COVID-19 vaccine hesitancy and acceptance among the public in the Gulf Cooperation Council countries: A review of the literature

Figures & data

Table 1. The COVID-19 vaccines available in each GCC country.

Vaccine	Saudi Arabia	UAE	Kuwait	Qatar	Oman	Bahrain
PfizerBioNTech – Comirnaty	✔	✔	✔	✔	✔	✔
Moderna – Spikevax	✔	✔	✔	✔		✔
Janssen – Ad26.COV 2-S	✔		✔	✔		✔
AstraZeneca – Vaxzevria	✔	✔	✔	✔	✔	✔
Beijing CNBG – BBIBP-CorV		✔	✔			✔
Sinovac – CoronaVac					✔
Gamaleya – Gam-COVID-Vac		✔			✔	✔
Gamaleya – Sputnik-Light		✔				✔
SII – Covishield		✔			✔	✔
National Vaccine and Serum Institute – CHO Cell		✔
Bharat Biotech – Covaxin						✔
Valneva – VLA2001						✔

✔ the vaccine is available.

Table 2. Vaccination status in each GCC country as of April 30^th, 2022.

Estimated vaccination status	Saudi Arabia	UAE	Kuwait	Qatar	Oman	Bahrain
Vaccination start date*	01/06/21	12/14/20	12/28/20	12/23/20	12/29/20	11/04/20
Total doses	64,212,008	4,959,691	7,969,160	1,529,091	7,030,077	3,433,683
Total doses per 100 population**	184	50	187	53	138	202

*Date format: month/day/year.

**Rounded to whole numbers.

Figure 1. PRISMA flowchart of literature search and review.

Table 3. COVID-19 vaccine hesitancy and acceptance rates and their associated variables per GCC country.

Author (survey period)	Reference no.	No. of participants	Hesitancy rate*	Factors associated with hesitancy**	Factors associated with acceptance**
Saudi Arabia
Abu-Farha (Dec 2020)	^Citation14	592 ⤓⤓	70% ⤒	Married History of COVID-19 infection Lower monthly income (<$1000)	Males ⤓ Having a medical degree ⤓ Positive behavior regarding the flu vaccine ⤓ Scoring high on COVID-19 fear score ⤓ Higher risk perception of contracting COVID-19 ⤓
Alfageeh (Dec 2020)	^Citation15	2,137	52%	Low-moderate perceived severity of COVID-19 Negative behavior regarding vaccines in general	Males Residents of the southern region Perceived risk of contracting COVID-19 Positive behavior regarding vaccination in general History of COVID-19 infection Support for compulsory vaccination
Almaghaslah (Jan–Feb 2021)	^Citation16	862	80% ⤒	Concerns about vaccine safety because of news on social media ⤓ Concerns about vaccine effectiveness ⤓ Not knowing whether they were eligible or how to register ⤓ Natural immunity is sufficient ⤓	Vaccine made mandatory ⤓ If provided with information on effectiveness and safety ⤓ If most of the public gets vaccinated ⤓
Al-Mohaithef (Jan–Mar 2021)	^Citation17	658	47%	Lower educational level ⤓ Concerns about vaccine effectiveness ⤓	Married High trust in the healthcare system and its role in controlling the pandemic
N. Alshahrani (Feb–Mar 2021)	^Citation18	2,236	15% ⤒	Married	Males Younger age ⤓ High risk perception of contracting COVID-19 Frequent travel
S. Alshahrani (Jan 2021)	^Citation19	758	36%	Obtaining COVID-19 information from other sources, such as social media, besides MOH official accounts Concerns about vaccine effectiveness Higher educational level (postgraduates)	Males Positive behavior regarding the flu vaccine If vaccination is mandatory for international travel
Alzahrani (Dec 2020–Feb 2021)	^Citation20	3,048	47% ⤒	Low perceived severity of COVID-19 Vaccines have not been tested sufficiently Concerns about vaccine safety	Males Residents of the western region Positive behavior regarding vaccines in general ⤓
Fayed (Jan–Mar 2021)	^Citation21	1,539	41% ⤒	N/A	Males Current or former smokers Higher risk perception of contracting COVID-19
Magadmi (May 2020)	^Citation22	3,101	55%	Concerns about vaccine safety ⤓ Concerns about vaccine effectiveness ⤓ Belief in conspiracy theories ⤓	Males Younger age (<30 years old) Education (high school and undergraduates) Higher risk perception of contracting COVID-19 ⤓ Positive behavior regarding the flu vaccine Positive beliefs about the COVID-19 vaccine
Mahmud (Jan–Mar 2021)	^Citation23	1,387	73% ⤒	Concerns about vaccine effectiveness Concerns about vaccine safety Religious/cultural convictions Residents of Riyadh	Older age (≥50 years old) HCWs Positive behavior regarding the flu vaccine Obtaining complete vaccine-related information When the vaccine uptake becomes more common amongst the public
Yahia (Jan–Mar 2021)	^Citation24	531	38%	Concerns about vaccine safety ⤓ Vaccines have not been tested sufficiently ⤓ Concerns about vaccine effectiveness ⤓	Males Younger age (<34 years old) Protect oneself and others ⤓ Trust in the Saudi health authorities ⤓
Zahid (Mar–Apr 2021)	^Citation25	1,599	21%	Concerns about vaccine safety There is no need for a vaccine Vaccines have not been tested sufficiently ⤓	Saudis Males Trust in the Saudi government’s decisions ⤓ Feeling responsible for ending the pandemic ⤓ Higher perceived risk/severity of COVID-19 ⤓
Almalki (Jan–May 2021)	^Citation26	407	6%	Concerns about vaccine safety ⤓ Vaccines have not been tested sufficiently ⤓	Positive behavior regarding the flu vaccine Trust in the Saudi government’s decisions ⤓ Trust in the Saudi healthcare system ⤓
Al-Mohaithef and Padhi (Unspecified)	^Citation27	992	35% ⤒	N/A	Older age (>45 years old) Married Trust in the Saudi healthcare system Perceived risk of contracting COVID-19
Noushad (Feb–Mar 2021)	^Citation28	879	44% ⤒	History of COVID-19 infection ⤓ Lower level of knowledge about the COVID-19 vaccine ⤓	Saudis Older age (≥50 years old) Males History of a chronic illness Compliance with protective measures Higher risk perception of contracting COVID-19 High perceived severity of COVID-19
Sallam (Dec 2020)	^Citation29	154 ⤓	68%	Lower educational level ⤓ Concerns about vaccine safety ⤓	Males History of a chronic illness Positive behavior regarding vaccines in general COVID-19 is of natural origin COVID-19 is not man-made to force people to get the vaccine
Alduwayghiri and Khan (Jan 2021)	^Citation30	1,713	45%	Concerns about vaccine effectiveness Concerns about vaccine safety Natural immunity is sufficient Vaccines have not been tested sufficiently Other preventive measures are enough Fear of injections	N/A
Al-Mansour (Feb–Apr 2021)	^Citation31	1935	31% ⤒	Saudis Younger age Higher monthly income (>18,000 SR) History of a chronic illness Lower level of knowledge about COVID-19 Concerns about vaccine safety ⤓ Vaccines have not been tested sufficiently ⤓ Mistrust in pharmaceutical companies ⤓	N/A
Al-Zalfawi (Mar–Apr 2021)	^Citation32	2,022	36%	N/A	Being 18–59 years of age Females
Alamer (July 2021)	^Citation33	655	33%	Concerns about vaccine effectiveness ⤓	Positive behavior regarding the flu vaccine Trust in the health system
Almalki (May 2020)	^Citation34	597	15%	N/A	Males
Almoayad (Jan 2021)	^Citation35	487	53%	Bachelor’s degree holders	Higher monthly income Private sector employees
Alobaidi (Jan 2021)	^Citation36	1,333	28%	Concerns about vaccine safety Willingness to get vaccinated only if the vaccine is accepted by a lot of the population Concerns about vaccine effectiveness ⤓	Higher monthly income (> 15,000 SR) No history of COVID-19 infection History of a chronic illness High risk perception of contracting COVID-19
Alqahtani (Unspecified)	^Citation37	391	43%	N/A	Higher perceived risk of contracting COVID-19 Positive behavior regarding the flu vaccine Trust in the healthcare system
Alrajeh (Unspecified)	^Citation38	401	82%	Concerns about vaccine safety Concerns about vaccine effectiveness	Higher perceived risk of contracting COVID-19 ⤓
Altulahi (Nov–Dec 2020)	^Citation39	8,056	48%	Concerns about vaccine side effects and safety Natural immunity is sufficient Concerns about vaccine effectiveness ⤓ Belief in conspiracy theories	Young adults Males Having less than or a high school degree Smokers History of a chronic illness Positive behavior regarding the flu vaccine
Fadhel (Jul 2021)	^Citation40	558	21%	Females Younger age (18–37-year-olds) Belief in conspiracy theories Psychosocial factors Concerns about vaccine safety ⤓ Concerns about vaccine effectiveness ⤓	Males Older age group (48–65-year-olds) Married
Jan (Unspecified)	^Citation41	756	22%	Lower level of knowledge about the COVID-19 vaccine ⤓	NA
Khalafalla (Mar–Aug 2021)	^Citation42	1,039	16%	Perceived barrier, including concerns about vaccine safety Concerns about vaccine effectiveness ⤓ Self-efficacy	Older age Perceived risk/severity of COVID-19 infection Cues to action, including positive behavior regarding vaccines in general
Mubarak (Mar–May 2021)	^Citation43	332	16%	Lower level of knowledge about COVID-19 ⤓ Concerns about vaccine safety Concerns about vaccine effectiveness ⤓	Perception of the vaccine as safe Trust in the health system
Narapureddy (Apr–Jun 2021)	^Citation44	782	34%	Young and middle-age groups (<20 and 40–59 years of age) Fear of injections Concerns about vaccine safety Concerns about vaccine effectiveness Exercising other precautionary measures	Males ⤓
Othman (Jun 2021)	^Citation45	504	5%	Concerns about vaccine safety Vaccines have not been tested sufficiently Concerns about vaccine effectiveness History of a chronic illness	N/A
Kuwait
Sallam (Dec 2020)	^Citation29	771 ⤓⤓	76% ⤒	Lower educational level ⤓ Concerns about vaccine safety ⤓	Males History of a chronic illness Positive behavior regarding vaccines in general COVID-19 is of natural origin COVID-19 is not man-made to force people to get the vaccine
AlAwadhi (May–Sep 2020)	^Citation46	7,241	33%	Older age Females Married ⤓ History of COVID-19 infection ⤓ Lower level of knowledge about COVID-19 ⤓ Knowing others with a history of COVID-19 infection ⤓ Having children ⤓ Negative behavior regarding the flu vaccine Protective measures are exaggerated	Younger age (<30 years old) Males HCWs Residential area Lower educational level Lower monthly income Informing oneself about COVID-19 Protecting oneself High or very high trust in the MOH, hospitals, doctors, and social media Knowledge of and compliance with protective measures Strong agreement with containment policies Higher probability of convincing others about protective measures Higher risk perception of contracting COVID-19 Higher risk perception of contracting the flu
Alqudeimat (Aug 2020)	^Citation47	2,368	73% ⤒	Concerns about vaccine safety ⤓ Concerns about vaccine effectiveness ⤓ Lack of vaccine-related information ⤓	Non-Kuwaitis Males Young adults (aged 21–24 years old) Farwaniya residents Physicians Former cigarette smokers Abnormal weight (underweight, overweight, and obese) Perception of the vaccine as effective Positive behavior regarding the flu vaccine Lower self-perceived overall health High risk perception of contracting COVID-19 High perceived severity of COVID-19 The vaccine-conferred immunity is superior to that developed after contracting COVID-19 Fewer vaccine-related concerns
Burhamah (Mar–Apr 2020)	^Citation48	2,345	17%	Married History of COVID-19 infection History of ICU admission Concerns about vaccine safety ⤓ Concerns about vaccine effectiveness ⤓	Feeling responsible for ending the pandemic ⤓ Protecting oneself ⤓ Asthmatic ⤓ HCWs ⤓ Positive behavior regarding vaccines in general ⤓
Alibrahim and Awad (Mar–Apr 2021)	^Citation49	4,147	26%	Aged 30–64 Married or divorced Residential area Lower monthly income (≤1000 KD) Nonsmokers Lack of knowledge of their family members’ COVID-19-related health statuses Low confidence in Kuwait health system’s ability to control the spread of COVID-19 Lack of adequate COVID-19 vaccine-related information from authorities or HCWs Exposure to COVID-19 is safer Family members’ hesitancy Concerns about commercial profiteering Concerns about vaccine effectiveness Concerns about vaccine safety ⤓ Vaccines have not been tested sufficiently ⤓	Males ⤓ Higher risk perception of contracting COVID-19 ⤓ Positive behavior regarding the flu vaccine and vaccines in general ⤓
Al-Ayyadhi (Jan 2021)	^Citation50	6,943	74%	Lower educational level ⤓ Concerns about vaccine safety ⤓ Concerns about vaccine effectiveness ⤓	Non-Kuwaitis Younger age Males HCWs Positive behavior regarding the flu vaccine Private sector employees
UAE
Albahri (Sep 2020)	^Citation51	2,705	40%	Unemployment Perception that COVID-19 is not serious Authorities are not tackling the pandemic appropriately Concerns about vaccine effectiveness Concerns about vaccine safety Natural immunity is sufficient	Non-Emiratis Males Younger age (<55 years old) ⤓ Residents of Sharjah and the Northern Emirates Lower educational level (undergraduate or less) High or very high perceived severity of COVID-19 High or very high risk perception of contracting COVID-19 Positive behavior regarding the flu vaccine ⤓ Protecting oneself and close relatives ⤓
Ahamed (Unspecified)	^Citation52	1,003	N/A	Concerns about vaccine safety ⤓ Concerns about vaccine effectiveness ⤓	Approval of vaccine safety ⤓
Saeed (Jan–Apr 2021)	^Citation53	1,080	23%	Concerns about vaccine effectiveness ⤓ Concerns about vaccine safety ⤓	N/A
Niankara (Jul–Aug 2020)	^Citation54	1,109	78% ⤒⤒	Non-Emiratis Lower educational level ⤓ Religious/cultural convictions Concerns about vaccine safety History of unpleasant experiences with vaccination Cost A need to travel to receive the vaccine	Higher monthly income Younger age ⤓ Gender Emirate of residence Perception of vaccine importance Positive behavior regarding vaccines in general ⤓
Alzubaidi (Feb 2021)	^Citation55	669	32%	Low risk perception of contracting COVID-19 Concerns about vaccine safety	Non-Emiratis Clinically vulnerable High risk perception of contracting COVID-19
Shahwan (Mar–Aug 2021)	^Citation56	467	44%	Concerns about vaccine safety Concerns about vaccine effectiveness Natural immunity is sufficient	Trusting pharmaceutical companies Country of the vaccine manufacturer
Qatar
Alabdulla (Oct–Nov 2020)	^Citation57	7,821	40% ⤒	Qataris Single Self-employment Non-HCWs Vaccines have not been tested sufficiently Authorities are motivated by financial benefits Exposure to COVID-19 is safer than the vaccine Concerns about vaccine safety Concerns about vaccine effectiveness ⤓	Males ⤓ Younger age (≤65 years old) ⤓ Immigrants of working age Positive behavior regarding the flu vaccine ⤓ Long-term medication ⤓ Perception of the vaccine as safe and protective ⤓
Al-Mulla (Feb 2021)	^Citation58	462 ⤓⤓⤓	37%	Lower educational level ⤓ Vaccines have not been sufficiently tested ⤓ Concerns about vaccine safety ⤓ Concerns about vaccine effectiveness ⤓	Non-Qataris Males Employment Older age (≥45 years old) Students at schools of health sciences Positive behavior regarding the flu vaccine
Khaled (Dec 2020–Jan 2021)	^Citation59	1,038	57% ⤒⤒	Arab ethnicity Migrants Concerns about vaccine safety	Males ⤓ Trust in the measures taken to tackle the pandemic Higher perceived risk of contracting COVID-19 ⤓
Hafizh (Unspecified)	^Citation60	175	N/A	Religious/cultural convictions Lower educational level ⤓	Seeing public figures or heads of state get vaccinated Positive behavior regarding vaccines in general ⤓
Oman
Al-Marshoudi (Dec 2020)	^Citation61	3,000	43%	Pregnancy	Omanis Males Employment Perception of the vaccine as safe Illiteracy History of chronic illness Hearing about the vaccine from friends

N/A: not applicable, HCWs: healthcare workers.

*Rounded to whole numbers.

**Reported as statistically significant (P < 0.05).

⤒ After considering those who were unsure about receiving the vaccine as vaccine hesitant.

⤒⤒ After considering those who were vaccine resistant as vaccine hesitant.

⤓ Not tested for significance.

⤓⤓ Significance testing was based on the answers of the total study participants from the different countries (2,925 participants [25] and 3,414 participants [40]).

⤓⤓⤓ 454 participants answered questions related to their willingness to receive the vaccine.

Figure 2. Medians of vaccine hesitancy rates (%) in each GCC country.

Figure 3. Predictors of COVID-19 vaccine acceptance.

The percentages are presented based on the total number of studies from each country (i.e., SA: 32, Kuwait: 6, UAE: 6, Qatar: 4, and Oman: 1).

Not all the findings reported in this figure were tested for significance.

Figure 4. Predictors of COVID-19 vaccine hesitancy.

The percentages are presented based on the total number of studies from each country (i.e., SA: 32, Kuwait: 6, UAE: 6, and Qatar: 4).

Not all the findings reported in this figure were tested for significance.

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