To our best of knowledge, this is the first nationally representative study conducted in Syria regarding vaccination intentions.
Although availability, effectiveness, and cost of the vaccine are key factors to determine the success of a vaccine, vaccine hesitancy plays a crucial role too [16, 17]. Only 37% of our population answered: “very likely” when asked whether they will take the vaccine upon its availability or not and 31% answered “uncertain”. These numbers raise a lot of concern, especially with the fact that immunization of at least 60–75% of individuals is required to achieve desired herd immunity [3]. Our results are much lower than other studies in United States of America (57.6%), Canada (80%), Libya (79.6%), Saudi Arabia (64.7%), Lebanon (58.8%), Iraq (61.7%), Qatar (42.7%), China (91.3%), Italy (53.7%), Poland (56.3%), Denmark (80%), Germany (70%), Portugal (75%), Russia (54.9%), and United Kingdom (55.8%). But higher than those in Kuwait (23.6%) and Jordan (28.4%) [8, 12, 13, 18,19,20,21,22,23,24,25,26].
Canada has the biggest per-capita hoard of the vaccines reserved, enough vaccines to immunize its citizens five times. The US and UK came second [27]. Out Of 832 million vaccine doses, only 0.2% have been sent to low-income countries [28, 29]. Unfair vaccination rollouts may indicate a deeper issue of inequality and jeopardize the health of fragile populations -such as Syria-, which has enough doses to immunize only 4% of the population [30].
With the fragile and weak health care system, vaccination offers the best hope for Syrians to fight against COVID-19. Appreciating this, about one-third (36.1%) are willing to pay to get vaccinated. Higher numbers were observed in other low-income countries like Libya (48.2%) and Lebanon (51.9%) [18, 20].
The official number of confirmed cases in Syria is to the date of writing 24,700 cases [4]. However, (60.7%) of our participants said that they personally knew at least someone who has had PCR-confirmed coronavirus disease, and (36.4%) said that they experienced COVID-19 symptoms, which strongly suggests that the community transmission of the disease surpasses the official numbers.
Interestingly, an optimism bias was observed among our study population, since most of them believe themselves to be less at risk of COVID-19 than others in the society [31]. This may be attributed to the fact that Syria has a relatively youthful community [32], and younger people tend to think they are at less risk to be infected. A similar observation was reported in the UK, France, and Lebanon [12, 20, 33].
In our study, only 4136 (54.9%) considered themselves knowledgeable enough about COVID-19 to make an informed decision about vaccination, this is relatively lower than the previous two studies that measured the knowledge of the Syrian population through structured questionnaires, which showed a mean knowledge ranging from 60 to 75.6% [34, 35]. This indicates that the Syrian population underestimates their knowledge and does not trust the knowledge they have. This disparity can be attributed to the fact that many participants rely on unreliable sources of information, as almost half of the participants get their information from social media. Social media information may be very misleading, especially in low income countries [11]. It can be anti-vaccine oriented as reported in several previous studies [36,37,38,39]. Moreover, only (33.8%) thought they have enough information about the vaccine, this can also be attributed to their reliance on unreliable sources, which will affect their quality of information and hence, their intentions to be vaccinated. Furthermore, unreliable sources of information will also help in the spread of conspiracy theories about the vaccine and this was evident in our results as (37.3%) of the participants think there are hidden motives behind the vaccine. Our results are similar to the numbers reported in Libya (38.7%), but much higher than the Lebanese study (19.7%). A US study showed that those who believed conspiracies are 3.9 times less likely to be vaccinated [40]. An educational framework must be set to counter those conspiracies and their effect on vaccination and the spread of COVID-19. Although the most common side effects of the vaccine are mild and resolve after 1–2 days such as mild fever, injection site reaction and fatigue [41], most of the participants in our study were reluctant to take the vaccine due to fear of its side effects. This may be a result of the media’s focus on the rare few cases in which some people have experienced serious and life-threatening side effects. Our results are similar to those reported in Qatar, Lebanon, UK, and Libya [12, 18, 20, 22]. The second most common reason for not taking the vaccine in our study is the lack of confidence in the vaccine formulation. Perhaps because of newly introduced technologies, as it is the first time people learned about vaccines that use Messenger RNA was with the Pfizer-Biontech vaccine [42]. The remarkable speed with which the Corona vaccine was developed made it more likely to be questioned by the public, which is evident in our study, as 42% of the participants said that they were not convinced of the speed of developing the vaccine. These results are in agreement with other studies in Lebanon and Australia [20, 43]. It should be noted that the types of vaccines that would be available in Syria were not yet known at the time of the distribution of this questionnaire. The type of vaccine may play a role in the behavior of vaccine hesitancy, especially since some countries have some preferences among the types of vaccines available. This may make some people -students who want to travel to their home countries- reluctant to take one of the types of vaccines even if it is available.
