intended to receive the COVID-19 vaccine with those of respondents who did not intend to receive the vaccine or were unsure. We then conducted crude and adjusted logistic regression analysis to measure the association between employment as an essential worker and COVID-19 vaccine acceptance. RESULTS: Of 435 respondents, 306 (70.3%) indicated that they planned to receive a COVID-19 vaccine. Being an essential worker (adjusted odds ratio [aOR] = 2.37; 95% CI, 1.44-3.90) and male sex (aOR = 1.87; 95% CI, 1.12-3.12) were significantly associated with higher odds of intending to receive a COVID-19 vaccine. Among respondents who intended to receive a COVID-19 vaccine, wanting to protect themselves (68.6%), family members (65.0%), and other people (54.3%) were the main reasons. CONCLUSION: Many refugees who responded to the survey, especially those who worked in essential industries, intended to receive a COVID-19 vaccine. Community organizations, health care providers, and public health agencies should work together to ensure that vaccine registration and vaccination sites are accessible to refugees.