Hesitancy toward vaccination against COVID-19: A scoping review of prevalence and associated factors in the Arab world

Figures & data

Figure 1. PRISMA flow chart illustrating study selection.

Figure 2. Distribution of the number of the included studies by country.

Table 1. Summary of the included studies based on characteristics.

Study characteristics	Number of articles (%) (Overall = 134)
Number of study participants
100–1000	69 (52.6)
1001–2000	34 (25.2)
2001–3000	11 (8.1)
3000 and more	6 (4.4)
4000 and above	14 (9.6)
Patient populations
General public	76 (55.5)
Healthcare workers	32 (25.5)
University staff and student	14 (10.4)
Refugees	4 (2.7)
Older adults	2 (1.5)
Patients with cancer	1 (0.7)
People with chronic illness	4 (3.0)
Air travelers	1 (0.7)
Dental patients	1 (0.7)
Pregnant and lactating women	7 (1)
Mothers in last two years	1 (5)
Methodology of data collection
Online survey	122 (91.1)
Telephone calls	2 (1.5)
Personal interview	5 (3.7)
Online survey and personal interview	1 (0.7)
Online survey and printed questionnaire	3 (2.2)
Printed Questionnaire	1 (0.7)
Year of publication
2021	70 (51.1)
2022	61 (46.7)
2023	3 (2.2)

Table 2. Summary of 124 articles with studies reporting hesitancy against primary COVID-19 vaccination.

First author, Year	Country	Studied Population	Mode of data collection	Sample size	Vaccine Hesitancy	Factors reported to be associated with VH
El-Sokkary, 2021^Citation17	Egypt	Health Care Workers	Online survey	308	74.0%	Income, years of experience
Elgendy, 2021^Citation18	Egypt	General Population	Online survey	871	12.0%	N/A
Fares, 2021^Citation19	Egypt	Health Care Workers	Online survey	358	79.0%	Having heard of anyone with bad reaction toward vaccine, lack of trust in pharmaceutical companies to develop safe and effective vaccine, belief that side effects are not openly discussed, belief in need of vaccine for immunity, belief in community responsibility to get vaccinated
Omar, 2021^Citation20	Egypt	General Population	Online survey	1,011	75.0%	Gender, residence and concerns on unforeseen vaccine side effects
Saied, 2021^Citation21	Egypt	University staff and Students Medical	Online survey	2,133	52.0%	Educational level, COVID-19 knowledge, self-perceived health status
Hammam, 2021^Citation22	Egypt	University staff	Online survey	187	45.4%	N/A
Abdulah, 2021^Citation23	Iraq	General Population	Online and and in person interview	926	53.2%	Educational level, professional category, concerns on vaccine side effects
Al-Metwali, 2021^Citation24	Iraq	General Population	Online survey	1,680	38.3%	Professional category, previous Influenza vaccine uptake, attitude toward vaccination in general and HBM constructs (preventive measures, perceived benefit, perceived barriers, cue to action, subjective norm)
Al‐Rawashdeh, 2021^Citation25	Jordan	General Population	Online survey	281	60.1%	Gender, professional category, self-perceived health status, perception on government measures’ adequacy, perceived susceptibility and attitudinal score toward COVID-19 vaccination
Abu-Farha, 2021^Citation26	Jordan	General Population	Online survey	1,287	N/A	Nationality, previous infection with COVID-19 and knowledge of someone to have passed away due to COVID-19
Al-Qerem, 2021^Citation27	Jordan	General Population	Online survey	1,144	63.2%	Gender, educational level, risk perception of COVID-19, marital status
El-Elimat, 2021^Citation28	Jordan	General Population	Online survey	3,100	62.6%	Gender, educational level, previous Influenza vaccine uptake
Sallam, 2021^Citation29	Jordan	University Students	Online survey	1,106	65.1%	Gender, educational level, Influenza vaccine uptake, conspirational claims
Al-Ayyadhi, 2021^Citation30	Kuwait	General Population	Online survey	7,274	74.3%	Age, gender, educational level, Previous Influenza vaccine uptake
Al-Sanafi, 2021^Citation31	Kuwait	Health Care Workers	Online survey	1,019	16.7%	Gender, workplace, 5C psychological determinants: confidence, constraints, calculation, collective responsibility
Al-Awadhi, 2021^Citation32	Kuwait	General Population	Online survey	7,241	32.7%	Age, gender, previous Influenza vaccine uptake, fear and worry regarding COVID-19, frequency of informing oneself of COVID-19, trust in doctors
Alqudeimat, 2021^Citation33	Kuwait	General Population	Online survey	2,368	46.9%	Gender, previous Influenzas vaccine uptake, self-perceived health status
Burhamah, 2021^Citation34	Kuwait	General Population	Online survey	2,345	17.0%	N/A
Salibi, 2021^Citation35	Lebanon	Syrian refugee beneficiaries aged 50 years and above	Telephone calls	1,037	34.2%	Vaccine safety, vaccine effectiveness
Moujaess, 2021^Citation36	Lebanon	Patients With Cancer	In person interviews	111	45.0%	N/A
Hamdan, 2021^Citation37	Lebanon	University Students	Online survey	3,805	13.0%	Belief that symptomatic cases are the only infection carriers, concerns on vaccine safety, attitude toward vaccine
Al Halabi, 2021^Citation38	Lebanon	General Population	Online survey	579	78.6%	Gender, marital status
Nasr, 2021^Citation39	Lebanon	Health Care Workers	Online survey	529	14.0%	Previous Influenza vaccine uptake, frequency of medical visits, COVID-19 vaccination knowledge, fear of infection contraction
Elhadi, 2021^Citation40	Libya	General Population, Health Care Workers	Online survey	15,087	20.4%	Age
Khamis, 2021^Citation41	Oman	Health Care Workers	Online survey	433	60.1%	N/A
Zawahrah, 2021^Citation42	Palestine	General Population	Online survey	1,080	36.3%	Age, marital status, COVID-19 knowledge, attitudinal score toward COVID-19 vaccination
Maraqa, 2021^Citation43	Palestine	Health Care Workers	Online survey	1,159	62.2%	Age, Gender, professional category, practice setting, previous Influenza vaccine uptake
Zaidi, 2021^Citation44	Qatar	University staff and Students	Online survey	364	31.9%	N/A
Al-Mulla, 2021^Citation45	Qatar	University staff and Students	Online survey	262	37.4%	Gender, education, previous Influenza vaccine uptake, worries on rushed pace of COVID-19 vaccine development, belief on failure to detect potential side effects, length of testing the vaccine
Alabdulla, 2021^Citation46	Qatar	General Population	Online survey	7,821	40.0%	Gender, migrant status, professional category, marital status, worry on vaccine side effects, previous Influenza vaccine uptake, belief in natural immunity
Khaled, 2021^Citation47	Qatar	General Population	Telephone calls	1,912	57.3%	Gender, ethnicity, migrant status, concern about vaccine side-effects
Kumar, 2021^Citation48	Qatar	Health Care Workers	Online survey	1,546	37.9%	Gender, concerns on vaccine safety and efficacy, understanding of disease and vaccine
Samannodi, 2021^Citation49	Saudi Arabia	Women aged 18 years and above	Online survey	431	60.0%	Pregnancy or intended pregnancy
Narapureddy, 2021^Citation50	Saudi Arabia	General Population	Online survey	782	33.1%	N/A
Barry, 2021^Citation51	Saudi Arabia	Health Care Workers	Online survey	1,512	30.0%	Gender, belief that vaccines were rushed without evidence-informed testing
Altulahi, 2021^Citation52	Saudi Arabia	General Population	Online survey	8,056	47.6%	Age, gender, educational status, previous Influenza vaccine uptake
AlSaeed, 2021^Citation53	Saudi Arabia	General Population	Printed questionnaire	486	30.5%	Nationality, income, having acquired COVID-19 infection, knowledge about vaccine safety, registration for vaccine, following friends and family members for vaccine uptake (Social cognitive theory)
Alghamdi, 2021^Citation54	Saudi Arabia	Patients with Chronic illness	Online survey	310	48.0%	N/A
Aldosary, 2021^Citation55	Saudi Arabia	Health Care Workers	Online survey	334	29.3%	N/A
Alamer, 2021^Citation56	Saudi Arabia	General Population	Online survey	655	33.0%	N/A
Alshahrani, 2021^Citation57	Saudi Arabia	Air travelers	Online survey	2,236	N/A	Gender, frequency of traveling, concern about contracting infection
Al-Hanawi, 2021^Citation58	Saudi Arabia	Older Adults aged 50 years and above	Online survey	488	N/A	Gender, educational level, previous refusal of general vaccine uptake, concern on infection contraction
Mansour, 2021^Citation59	Saudi Arabia	General Population	Online survey	1,935	30.7%	Age, nationality, monthly income, having chronic diseases, vaccine knowledge and concerns about vaccine safety
Al-Mohaithef, 2021^Citation60	Saudi Arabia	General Population	Online survey	658	46.7%	Risk perception, trust in healthcare system
Aldossari, 2021^Citation61	Saudi Arabia	Patients with diabetes	Online survey	709	63.8%	Gender, duration of illness, previous history of Influenza vaccine uptake
Alfageeh, 2021^Citation62	Saudi Arabia	General Population	Online survey	2,137	52.0%	Residence, previous general vaccine refusal, concern on infection contraction
Almaghasla, 2021^Citation63	Saudi Arabia	General Population	Online survey	862	52.0%	N/A
Almalki, 2021^Citation64	Saudi Arabia	UniversityStudents	Online survey	407	9.6%	Previous Influenza vaccine uptake
Alshahrani, 2021^Citation65	Saudi Arabia	General Population	Online survey	758	18.3%	Previous Influenza vaccine uptake, perception on vaccine effectiveness, source of health information and intention for international travel
Magadmi, 2021^Citation66	Saudi Arabia	General Population	Online survey	3,101	55.3%	Age, gender, previous Influenza vaccine uptake
Mahmud, 2021^Citation67	Saudi Arabia	General Population	Online survey	1,387	42.4%	Age, professional category, previous Influenza vaccine uptake, HBM constructs (perceived susceptibility, severity, benefits and barriers)
Noushad, 2021^Citation68	Saudi Arabia	General Population	Online survey	879	44.0%	Age, nationality, Updating self on vaccine development
Qattan, 2021^Citation69	Saudi Arabia	Health Care Workers	Online survey	736	49.5%	Gender, risk perception, belief in vaccine compulsion for all citizens
Zahid, 2021^Citation70	Saudi Arabia	General Population	Online survey	1,599	20.8%	Age, gender, nationality
Ahmed, 2021^Citation71	Somalia	General Population	Online survey	4,543	23.2%	Gender, professional category, protective measure adherence score
Mohamad, 2021^Citation72	Syria	General Population	Online survey	3,402	64.1%	Age, gender, residence, smoking, fear of COVID-19, perceived severity, belief on origin of disease, general vaccine hesitancy
Ahamed, 2021^Citation73	UAE	General Population	Online survey	1,003	57.0%	N/A
Albahri, 2021^Citation74	UAE	General Population	Online survey	2,705	40.9%	Age, gender, nationality, residence, educational status, risk perception, previous Influenza vaccine uptake, trust in authorities
Albahri, 2021^Citation75	UAE	Health Care Workers	Online survey	176	40.9%	Nationality, professional category
Alremeithi, 2021^Citation76	UAE	General Population	Online survey	1,867	35.5%	Age, gender, nationality, COVID-19 knowledge
Alzubaidi, 2021^Citation77	UAE	University Students	Online survey	669	31.8%	Attitudes and beliefs toward vaccination, perceived side effects, perceived access to vaccination center, perception on adherence to distancing guidelines
Harapan, 2021^Citation78	Multiple countries (Egypt, Sudan, Tunisia)	General Population	Online survey	466	49.1%, 34.8%,45.3%	Gender, professional category previous Influenza vaccine uptake
Anjorin, 2021^Citation79	Multiple countries (Egypt, Sudan, Morocco)	General Population	Online survey	1361	28–35%	Age, gender, employment status, income, residence, rural versus urban settlement
Kaadan, 2021^Citation80	22 Mutiple Arab countries	General Population	Online survey	870	37.6%	Gender, migrant status
Abu-Farha, 2021^Citation81	4 Mutiple countries	General Population	Online survey	2,925	70.6%	Nationality, previous COVID-19 infection, having known someone with COVID-19
Sallam, 2021^Citation82	Multiple Arab countries	General Population	Online survey	3,414	70.6%	Gender, educational level, residence, history of chronic disease, conspirational beliefs
Qunaibi, 2021^Citation83	23 Mutiple Arab countries	General Population	Online survey	36220	83.0%	Gender, professional category, previous Influenza vaccine uptake, knowledge of vaccine type
Qunaibi, 2021^Citation84	21 multiple Arab countries	Health Care Workers	Online survey	6043	74.2%	Gender, previous Influenza vaccine uptake, knowledge of vaccine type, previous COVID-19 infection
Abdou, 2021^Citation85	13 Multiple Arab countries	General Population	Online survey	4474	N/A	5C psychological determinants: confidence, constraints, calculation, collective responsibility
Sitarz, 2022^Citation86	Egypt among multiple countries	Students	Onlie survey	566	39.4%	N/A
Waheed, 2022^Citation87	Egypt	Health Care Workers	Online and printed questionnaire	500	23%	Educational level, previous influenza vaccine, belief on vaccine safety and effectiveness and sufficient evidence on vaccine
Alhneiti, 2022^Citation88	Jordan	Health Care Workers	Online survey	1594	34.2%	Age, knowledge, compliance
Saikarthik, 2022^Citation89	Multiple countries including Saudi Arabia	General population	Online survey	302	55.7%	Gender, development of infection after previous vaccine, levels of depression, anxiety, and perceived need for mental health support before and after COVID-19
Amer, 2022^Citation90	Egypt	Health Care workers	Online survey	436	52.1	Residence, concerns about future side effects, trust regarding vaccine benefit, preference for natural immunity
Majer, 2022^Citation91	Palestine, Gaza strip	General population,Health Care Workers Health Care Workers	Online survey	1075	34.08%	Gender, age, educational level, common source of information, belief in possibility of serious illness, and belief on vaccine safety
Baklouti,2022^Citation92	Tunisia	Health Care Workers	Online survey	300	34.7%	Age, residence, medical professional category, not having cared for COVID patient.
Ali, 2022^Citation93	Lebanon	Refugees Lebanese nationals Lebanese nationals	Two in-person surveys, pre and post vaccine rollout	39274174 4174	75.6% 55.6%	Age, refugee status, HBM constructs
Noushad, 2022^Citation94	Yemen	General population	Online survey	5329	49.9%	Gender, following updates about COVID-19 vaccines, risk perception, anxiety about contracting COVID-19, concerns on COVID-19 vaccines side effects, access to COVID-19 vaccine
El-Ghitany,^Citation95	Egypt	General populationHealth Care Workers	In person iterview	2919	33.5%	Gender, residence, educational level, client facing job category,
Hatamleh, 2022^Citation96	Jordan	Palestenian refugees, Jordanian citizens (general population)	In person interview	992501491 501 491	45.9% 54.1%	Gender, educational level of education. age
El-Qerem, 2022^Citation97	Jordan	Young adults 18-30 yrs	Online survey	1897	80.1%	Gender, risk perception, lCOVID-19 knowledge, COVID-19 preventive measures’ practice score, specific vaccine knowledge score
Mahmud, 2022^Citation98	Jordan	General population	Online survey	2307	16.3%	Gender, residence, previous infection with COVID 19, professional category.
Shehata, 2022^Citation99	Egypt	Health Care workers	Online survey	1268	75.7%	Age, gender, educational level, prior COVID-19 infection, direct contact with patients, practice settings
Elbadawi, 2022^Citation100	Sudan	Health Care workers	Online survey	930	31.4%	N/A
Lataifeh, 2022^Citation101	Jordan	Health Care workers	Online survey	364	37.1%	N/A
Sharaf, 2022^Citation102	Egypt	Dental teaching staff, Health Care workers	Online survey	171	54.4%	Gender, practice setting, intention to travel internationally, having anyone sick in the immediate social circle, anxiety about COVID-19
Boshra, 2022^Citation103	Egypt	General population	Online survey	390	42.3%	N/A
Al-Awaidy, 2022^Citation104	Oman	Health Care workers	Online survey	608	57%	Gender, trust in government, COVID-19 vaccine knowledge, attitudes toward vaccination
AbdelKadir, 2022^Citation105	Egypt	Nursing students	Online survey	500	24%	N/A
Abuhammad, 2022^Citation106	Jordan	Pregnant and lactating women	Online survey	413	49.1%	N/A
Noushad 2022,^Citation107	Yemen	Health Care Worker	Online and printed questionnaire	1581	38.3%	Having a systemic disease, following the updates about COVID-19 vaccines, risk perception, compliance with preventive guidelines, anxiety about contracting COVID-19, previous COVID-19 infection, concern about the side effects of COVID-19 vaccine, access to COVID-19 vaccine
Talafha, 2022^Citation108	Jordan	Syrian refugees	Online survey	230	10.4%	N/A
Shareef, 2022^Citation109	Iraq	General population	Online survey	1221	43.8	Gender, old age. Residence
Nemr, 2022^Citation110	Egypt	Health Care Workers	Online survey	451	59.2%	N/A
Tharwat, 2022^Citation111	Egypt	Health Care Workers	In person Interviews	455	29.5%	N/A
Bhat, 2022^Citation112	Saudi Arabia	General population	Online survey	756	22.1%	N/A
Raja, 2022^Citation113	Sudan	Medical Students	Online survey	281	44.2%	Previous history of COVID-19 infection, Belief in the general safety of vaccines, trust in COVID-19 vaccine to end pandemic, previous vaccination for other diseases in the last five years
Luma, 2022^Citation114	Iraq	Health Care Workers	Online survey	1704	27.9%	Gender, educational level, preexisting chronic disease, and self-perceived poor health status
Abdullah, 2022^Citation115	Jordan	General population	Online survey	1607	45.5%	Gender, income, educational level, risk perception
Darweesh, 2022^Citation116	Iraq	Health Care Workers	Online survey	2202	10.03%	N/A
Nusair, 2022^Citation117	Jordan	General populatin	Online survey	2268	27.7%	Gender, age, risk perception score, having children
Yassin, 2022^Citation118	Sudan	Health Care workers	Online survey	400	36.2%	N/A
El Kibbi, 2022^Citation119	Multiple countries	Health Care Workers Rheumatic disease patients	Online survey	3176	Patients 37% HCWs 28%	Income, belief that it is important to be personally vaccinated, concern regarding the vaccine side-effects, concerns about vaccination in general, previous influenza vaccine uptake, fear of COVID-19, and concerns about the risk of autoimmune flare
Kacimi, 2022^Citation120	Algeria	General population	Online survey	1019	47%	N/A
Kurdee, 2022^Citation121	Saudi Arabia	General population	Online survey	922	43.2%	Marital status
Salman, 2022^Citation122	Multiple Countries Saudi Arabia, Sudan Egypt	General population	Online survey	1393	39%	N/A
Othman, 2022^Citation123	Saudi Arabia	General population	Online survey	504	5.4%	Pre-existing chronic condition, or concern about vaccine side effects
Okmi, 2022^Citation124	Saudi Arabia	General population	Online survey	1939	26.7%	Gender, professional category, risk of infection contraction and severity perception of vaccine benefits, belief on effectiveness of vaccine and that it is media advertisement, less cues to action
Faqihi, 2022^Citation125	Saudi Arabia	General population	Online survey	7188	36.2%	N/A
Saddik, 2022^Citation126	United Arab Emirates	Health Care Workers	Online survey	517	42%	Gender, previous influenza vaccine uptake, attitude, risk perception, concerns about inadequate data on vaccine safety, side effect, avoidance of vaccines in general
Khalafalla, 2022^Citation127	Saudi Arabia	University Students	Online survey	1039	16.4%	Age, perceived disease severity, benefit, cues to action, efficacy and barriers (HBM constructs)
Alshahrani, 2022^Citation128	Saudi Arabia	Pregnant and breast feeding women	Online survey	854	68.1% pregnant 14.1% High risk pregnancy 17.8% Breastfeeding	N/A
Mohamed, 2022^Citation129	Mutiple countries Egypt, Saudi Arabia and Tunisia	People living with HIV	Online survey	540	35.4%	Worry about COVID-19 transmission post-vaccination, belief in disease prevention by vaccine.
Almeshary, 2022^Citation130	Saudi Arabia	General population	Online survey	1658	28%	Gender, previous COVID-19 infection, income, employment, residence
Alshareef, 2022^Citation131	Saudi Arabia	Women aged 18 years and above	Online survey	910	59%	Age, educational level, refusal in previous vaccination uptake
Arraj, 2022^Citation132	Lebanon	Adult population	Online survey	1185	53%	N/A
Habib, 2022^Citation133	Saudi Arabia	Medical students	Online survey	1445	33.3%	N/A
Nour, 2022^Citation134	Saudi Arabia	General population	Online survey	507	28.8%	Gender, income, educational level, COVID-19 knowledge, previous influenza vaccine uptake, history of COVID-19
Al-Kafarna, 2022^Citation135	Palestine	General population	Online survey	6226	27.9%	N/A
Salem, 2022^Citation136	Egypt	General population	Online survey	1053	69.5%	Previous history of influenza vaccine uptake, perceived vaccine effectiveness, vaccine price and doctors’ recommendation to take the vaccine
Ghamri, 2022^Citation137	Saudi Arabia	Pregnant/lactatting women	Online survey	300	20%	Risk perception, vaccine uptake by pregnant and breastfeeding/lactating womenLactating women: educational level, concern about efficacy and safety, recommendation by OB/GYN Lactating women: educational level, concern about efficacy and safety, recommendation by OB/GYN
Banyad, 2023^Citation138	Morocco	Mothers (given birth in last two years)	In person interview	458	36%	Income, health coverage
Reagu, 2023^Citation139	Qatar	General population	Online surveys	5340	20%	Personality traits of openness, conscientiousness, and neuroticism
Al-ghurabi, 2023^Citation140	Saudi Arabia	General population	Online surveys	444	38.3%	N/A

Table 3. Summary of 11 articles with studies reporting hesitancy against COVID-19 booster vaccination.

First author, Year	Country	Studied Population	Mode of data collection	Sample size	Hesitancy	Factors associated with hesitancy
El-Qerem, 2022^Citation141	Jordan	General population	Online survey	915	Booster 30.7%	Previous symptoms, imposition of law to get vaccinated
Abdullais, 2022^Citation142	Saudi Arabia	General population	Online survey	520	49.8% booster	N/A
Esra’O, 2022^Citation143	Jordan	Pregnant and lactating mothers	Online survey	584	booster 43.8	Income, residence, breastfeeding status, knowledge of pregnant/lactating women previously infected with COVID-19, commitment to routine immunization for children, previous influenza vaccine uptake, worry about contracting COVID-19
El-Qerem 2022^Citation144	Iraq	General population	Online survey	754	Booster 55.4%	Risk perception, belief in being infected with COVID-19 in next 6 months, knowledge score group, imposed laws vaccine type, age, practice level, knowledge of someone who had died due to COVID-19, side effects score
Lounis, 2022^Citation145	Algeria	General population	Online survey	656	30.5 Booster	Gender, professional category belief in natural origin of the pandemic, previous COVID-19 infection in family
Abuhammad, 2022^Citation106	Jordan	Pregnant and lactating women	Online survey	413	65.9%	N/A
Abullais, 2022^Citation146	Saudi Arabia	Dental patients	Online and printed questionnaire person	609	48.1% booster	N/A
Mugheed, 2022^Citation147	Multiple countries, Oman, Saudi Arabia	Nursing students	Online survey	216	24.5 Booster	N/A
Abouzid, 2022^Citation148	Multiple (MENA) countries	General vaccinated population	Online survey	222	Booster 24.4	Fear of COVID-19, immunocompromised status
Al Obaidi, 2022^Citation149	Saudi Arabi	Hemodialysis patients	In person interview	179	Booster 21.8%	Marital status, confidence in the locally manufactured vaccine, educational level, rating of health status
Vellapally, 2022^Citation150	Saudi Arabia	Health Care Workers	Online survey	303	33% booster	Belief in safety provided by pharmaceutical companies

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