Combining COVID-19 and seasonal influenza vaccines together to increase the acceptance of newly developed vaccines in the Eastern Mediterranean Region: a cross-sectional study

Figures & data

Table 1. Baseline characteristics of respondents (N = 3300).

Variable	n (%)
Age categories
18 to <25 years	1343 (40.7%)
25 to <35 years	925 (28.0%)
35 to <50 years	671 (20.3%)
50 to 65 years	249 (7.6%)
Above 65 years	112 (3.4%)
Gender
Female	1998 (60.6%)
Male	1302 (39.4%)
Level of education completed
Primary education	47 (1.4%)
Secondary education	659 (20.0%)
University education	1782 (54.0%)
Postgraduate	812 (24.6%)
Social status
Unmarried	1817 (55.1%)
Married	1483 (44.9%)
Occupation
High-skilled (non-manual)	1263 (38.3%)
Low-skilled (non-manual)	299 (9.1%)
Skilled (manual)	77 (2.3%)
Others	1661 (50.3%)
Suffering from chronic diseases
No	2664 (80.7%)
Yes	636 (19.3%)
Had previous COVID-19 infection
No	1345 (40.8%)
Yes	1421 (43.1%)
I don’t know	534 (16.1%)
Had relatives or friends died from COVID-19 infection
No	1644 (49.8%)
Yes	1384 (41.9%)
Maybe	272 (8.3%)
Continent
Asia	2400 (72.7%)
Africa	900 (27.3%)
Intention of taking COVID and influenza vaccines together in one shot
I will take this combined vaccine	1428 (43.3%)
I will not take this combined vaccine	1872 (56.7%)

Figure 1. Status of the respondents regarding seasonal influenza vaccine.

Figure 2. Status of the respondents regarding COVID-19 vaccination.

Figure 3. (a) Reasons for accepting the theoretical combination (COVID-19 and influenza vaccines) in one dose among participants. (b) Reasons for rejecting the theoretical combination (COVID-19 and influenza vaccines) in one dose among participants.

Table 2. Respondents’ intention to take COVID-19 and seasonal influenza vaccines if they are available in one shot.

Variable	Accepting both together	Rejecting both together	χ^2 test and p-value
Age categories
18–24 years	615 (45.8)	728 (54.2)	χ^2 = 11.32
25–34 years	404 (43.7)	521 (56.3)	p = .023
35–49 years	266 (39.6)	405 (60.4)
50–65 years	92 (36.9)	157 (63.1)
Above 65 years	51 (45.5)	61 (54.5)
Gender
Female	781 (39.1)	1217 (60.9)	χ^2 = 36.10
Male	647 (49.7)	655 (50.3)	p < .001
Level of education completed
Primary education	17 (36.2)	30 (63.8)	χ^2 = 10.14
Secondary education	252 (38.2)	407 (61.8)	p = .017
University education	790 (44.3)	992 (55.7)
Postgraduate	369 (45.4)	443 (54.6)
Country
Egypt	144 (48.0)	156 (52.0)
Sudan	158 (52.7)	142 (47.3)
Kuwait	89 (29.7)	211 (70.3)
Saudi Arabia	99 (33.0)	201 (67.0)	χ^2 = 219.46
Morocco	180 (60.0)	120 (40.0)	p < .001
Iraq	113 (37.7)	187 (62.3)
Yemen	119 (39.7)	181 (60.3)
Lebanon	67 (22.3)	233 (77.7)
Libya	106 (35.3)	194 (64.7)
Afghanistan	157 (52.3)	143 (47.7)
Pakistan	196 (65.3)	104 (34.7)
Marital status			χ^2 = 14.95
Unmarried	841 (46.3)	976 (53.7)	p = <.001
Married	587 (39.6)	896 (60.4)
Occupation
High-skilled (non-manual)	550 (43.5)	713 (56.5)	χ^2 = 2.11
Low-skilled (non-manual)	118 (39.5)	181 (60.5)	p = .551
Skilled (manual)	32 (41.6)	45 (58.4)
Others	728 (43.8)	933 (56.2)
Suffering from chronic diseases			χ^2 = 12.63
No	1112 (41.8)	1552 (58.2)	p < .001
Yes	315 (49.5)	321 (50.5)
Had previous COVID-19 infection
No	633 (47.1)	712 (52.9)	χ^2 = 13.94
Yes	570 (40.1)	851 (59.9)	p = .001
I don’t know	225 (42.1)	309 (57.9)
Had relatives or friends died from COVID-19 infection
No	684 (41.6)	960 (58.4)	χ^2 = 0.14
Yes	618 (44.7)	766 (55.3)	p = .138
Maybe	126 (46.3)	146 (53.7)
Continent			χ^2 = 6.19
Asia	1007 (42.0)	1393 (58.0)	p = .014
Africa	421 (46.8)	479 (53.2)
For seasonal influenza vaccination
I received the vaccination last year	196 (49.6)	199 (50.4)
I received the vaccination last year and the current year	123 (56.2)	96 (43.8)	χ^2 = 188.38
I received the vaccination last year and waiting for the vaccine this year	203 (61.0)	130 (39.0)	p < .001
I didn’t get vaccinated before but will take it this year	350 (55.6)	279 (44.4)
I have not had the vaccination before and will not take it this year	495 (32.4)	1034 (67.6)
I took it last year and won’t take it this year	61 (31.3)	134 (68.7)
Uptake of the COVID-19 vaccination
I didn’t take any doses	222 (27.5)	584 (72.5)	χ^2 = 211.48
I only took the first dose and won’t take any other doses	98 (44.7)	121 (55.3)	p < .001
I took the first dose and am waiting for the second dose	125 (49.4)	128 (50.6)
I took the first and second doses and am waiting for the booster dose	408 (60.2)	270 (39.8)
I took the first, second and booster doses	374 (51.3)	355 (48.7)
I took the first and second doses and I won’t take the booster dose	201 (32.7)	414 (67.3)

Figure 4. Distribution of respondents according to their intention to take the vaccination (COVID-19 and seasonal influenza) if they are available in one shot across countries.

Table 3. The results of multi-level logistic model with random intercept and a random slope.

Variable	Random intercept model	Random intercept and random slope
	Odds ratio [95% CI]	Odds ratio [95% CI]
Intercept	0.32** [0.14–0.74]	0.29** [0.14–0.63]
Age categories
18–24 years (reference group)
25–34 years	0.99 [0.79–1.24]	0.97 [0.77–1.21]
35–49 years	0.81 [0.62–1.07]	0.84 [0.64–1.10]
50–65 years	0.54** [0.38–0.78]	0.55** [0.39–0.80]
Above 65 years	0.50** [0.38–0.78]	0.50** [0.31–0.79]
Gender
Female (reference group)
Male	1.18 [1.00–1.39]	1.21* [1.03–1.42]
Education level
Primary education (reference group)
Secondary education	1.11 [0.56–2.20]	1.25 [0.64–2.47]
University education	1.14 [0.58–2.24]	1.28 [0.66–2.49]
Postgraduate	1.14 [057–2.27]	1.35 [0.68–2.66]
Marital status
Unmarried (reference group)
Married	0.92 [0.76–1.11]	0.91 [0.75–1.10]
Occupation
High-skilled (non-manual; reference group)
Low-skilled (non-manual)	0.83 [0.62–1.12]	0.83 [0.62–1.12]
Skilled (manual)	0.86 [0.51–1.47]	0.85 [0.50–1.44]
Others	1.02 [0.83–1.26]	1.04 [0.84–1.27]
Suffering from chronic diseases
No (reference group)
Yes	1.17 [0.95–1.44]	1.14 [0.92–1.41]
Having COVID-19 infection before
No (reference group)
Yes	0.82* [0.68–0.98]	0.79* [0.65–0.95]
I don’t know	0.98 [0.79–1.23]	0.94 [0.75–1.18]
Any family members or friend died of COVID-19 infection
No (reference group)
Yes	1.24* [1.05–1.47]	1.22* [1.03–1.44]
Maybe	1.12 [0.84–1.49]	1.11 [0.83–1.48]
Continent
Asia (reference group)
Africa	1.36 [0.73–2.54]	1.55* [1.10–2.17]
For seasonal influenza vaccination
I received the vaccination last year. (Reference group)
I received the vaccination last year and the current year	1.39 [0.97–1.99]	1.60* [1.03–2.48]
I received the vaccination last year and waiting for the vaccine this year	1.53** [1.11–2.10]	1.52* [1.09–2.13]
I didn’t get vaccinated before but will take it this year	1.14 [0.87–1.50]	1.23 [0.86–1.75]
I have not had the vaccination before and will not take it this year	0.55*** [0.43–0.71]	0.59* [0.36–0.98]
I took it last year and won’t take it this year	0.50*** [0.34–0.75]	0.51** [0.33–0.79]
Uptake of the COVID-19 vaccination
I didn’t take any doses (reference group)
I only took the first dose and won’t take any other doses	2.55** [1.79–3.63]	2.29*** [1.62–3.25]
I took the first dose and am waiting for the second dose	2.56*** [1.75–3.73]	2.09*** [1.45–2.99]
I took the first and second doses and am waiting for the booster dose	4.50*** [3.39–5.98]	4.01*** [3.04–5.28]
I took the first, second and booster doses	4.11*** [3.03–5.57]	3.49*** [2.61–4.66]
I took the first and second doses, and I won’t take the booster dose	2.03*** [1.51–2.74]	1.85*** [1.38–2.48]
Random effects		3.29
σ2	3.29	0.00country
σ00	0.20country	0.15Country.Influ_vaccinationI received the vaccination last year and the current year
σ11		0.05Country.Influ_vaccinationI received the vaccination last year and am waiting for the vaccine this year
		0.16Country.Influ_vaccinationI didn’t get vaccinated before but will take it this year
		0.56Country.Influ_vaccinationI have not had the vaccination before and will not take it this year
		0.11Country.Influ_vaccinationI took it last year and won’t take it this year
ICC	0.06
N	11country	11county
Observations	3298	3298

*p < .05, **p < .01, ***p < .001.

Data availability statement

All data are available upon request from the corresponding author.