RESUMEN
ImportanceVaccines are essential to prevent infection and reduce morbidity of infectious diseases, and vulnerable populations may lack access to vaccination campaigns. Previous evidence has shown that migrants and refugees are particularly vulnerable to exclusion, stigma and discrimination, and low COVID-19 vaccine intention and uptake were observed among refugees globally. ObjectiveTo develop and internally validate prediction models of COVID-19 vaccine uptake by nationality. DesignThis is a nested prognostic population-based cross-sectional analysis. SettingData was collected between June and October 2022 in Sin-El-Fil, a district of Beirut, Lebanon. ParticipantsAll Syrian adults and a random sample of other adults from low-socioeconomic status neighborhoods were invited to participate in the study (n=3,138). A telephone survey with consenting participants (n=2,045) was conducted. ExposuresCandidate predictors of COVID-19 vaccine uptake identified from the literature were collected. Main Outcome and MeasuresThe 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. The models discrimination capabilities are presented using the AUC, and their calibration are presented using the calibration slopes. ResultsOf 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 and RelevanceThese 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. FundingInternational Development Research Centre (IDRC) - Canada Key PointsO_ST_ABSQuestionC_ST_ABSWhat are the context-specific differential predictors of vaccine uptake among the resident population by nationality in Lebanon? FindingsThis is a nested population-based cross-sectional analysis that examined predictors of COVID-19 vaccine uptake among Lebanese and Syrians living in low-socioeconomic neighborhoods in 2022. Socioeconomic, demographic and health risk perceptions were identified for both Syrians and Lebanese, while additional barriers identified in Syrian refugees included legal residency status in the country. MeaningDespite the availability of vaccines to all residents, there were inequalities in vaccine uptake between Syrians and Lebanese which need to be addressed.