Vaccine conspiracy association with higher COVID-19 vaccination side effects and negative attitude towards booster COVID-19, influenza and monkeypox vaccines: A pilot study in Saudi Universities

Figures & data

Table 1. Summary description of the study sample divided by occupation (N = 273).

Variable	Category	Student	Academic staff
		N^b (%)	N (%)
Sex	Male	93 (50.5)	37 (41.6)
	Female	91 (49.5)	52 (58.4)
Nationality	Saudi	180 (97.8)	70 (78.7)
	Non-Saudi	4 (2.2)	19 (21.3)
Educational level	Undergraduate	163 (88.6)	7 (7.9)
	Postgraduate	21 (11.4)	82 (92.1)
Sector	Public	173 (94.0)	87 (97.8)
	Private	11 (6.0)	2 (2.2)
Experience	Student in the first 3 years	84 (45.7)	–
	Student at the fourth year or higher	100 (54.3)	–
	Staff with less than 3-year experience	–	13 (14.6)
	Staff with 3–10-year experience	–	29 (32.6)
	Staff with more than 10-year experience	–	47 (52.8)
History of COVID-19^a	Yes	91 (49.5)	49 (55.1)
	No	93 (50.5)	40 (44.9)
Frequency of COVID-19	No history of infection	93 (50.5)	40 (44.9)
	Single time	69 (37.5)	36 (40.4)
	Two times	19 (10.3)	11 (12.4)
	Three times or more	3 (1.6)	2 (2.2)
Have you received COVID-19 vaccination?	Yes	182 (98.9)	86 (96.6)
	No	2 (1.1)	3 (3.4)
Number of COVID-19 vaccine doses received	Single	2 (1.1)	3 (3.4)
	Two	39 (21.2)	11 (12.4)
	Three	138 (75.0)	65 (73.0)
	Four	3 (1.6)	7 (7.9)
First COVID-19 vaccine dose	Pfizer-BioNTech vaccine	151 (83.0)	65 (75.6)
	Oxford – AstraZeneca vaccine	30 (16.5)	21 (24.4)
	Others	1 (0.5)	0
Second COVID-19 vaccine dose	Pfizer-BioNTech vaccine	144 (80.0)	72 (86.7)
	Oxford – AstraZeneca vaccine	34 (18.9)	10 (12.0)
	Others	2 (1.1)	1 (1.2)
Third COVID-19 vaccine dose	Pfizer-BioNTech vaccine	114 (80.9)	61 (84.7)
	Oxford – AstraZeneca vaccine	15 (10.6)	7 (9.7)
	Others	12 (8.5)	4 (5.6)
Fourth COVID-19 vaccine dose	Pfizer-BioNTech vaccine	3 (100.0)	5 (71.4)
	Oxford – AstraZeneca vaccine	0	2 (28.6)

^aCOVID-19: Coronavirus disease 2019; ^bN: Number.

Educational level for academic staff denotes a completed degree.

Figure 1. Attitude of the participants towards booster COVID-19, seasonal influenza and monkeypox (mpox) vaccination and their attitude towards compulsory vaccination.

KSA: Kingdom of Saudi Arabia.

Table 2. Attitude toward vaccination stratified by participants’ demographics.

Variable	Category	Willingness to receive booster COVID-19 vaccination				Willingness to receive seasonal influenza vaccination				Willingness to receive mpox^g vaccination				Attitude to mandatory vaccination
		A^c	H^e	R^f	p value, χ^2	A	H	R	p value, χ^2	A	H	R	p value, χ^2	F^h	N^i	U^j	p value, χ^2
		N^d (%)	N (%)	N (%)		N (%)	N (%)	N (%)		N (%)	N (%)	N (%)		N (%)	N (%)	N (%)
Sex	Male	41 (31.5)	20 (15.4)	69 (53.1)	.130, 4.077	66 (50.8)	16 (12.3)	48 (36.9)	.248, 2.785	50 (38.5)	34 (26.2)	46 (35.4)	.325, 2.248	34 (26.2)	14 (10.8)	82 (63.1)	.508, 1.356
	Female	30 (21.0)	23 (16.1)	90 (62.9)		62 (43.4)	14 (9.8)	67 (46.9)		43 (30.1)	40 (28.0)	60 (42.0)		33 (23.1)	11 (7.7)	99 (69.2)
Age categories	≤22 years	31 (24.6)	23 (18.3)	72 (57.1)	.561, 1.157	59 (46.8)	21 (16.7)	46 (36.5)	.013, 8.617	49 (38.9)	39 (31.0)	38 (30.2)	.025, 7.404	36 (28.6)	14 (11.1)	76 (60.3)	.151, 3.787
	>22 years	40 (27.2)	20 (13.6)	87 (59.2)		69 (46.9)	9 (6.1)	69 (46.9)		44 (29.9)	35 (23.8)	68 (46.3)		31 (21.1)	11 (7.5)	105 (71.4)
Nationality	Saudi	63 (25.2)	41 (16.4)	146 (58.4)	.461, 1.550	113 (45.2)	28 (11.2)	109 (43.6)	.178, 3.454	83 (33.2)	72 (28.8)	95 (38.0)	.115, 4.318	58 (23.2)	23 (9.2)	169 (67.6)	.230, 2.940
	Non-Saudi	8 (34.8)	2 (8.7)	13 (56.5)		15 (65.2)	2 (8.7)	6 (26.1)		10 (43.5)	2 (8.7)	11 (47.8)		9 (39.1)	2 (8.7)	12 (52.2)
Occupational category	Student	45 (24.5)	34 (18.5)	105 (57.1)	.190, 3.321	86 (46.7)	25 (13.6)	73 (39.7)	.118, 4.274	67 (36.4)	54 (29.3)	63 (34.2)	.081, 5.020	48 (26.1)	22 (12.0)	114 (62.0)	.030, 6.984
	Academic staff	26 (29.2)	9 (10.1)	54 (60.7)		42 (47.2)	5 (5.6)	42 (47.2)		26 (29.2)	20 (22.5)	43 (48.3)		19 (21.3)	3 (3.4)	67 (75.3)
Educational level	Undergraduate	42 (24.7)	32 (18.8)	96 (56.5)	.198, 3.237	80 (47.1)	27 (15.9)	63 (37.1)	.002, 12.566	65 (38.2)	50 (29.4)	55 (32.4)	.018, 8.048	46 (27.1)	20 (11.8)	104 (61.2)	.043, 6.292
	Postgraduate	29 (28.2)	11 (10.7)	63 (61.2)		48 (46.6)	3 (2.9)	52 (50.5)		28 (27.2)	24 (23.3)	51 (49.5)		21 (20.4)	5 (4.9)	77 (74.8)
History of COVID-19^a	Yes	31 (22.1)	18 (12.9)	91 (65.0)	.066, 5.432	59 (42.1)	14 (10.0)	67 (47.9)	.144, 3.877	38 (27.1)	35 (25.0)	67 (47.9)	.005, 10.547	25 (17.9)	13 (9.3)	102 (72.9)	.029, 7.101
	No	40 (30.1)	25 (18.8)	68 (51.1)		69 (51.9)	16 (12.0)	48 (36.1)		55 (41.4)	39 (29.3)	39 (29.3)		42 (31.6)	12 (9.0)	79 (59.4)
Mini-VCBS^b	<9	33 (45.2)	10 (13.7)	30 (41.1)	<.001, 45.812	43 (58.9)	5 (6.8)	25 (34.2)	<.001, 21.153	28 (38.4)	23 (31.5)	22 (30.1)	<.001, 27.017	20 (27.4)	4 (5.5)	49 (67.1)	<.001, 27.345
	9	9 (16.1)	21 (37.5)	26 (46.4)		30 (53.6)	12 (21.4)	14 (25.0)		13 (23.2)	28 (50.0)	15 (26.8)		13 (23.2)	15 (26.8)	28 (50.0)
	>9	29 (20.1)	12 (8.3)	103 (71.5)		55 (38.2)	13 (9.0)	76 (52.8)		52 (36.1)	23 (16.0)	69 (47.9)		34 (23.6)	6 (4.2)	104 (72.2)

^aCOVID-19: Coronavirus disease 2019; ^bMini-VCBS, miniaturized version of the Vaccine Conspiracy Beliefs Scale with higher scores indicating higher embrace of vaccine conspiracies and a score of 9 indicated a neutral attitude; ^cA: Vaccine acceptance group; ^dN: Number; ^eH: Vaccine hesitancy group; ^fR: Vaccine resistance group; ^gmpox: Monkeypox; ^hF: Favorable; ⁱN: Neutral; ^jU: Unfavorable.

Figure 2. Self-reported side effects of COVID-19 vaccines per dose.

GI: Gastrointestinal; CVS: Cardiovascular.

Table 3. Summary of the self-reported COVID-19 vaccination side effects (SERVASE) scores per dose comparing different study variables.

Variable	SERVASE^d dose 1 (mean (95% CI^e), median, IQR^f)	p value^g	SERVASE dose 2 (mean (95% CI), median, IQR)	p value	SERVASE dose 3 (mean (95% CI), median, IQR)	p value
Sex
Male	5.8 (4.6–6.6), 4.0, 1.3–9.0	<.001	5.4 (4.5–6.4), 4.0, 1.3–4.0	<.001	6.0 (5.0–7.0), 5.0, 2.0–8.5	<.001
Female	10.2 (8.4–11.0), 9.0, 4.0–14.0		9.5 (7.7–10.4), 8.0, 4.0–13.0		9.4 (8.1–10.6), 8.0, 4.0–13.0
Age
≤22 years	8.3 (7.2–9.8), 7.0, 3.0–12.0	.357	8.1 (6.8–9.4), 7.0, 4.0–12.0	.037	7.9 (6.7–9.1), 7.0, 3.0–11.0	.715
>22 years	7.9 (6.1–8.5), 5.0, 2.0–12.3		7.1 (5.6–8.1), 5.0, 2.0–11.0		7.8 (6.6–9.0), 6.0, 3.0–12.0
Education
Undergraduate	8.2 (7.1–9.2), 7.0, 3.0–12.0	.240	7.9 (6.7–8.8), 7.0, 4.0–12.0	.021	8.0 (7.0–9.0), 7.0, 4.0–11.0	.351
Postgraduate	7.9 (5.8–8.9), 5.0, 2.0–13.0		7.0 (5.3–8.4), 4.0, 2.0–11.0		7.6 (6.2–9.1), 6.0, 2.5–11.0
Occupation
Student	8.6 (7.6–9.9), 7.0, 3.0–12.0	.041	8.2 (7.1–9.4), 7.0, 3.3–12.0	.006	8.5 (7.4–9.5), 7.0, 3.0–12.0	.058
Academic staff	7.1 (4.7–7.3), 5.0, 2.0–12.0		6.1 (4.5–7.0), 4.0, 2.0–10.0		6.6 (5.4–7.8), 5.0, 3.0–9.8
History of COVID-19^a
Yes	8.6 (6.8–9.8), 6.0, 2.5–14.0	.998	8.4 (6.8–9.8), 6.0, 2.0–13.0	.262	8.8 (7.4–10.1), 8.0, 3.0–13.0	.127
No	7.6 (6.4–8.4), 6.0, 3.0–11.0		6.6 (5.6–7.5), 5.5, 3.0–11.0		6.9 (6.0–7.9), 6.0, 3.0–10.0
Vaccine type
Pfizer-BioNTech	7.9 (7.0–8.8), 6.0, 3.0–11.0	.183	7.3 (6.5–8.1), 6.0, 2.8–11.3	.255	7.6 (6.7–8.5), 6.0, 3.0–11.0	.137
Oxford – AstraZeneca	8.9 (7.1–10.8), 8.0, 2.0–12.5		8.8 (6.5–11.0), 6.0, 2.3–11.8		9.7 (6.7–12.7), 8.5, 4.0–15.3
Mini-VCBS^b
<9	6.5 (5.0–7.4), 5.0, 2.0–10.5	.002	5.7 (4.7–6.8), 5.0, 2.0–9.0	<.001	6.2 (5.0–7.4), 5.0, 2.0–10.0	<.001
9	6.5 (5.1–8.0), 5.0, 2.0–10.5		5.5 (4.3–6.8), 4.0, 2.0–9.5		5.5 (4.2–6.7), 5.0, 2.0–8.0
>9	9.7 (8.4–11.0), 7.0, 4.0–14.0		9.4 (8.1–10.7), 7.0, 4.0–13.0		9.7 (8.4–11.0), 8.0, 5.0–14.0
SMV^c
<9	6.3 (5.0–7.7), 5.0, 2.0–9.0	.042	5.7 (5.0–7.7), 5.0, 2.0–10.0	.019	5.9 (4.8–7.0), 5.0, 3.0–8.0	.012
9	6.5 (4.2–8.9), 4.5, 2.0–11.8		6.3 (4.2–8.9), 4.0, 2.0–9.5		6.6 (4.1–9.0), 5.0, 2.0–10.5
>9	9.0 (7.9–10.0), 7.0, 3.0–14.0		8.5 (7.9–10.0), 7.0, 3.0–12.0		8.9 (7.8–10.0), 8.0, 3.5–12.0

^aCOVID-19: Coronavirus disease 2019; ^bMini-VCBS, miniaturized version of the Vaccine Conspiracy Beliefs Scale with higher scores indicating higher embrace of vaccine conspiracies and a score of 9 indicated a neutral attitude; ^cSMV: the Score for Mandatory Vaccination with higher scores indicating disagreement toward mandatory vaccination and a score of 9 indicated a neutral attitude; ^dSERVASE: Self-Reported Vaccination Side Effects Score; ^eCI: Confidence interval; ^fIQR: Interquartile range; ^gp values: Calculated using the Mann – Whitney U test or the Kruskal – Wallis test.

Table 4. Variables associated with higher self-reported vaccination side effects scores (SERVASE) following COVID-19 vaccination in multinomial logistic regression analyses.

Model	aOR^c (95% CI^d)	p value
SERVASE 1 < 8 vs. SERVASE 1 ≥ 8
Nagelkerke R^2  = 0.164
Male	2.90 (1.70–4.93)	<.001
Female	Ref.
Student	0.45 (0.25–0.81)	.007
Academic staff	Ref.
Pfizer-BioNTech COVID-19 vaccine	2.35 (1.20–4.61)	.012
Oxford – AstraZeneca COVID-19 vaccine	Ref.
Mini-VCBS^a <9	1.60 (0.87–2.96)	.134
Mini-VCBS = 9	1.86 (0.90–3.82)	.093
Mini-VCBS >9	Ref.
SMV^b <9	1.83 (0.99–3.40)	.056
SMV = 9	1.77 (0.64–4.86)	.270
SMV >9	Ref.
SERVASE 2 < 8 vs. SERVASE 2 ≥ 8
Nagelkerke R^2  = 0.167
Male	2.91 (1.68–5.04)	<.001
Female	Ref.
Age ≤22 years	0.75 (0.34–1.65)	.474
Age >22 years	Ref.
Undergraduate	1.04 (0.39–2.76)	.943
Postgraduate	Ref.
Student	0.71 (0.28–1.78)	.460
Academic staff	Ref.
Mini-VCBS <9	2.14 (1.14–4.04)	.019
Mini-VCBS = 9	2.64 (1.26–5.55)	.010
Mini-VCBS >9	Ref.
SMV <9	1.94 (1.02–3.68)	.042
SMV = 9	1.16 (0.43–3.16)	.774
SMV >9	Ref.
SERVASE 3 < 8 vs. SERVASE 3 ≥ 8
Nagelkerke R^2  = 0.266
Male	4.07 (2.12–7.79)	<.001
Female	Ref.
Student	0.54 (0.27–1.08)	.080
Academic staff	Ref.
History of COVID-19	0.90 (0.47–1.73)	.760
No history of COVID-19	Ref.
Pfizer-BioNTech COVID-19 vaccine	2.49 (0.84–7.33)	.099
Oxford – AstraZeneca COVID-19 vaccine	Ref.
Mini-VCBS <9	1.51 (0.70–3.23)	.292
Mini-VCBS = 9	4.60 (1.88–11.28)	.001
Mini-VCBS >9	Ref.
SMV <9	2.87 (1.31–6.27)	.008
SMV = 9	1.05 (0.32–3.47)	.938
SMV >9	Ref.

^aMini-VCBS: miniaturized version of the Vaccine Conspiracy Beliefs Scale with higher scores indicating higher embrace of vaccine conspiracies and a score of 9 indicated a neutral attitude; ^bSMV: the Score for Mandatory Vaccination with higher scores indicating disagreement toward mandatory vaccination and a score of 9 indicated a neutral attitude; ^caOR: Adjusted odds ratio; ^dCI: confidence interval.

Table 5. Factors associated with acceptance of yearly booster COVID-19, seasonal influenza, and mpox vaccination in multinomial logistic regression analyses.

Model	aOR^b (95% CI^c)	p value	Model	aOR (95% CI)	p value
Yearly booster COVID-19 vaccine acceptance vs. resistance			Yearly booster COVID-19 vaccine hesitancy vs. resistance
Nagelkerke R^2  = 0.206
Male	1.70 (0.94–3.10)	.081	Male	0.95 (0.46–1.99)	.900
Female	Ref.		Female	Ref.
Student	0.99 (0.35–2.81)	.986	Student	1.44 (0.38–5.40)	.590
Academic staff	Ref.		Academic staff	Ref.
Undergraduate	0.89 (0.32–2.48)	.817	Undergraduate	1.61 (0.46–5.72)	.459
Postgraduate	Ref.		Postgraduate	Ref.
History of COVID-19	0.63 (0.35–1.14)	.127	History of COVID-19	0.62 (0.30–1.29)	.201
No history of COVID-19	Ref.		No history of COVID-19	Ref.
Mini-VCBS^a <9	3.78 (1.96–7.26)	<.001	Mini-VCBS <9	2.85 (1.11–7.33)	.030
Mini-VCBS = 9	1.19 (0.50–2.83)	.703	Mini-VCBS = 9	7.10 (3.05–16.55)	<.001
Mini-VCBS >9	Ref.		Mini-VCBS >9	Ref.
Seasonal influenza vaccine acceptance vs. resistance			Seasonal influenza vaccine hesitancy vs. resistance
Nagelkerke R^2  = 0.191
Age ≤22 years	0.96 (0.44–2.07)	.914	Age ≤22 years	1.80 (0.52–6.29)	.354
Age >22 years	Ref.		Age >22 years	Ref.
Saudi	0.26 (0.09–0.77)	.015	Saudi	0.22 (0.03–1.53)	.125
Non-Saudi	Ref.		Non-Saudi	Ref.
Student	1.05 (0.41–2.67)	.920	Student	0.23 (0.03–1.53)	.127
Academic staff	Ref.		Academic staff	Ref.
Undergraduate	1.80 (0.68–4.75)	.236	Undergraduate	24.54 (3.13–192.56)	.002
Postgraduate	Ref.		Postgraduate	Ref.
History of COVID-19	0.75 (0.44–1.29)	.296	History of COVID-19	0.86 (0.36–2.04)	.724
No history of COVID-19	Ref.		No history of COVID-19	Ref.
Mini-VCBS <9	2.75 (1.46–5.19)	.002	Mini-VCBS <9	1.40 (0.43–4.53)	.576
Mini-VCBS = 9	3.28 (1.55–6.91)	.002	Mini-VCBS = 9	6.35 (2.25–17.88)	<.001
Mini-VCBS >9	Ref.		Mini-VCBS >9	Ref.
Mpox vaccine acceptance vs. resistance			Mpox vaccine hesitancy vs. resistance
Nagelkerke R^2  = 0.170
Age ≤22 years	1.31 (0.57–3.00)	.523	Age ≤22 years	1.33 (0.53–3.34)	.541
Age >22 years	Ref.		Age >22 years	Ref.
Student	0.91 (0.33–2.52)	.852	Student	1.27 (0.42–3.87)	.671
Academic staff	Ref.		Academic staff	Ref.
Undergraduate	1.87 (0.65–5.35)	.245	Undergraduate	1.41 (0.44–4.49)	.564
Postgraduate	Ref.		Postgraduate	Ref.
History of COVID-19	0.43 (0.24–0.78)	.005	History of COVID-19	0.61 (0.32–1.15)	.127
No history of COVID-19	Ref.		No history of COVID-19	Ref.
Mini-VCBS <9	1.66 (0.83–3.32)	.151	Mini-VCBS <9	3.18 (1.47–6.88)	.003
Mini-VCBS = 9	1.13 (0.48–2.65)	.776	Mini-VCBS = 9	5.63 (2.52–12.57)	<.001
Mini-VCBS >9	Ref.		Mini-VCBS >9	Ref.
Favorable vs. unfavorable attitude to mandatory vaccination			Neutral vs. unfavorable attitude to mandatory vaccination
Nagelkerke R^2  = 0.164
Age ≤22 years	1.26 (0.54–2.94)	.593	Age ≤22 years	0.67 (0.21–2.11)	.496
Age >22 years	Ref.		Age >22 years	Ref.
Student	0.99 (0.34–2.87)	.979	Student	3.85 (0.67–22.20)	.131
Academic staff	Ref.		Academic staff	Ref.
Undergraduate	1.32 (0.44–3.99)	.620	Undergraduate	1.89 (0.37–9.64)	.443
Postgraduate	Ref.		Postgraduate	Ref.
History of COVID-19	0.49 (0.27–0.88)	.016	History of COVID-19	1.00 (0.40–2.49)	.998
No history of COVID-19	Ref.		No history of COVID-19	Ref.
Mini-VCBS <9	1.18 (0.60–2.29)	.632	Mini-VCBS <9	1.59 (0.42–6.05)	.493
Mini-VCBS = 9	1.37 (0.63–2.99)	.434	Mini-VCBS = 9	10.62 (3.65–30.91)	<.001
Mini-VCBS >9	Ref.		Mini-VCBS >9	Ref.

^aMini-VCBS: miniaturized version of the Vaccine Conspiracy Beliefs Scale with higher scores indicating higher embrace of vaccine conspiracies and a score of 9 indicated a neutral attitude; ^baOR: Adjusted odds ratio; ^cCI: confidence interval.

Data availability statement

The data presented in this study are available on request from the corresponding author (Malik Sallam).