ABSTRACT
Between December 2020 and February 2021, Israel administered two doses of COVID-19 vaccine to >50% of its adult population. Nonetheless, due to declining immunity and the spread of the COVID-19 delta variant, the government offered a third COVID-19 vaccine dose in July 2021. Although the vaccine was shown to provide effective protection against severe illness, the compliance rate among the Arab minority remained low. The present study sought to identify the factors predicting willingness to uptake the COVID-19 vaccine in the Arab community. An online survey of 2486 participants was conducted in November 2021 to assess vaccination-related behaviours, such as perceived benefits, barriers, incentives (e.g., the green pass), subjective norms, and pandemic fatigue. Positive correlations were found among reasons for obtaining a green pass, trust in formal authorities, perceived effectiveness of the third COVID-19 vaccine dose, subjective norms, and attitudes toward the booster dose. Pandemic fatigue was positively correlated with vaccination barriers. Trust in authorities, perceived booster dose effectiveness, subjective norms, and attitudes were negatively related to pandemic fatigue and barriers to vaccination. Demographic variables such as age, education level, and income level were positively related to odds of getting the booster. Participants who reported being religious exhibited a lower rate of booster dose compliance than secular participants. The study findings show that the reasons for acquiring a green pass were positively correlated with the perceived effectiveness of the booster dose, demonstrating that individuals understood the vaccine benefits. Further, having a green pass was negatively related to barriers. Incentives such as the green pass play a major role in encouraging the population to take the COVID-19 vaccine. In addition, public campaigns to explain the health benefits and refute erroneous myths support higher vaccination rates.
ABSTRACT
BACKGROUND: COVID-19 is disproportionately affecting disadvantaged populations, with greater representation and worse outcomes in low socioeconomic and minority populations, and in persons from marginalized groups. General health care system approaches to inequity reduction (i.e., the minimization of differences in health and health care which are considered unfair or unjust), address the major social determinants of health, such as low income, ethnic affiliation or remote place of residents. Yet, to effectively reduce inequity there is a need for a multifactorial consideration of the aspects that intersect and generate significant barriers to effective care that can address the unique situations that people face due to their gender, ethnicity and socioeconomic situation. MAIN BODY: To address the health equity challenges of diverse population groups in Israel, we propose to adopt an intersectional approach, allowing to better identify the needs and then better tailor the infection prevention and control modalities to those who need them the most. We focus on the two main ethnic - cultural-religious minority groups, that of Arab Palestinian citizens of Israel and Jewish ultra-orthodox (Haredi) communities. Additionally, we address the unique needs of persons with severe mental illness who often experience an intersection of clinical and sociodemographic risks. CONCLUSIONS: This perspective highlights the need for responses to COVID-19, and future pandemic or global disasters, that adopt the unique lens of intersectionality and equity. This requires that the government and health system create multiple messages, interventions and policies which ensure a person and community tailored approach to meet the needs of persons from diverse linguistic, ethnic, religious, socioeconomic and cultural backgrounds. Under-investment in intersectional responses will lead to widening of gaps and a disproportionate disease and mortality burden on societies' most vulnerable groups.