Monitoring COVID-19 Vaccine Acceptance in Kuwait During the Pandemic: Results from a National Serial Study

Figures & data

Table 1 Participant Characteristics and the Association with Agreement Towards Taking the COVID-19 Vaccination, Kuwait, May–Aug, 2020

Variables	Total				p-value	Kuwaiti				p-value	Non-Kuwaiti				p-value
	n	%/	Disagree	Agree		n	%/	Disagree	Agree		n	%/	Disagree	Agree
		Mean	%/Mean	%/Mean			Mean	%/Mean	%/Mean			Mean	%/Mean	%/mean
Total	7241	100.00	32.65	67.35		5651	100.00	34.79	65.21		1,590	100.00	25.03	74.97
MOH Stage€
Complete lockdown	1,846	25.49	19.04	28.62	<0.001***	1,243	22.00	16.84	24.75	<0.001***	603	37.92	29.90	40.60	<0.001***
Stage 1	2,144	29.61	26.95	30.90		1,643	29.07	25.64	30.91		501	31.51	33.42	30.87
Stage 2	1,607	22.19	20.98	22.78		1,336	23.64	21.36	24.86		271	17.04	19.10	16.36
Stage 3	894	12.35	16.62	10.27		746	13.20	17.80	10.75		148	9.31	10.80	8.81
Stage 4	750	10.36	16.41	7.42		683	12.09	18.36	8.74		67	4.21	6.78	3.36
Gender
Male	1,978	27.32	21.83	29.98	<0.001***	1,321	23.38	19.68	25.35	<0.001***	657	41.32	32.41	44.30	<0.001***
Female	5,263	72.68	78.17	70.02		4,330	76.62	80.32	74.65		933	58.68	67.59	55.70
Age (years)
Age (continuous)	7,241	38.03	39.82	37.16	<0.001***	5,651	38.25	40.13	37.25	<0.001***	1,590	37.24	38.29	36.89	0.040*
18–29	2,063	28.49	23.14	31.08	<0.001***	1,593	28.19	22.08	31.45	<0.001***	470	29.56	28.39	29.95	0.541
30–44	2,968	40.99	42.30	40.35		2,279	40.33	42.42	39.21		689	43.33	41.71	43.88
45–59	1,762	24.33	26.69	23.19		1,397	24.72	27.01	23.50		365	22.96	25.13	22.23
60–74	448	6.19	7.87	5.37		382	6.76	8.49	5.83		66	4.15	4.77	3.94
Governorate
Capital	1,396	19.28	21.02	18.43	<0.001***	1,257	22.24	23.60	21.52	0.005**	139	8.74	8.29	8.89	0.565
Ahmadi	927	12.80	11.84	13.27		729	12.90	12.21	13.27		198	12.45	10.05	13.26
Farwaniya	851	11.75	10.83	12.20		674	11.93	10.83	12.51		177	11.13	10.80	11.24
Hawalli	2,512	34.69	35.07	34.50		1,628	28.81	30.21	28.06		884	55.60	59.05	54.45
Jahra	396	5.47	4.30	6.03		278	4.92	3.76	5.54		118	7.42	7.04	7.55
Mubarak Alkabeer	1,159	16.01	16.92	15.56		1,085	19.20	19.38	19.10		74	4.65	4.77	4.61
Education
No formal education	21	0.29	0.34	0.27	<0.001***	12	0.21	0.25	0.19	0.009**	9	0.57	0.75	0.50	0.050*
High school or less	660	9.11	7.02	10.13		425	7.52	6.31	8.17		235	14.78	10.55	16.19
University	5,204	71.87	72.55	71.54		4,213	74.55	73.96	74.87		991	62.33	65.58	61.24
Post-graduate	1,356	18.73	20.09	18.06		1,001	17.71	19.48	16.77		355	22.33	23.12	22.06
Income
Very low <500KD	1,440	19.89	16.16	21.69	<0.001***	851	15.06	12.46	16.45	0.001**	589	37.04	34.42	37.92	0.254
Low 500–699KD	729	10.07	8.97	10.60		385	6.81	6.71	6.87		344	21.64	20.10	22.15
Lower middle 700–1399	2,368	32.70	35.49	31.35		2,017	35.69	37.49	34.74		351	22.08	25.63	20.89
Upper middle 1400–239	1,702	23.51	24.32	23.11		1,512	26.76	26.60	26.84		190	11.95	13.07	11.58
High >2400KD	1,002	13.84	15.06	13.25		886	15.68	16.73	15.12		116	7.30	6.78	7.47
Size of household
One person	189	2.61	2.03	2.89	0.072	64	1.13	1.07	1.17	0.278	125	6.78	8.22	7.86	0.427
Two people	343	4.74	4.44	4.88		140	2.48	2.49	2.47		203	14.07	12.33	12.77
Three to five people	2,192	30.27	29.61	30.59		1,338	23.68	25.18	22.88		854	51.51	54.45	53.71
Six people or more	4,517	62.38	63.92	61.64		4,109	72.71	71.26	73.49		408	27.64	25.00	25.66
Marital status
Single	2,188	30.22	25.59	32.46	<0.001***	1,640	29.02	24.06	31.67	<0.001***	548	33.17	34.90	34.47	0.265
Married	4,499	62.13	65.57	60.47		3,530	62.47	66.53	60.30		969	60.80	60.99	60.94
Divorced/widowed	554	7.65	8.84	7.07		481	8.51	9.41	8.03		73	6.03	4.11	4.59
Have children under 18
Yes	4,457	61.55	64.04	60.34	0.002**	3,629	64.22	66.38	63.07	0.013*	828	52.08	52.51	51.93	0.840
No	2,784	38.45	35.96	39.66		2,022	35.78	33.62	36.93		762	47.92	47.49	48.07
Have chronic illness
Yes	1,817	25.09	26.02	24.65	0.405	1,553	27.48	27.47	27.49	1.000	264	16.60	18.84	15.86	0.199
No	5,168	71.37	70.35	71.87		3,908	69.16	69.18	69.15		1,260	79.25	76.13	80.29
Do not know	256	3.54	3.64	3.49		190	3.36	3.36	3.36		66	4.15	5.03	3.86
Front-line worker
Yes	1,068	14.75	12.94	15.62	0.003**	787	13.93	12.51	14.68	0.025*	281	17.67	15.08	18.54	0.117
No	6,173	85.25	87.06	84.38		4,864	86.07	87.49	85.32		1,309	82.33	84.92	81.46
Infected with COVID-19
Yes, confirmed	149	2.06	2.28	1.95	0.047*	118	2.09	2.14	2.06	0.355	31	1.95	3.02	1.59	0.007**
Yes, but not confirmed	62	0.86	1.23	0.68		42	0.74	1.02	0.60		20	1.26	2.26	0.92
No	6,350	87.70	86.59	88.23		4,977	88.07	87.59	88.33		1,373	86.35	81.66	87.92
Do not know	680	9.39	9.90	9.14		514	9.10	9.26	9.01		166	10.44	13.07	9.56
Know others infected with COVID-19
Yes, confirmed	3,490	48.20	51.02	46.83	0.006**	2,951	52.22	53.41	51.59	0.511	539	33.90	39.20	32.13	0.006**
Yes, but not confirmed	163	2.25	2.37	2.19		105	1.86	1.78	1.90		58	3.65	5.28	3.10
No	3,315	45.78	42.85	47.20		2,406	42.58	41.30	43.26		909	57.17	50.50	59.40
Do not know	273	3.77	3.76	3.77		189	3.34	3.51	3.26		84	5.28	5.03	5.37

Notes: Acceptance was measured using a Likert scale ranging from 1 to 7; 1–4 indicated disagreement or less likely to agree (Disagree), while 5–7 indicated agreement or more likely to take the vaccine (Agree). € Ministry of Health return to normality stages a P-value for agreement (disagree vs agree); *P-value <0.05, **p-value<0.01, ***P-value<0.001; values in bold are statistically significant. P-values for categorical variables were obtained by Chi-squared test, and for continuous variables by the t-test.

Table 2 Association Between Knowledge, Risk Perceptions, Preparedness and Perceived Self-Efficacy, Precautionary Measures, Information and Trust, Policies, Panic Behaviours and Fear, and the Seasonal Influenza on Agreement Towards Taking the COVID-19 Vaccination, Kuwait, May–Aug, 2020

Variables	Total n=(7241)				p-value	Kuwaiti n=(5651)				p-value	Non-Kuwaiti n=(1590)				p-value
	n	%/	Disagree	Agree		n	%/	Disagree	Agree		n	%/	Disagree	Agree
		Mean	%/Mean	%/Mean			Mean	%/Mean	%/Mean			mean	%/mean	%/mean
Knowledge about COVID-19
Perceived knowledge ¥
	7,241	5.45	5.41	5.47	0.082	5,651	5.45	5.41	5.46	0.182	1,590	5.48	5.42	5.51	0.293
Real knowledge ¥
	7,241	6.18	6.11	6.21	<0.001***	5,651	6.16	6.09	6.19	<0.001***	1,590	6.24	6.21	6.25	0.428
Risk perceptions
Probability of getting COVID-19 infection
Extremely unlikely	2,514	34.72	34.26	34.94	0.111	1,885	33.36	33.57	33.24	0.218	629	39.56	37.69	40.18	0.409
Partly likely	1,832	25.30	26.82	24.56		1,466	25.94	27.11	25.32		366	23.02	25.38	22.23
Extremely likely	2,895	39.98	38.92	40.50		2,300	40.70	39.32	41.44		595	37.42	36.93	37.58
Susceptibility of getting infected with COVID-19
Not/less susceptible	2,830	39.08	38.32	39.45	0.041*	2,131	37.71	37.23	37.96	0.277	699	43.96	43.72	44.04	0.085
Partly susceptible	1,959	27.05	28.93	26.14		1,574	27.85	29.15	27.16		385	24.21	27.89	22.99
More/very susceptible	2,452	33.86	32.74	34.41		1,946	34.44	33.62	34.87		506	31.82	28.39	32.97
Severity of COVID-19, if infected
Not/less severe	2,086	28.81	26.95	29.71	0.041*	1,523	26.95	25.84	27.54	0.295	563	35.41	32.41	36.41	0.345
Partly severely	2,355	32.52	33.84	31.88		1,899	33.60	34.69	33.03		456	28.68	29.65	28.36
More/very severe	2,800	38.67	39.21	38.40		2,229	39.44	39.47	39.43		571	35.91	37.94	35.23
Preparedness and perceived self-efficacy
Preparedness towards COVID-19
Not at all	285	3.94	4.74	3.55	<0.001***	239	4.23	4.88	3.88	0.002**	46	2.89	4.02	2.52	0.003**
Somewhat	658	9.09	11.13	8.10		556	9.84	11.44	8.98		102	6.42	9.55	5.37
Very much so	6,298	86.98	84.14	88.35		4,856	85.93	83.67	87.14		1,442	90.69	86.43	92.11
Self-efficacy in avoiding COVID-19 infection
Extremely difficult/difficult	1,554	21.46	20.47	21.94	0.244	1,230	21.77	21.01	22.17	0.543	324	20.38	17.84	21.22	0.281
Somewhat easy	1,861	25.70	26.65	25.24		1,484	26.26	26.86	25.94		377	23.71	25.63	23.07
Easy/extremely easy	3,826	52.84	52.88	52.82		2,937	51.97	52.14	51.89		889	55.91	56.53	55.70
Follow recommendations from authorities in my country ¥
	7,241	6.50	6.37	6.56	<0.001***	5,651	6.48	6.36	6.54	<0.001***	1,590	6.57	6.45	6.61	0.002**
Preventive measures
Correctly identifying protective measures ¥
	7,241	6.89	6.85	6.90	<0.001***	5,651	6.89	6.85	6.91	<0.001***	1,590	6.88	6.85	6.89	0.103
Misinformation about preventive measures ¥
	7,241	2.88	2.82	2.90	0.057	5,651	2.77	2.77	2.76	0.750	1,590	3.28	3.07	3.35	0.007**
Taking protective measures ¥
	7,241	6.81	6.76	6.84	<0.001***	5,651	6.80	6.75	6.83	<0.001***	1,147	6.86	6.80	6.88	0.006**
Information and trust
Frequency of informing oneself about the coronavirus
Never/rarely	1,648	22.76	29.48	19.50	<0.001***	1,411	24.97	30.57	21.98	<0.001***	237	14.91	24.12	11.83	<0.001***
Sometimes	1,258	17.37	21.57	15.34		1,052	18.62	22.38	16.61		206	12.96	17.59	11.41
Often/very often	4,335	59.87	48.94	65.16		3,188	56.41	47.05	61.41		1,147	72.14	58.29	76.76
Trust in media ¥
Very low/low confidence	1,671	29.10	20.16	23.08	<0.001***	1,360	24.07	29.6	21.11	<0.001***	311	19.56	26.63	17.2	<0.001***
Partial confidence	1,514	25.51	18.68	20.91		1,184	20.95	25.84	18.34		330	20.75	23.87	19.71
High/very high confidence	4,056	45.39	61.16	56.01		3,107	54.98	44.56	60.54		949	59.69	49.5	63.09
Trust in doctors ¥
Very low/low confidence	512	4.78	7.07	11.8	<0.001***	426	7.54	11.8	5.26	<0.001***	86	5.41	11.81	3.27	<0.001***
Partial confidence	785	8.76	10.84	15.14		614	10.87	15.36	8.47		171	10.75	14.07	9.65
High/very high confidence	5,944	86.47	82.09	73.05		4,611	81.6	72.84	86.27		1,333	83.84	74.12	87.08
Trust in hospitals ¥
Very low/low confidence	1,090	15.05	20.69	12.32	<0.001***	901	15.94	20.6	13.46	<0.001***	189	11.89	21.11	8.81	<0.001***
Partial confidence	1,196	16.52	20.98	14.35		958	16.95	21.72	14.41		238	14.97	17.34	14.18
High/very high confidence	4,955	68.43	58.33	73.32		3,792	67.1	57.68	72.13		1,163	73.14	61.56	77.01
Trust in Ministry of Health ¥
Very low/low confidence	1,024	14.14	19.46	11.56	<0.001***	866	15.32	19.68	13.00	<0.001***	158	9.94	18.34	7.13	<0.001***
Partial confidence	1,048	14.47	19.8	11.89		858	15.18	20.75	12.21		190	11.95	15.08	10.91
High/very high confidence	5,169	71.39	60.74	76.54		3,927	69.49	59.56	74.79		1,242	78.11	66.58	81.96
Policies
Think measures currently taken greatly exaggerated ¥
	7,241	2.61	2.92	2.46	<0.001***	5,651	2.54	2.89	2.36	<0.001***	1,590	2.87	3.11	2.78	<0.001***
Think the decisions are fair ¥
	7,241	5.17	4.88	5.30	<0.001***	5,651	5.12	4.88	5.25	<0.001***	1,590	5.32	4.89	5.46	<0.001***
Would convince others that the decisions are right ¥
	7,241	5.05	4.61	5.26	<0.001***	5,651	4.97	4.58	5.18	<0.001***	1,590	5.31	4.76	5.50	<0.001***
Discriminatory policies ¥
	7,241	4.47	4.29	4.56	<0.001***	5,651	4.63	4.43	4.74	<0.001***	1,590	3.91	3.60	4.01	<0.001***
Containment policies ¥
	7,241	4.42	4.15	4.55	<0.001***	5,651	4.43	4.18	4.56	<0.001***	1,590	4.39	4.00	4.52	<0.001***
Panic and Fear
Panic buying ¥
	7,241	3.00	2.94	3.03	0.087	5,651	2.97	2.97	2.97	0.948	1,590	3.11	2.76	3.22	<0.001***
Panic behaviours ¥
	7,241	6.06	5.96	6.11	<0.001***	5,651	6.07	5.98	6.11	0.001**	1,590	6.04	5.87	6.09	0.006**
Fears and worries ¥
	7,241	4.86	4.69	4.95	<0.001***	5,651	4.72	4.60	4.79	<0.001***	1,590	5.36	5.13	5.44	<0.001***
Influenza
Probability of getting infected with influenza
Extremely unlikely	1,741	24.04	25.21	23.48	<0.001***	1,267	22.42	23.86	21.66	<0.001***	474	29.81	31.91	29.11	0.038*
Partly likely	1,708	23.59	25.97	22.43		1,317	23.31	25.58	22.09		391	24.59	27.89	23.49
Extremely likely	3,792	52.37	48.82	54.09		3,067	54.27	50.56	56.26		725	45.60	40.20	47.40
Susceptibility to getting infected with influenza
Not/less susceptible	2,360	32.59	33.80	32.01	<0.001***	1,770	31.32	32.71	30.58	<0.001***	590	37.11	39.20	36.41	0.463
Partly susceptible	2,019	27.88	29.95	26.88		1,577	27.91	30.32	26.62		442	27.80	28.14	27.68
More/very susceptible	2,862	39.52	36.25	41.11		2,304	40.77	36.98	42.80		558	35.09	32.66	35.91
Severity of influenza, if infected
Not/less severe	4,078	56.32	57.53	55.73	0.003**	3,182	56.31	57.27	55.79	0.035*	896	56.35	58.79	55.54	0.051
Partly severely	1,512	20.88	22.00	20.34		1,179	20.86	21.82	20.35		333	20.94	22.86	20.30
More/very severe	1,651	22.80	20.47	23.93		1,290	22.83	20.91	23.85		361	22.70	18.34	24.16
Taken the Influenza vaccine in 2019
Yes	1,199	16.56	12.10	18.72	<0.001***	917	16.23	11.90	18.53	<0.001***	282	17.74	13.07	19.30	0.005**
No	6,042	83.44	87.90	81.28		4,734	83.77	88.10	81.47		1,308	82.26	86.93	80.70

Notes: Acceptance was measured using a Likert scale ranging from 1 to 7; 1–4 indicated disagreement or less likely to agree (Disagree), while 5–7 indicated agreement or more likely to take the vaccine (Agree). P-value for agreement (disagree vs agree); *P-value <0.05, **p-value<0.01, ***P-value<0.001; values in bold are statistically significant. P-values for categorical variables were obtained by Chi-squared test, and for continuous variables by the t-test; ¥, on a 1–7 point scale.

Figure 1 National epidemic trend of new COVID-19 cases and political situation in Kuwait, May–August 2020.

Notes: Complete lockdown, closure of the entire country's facilities and institutions, with exception to supermarkets, and full curfew with a maximum of 2 hours per day for exercise; Ministry of Health (MOH) stage 1 of the government's restoration to normality plan, with partial curfew from 6:00 p.m. to 6:00 a.m., and some reopening of industrial activities, public services, and home delivery for restaurants and retail shops; MOH Stage 2, with partial curfew from 8:00 p.m. to 6:00 a.m., and further openings including workplaces (less than 30%), finance and banking, commercial complexes, retail shops, restaurants (take away only), gardens and public parks; MOH Stage 3, with partial curfew from 9:00 p.m. to 05:00 a.m., and opening of workplaces (less than 50%), social welfare home visits, hotels, resorts, and hotel apartments, taxis, mosques to allow group Friday prayers; MOH Stage 4, with no curfew, and opening of workplace (more than 50%), restaurants and cafes (with social distancing), public transportations, personal care shops (salons, shaving, spa), and public and private sports courts.

Figure 2 The mean level of acceptance to taking the COVID-19 vaccine if it becomes available and recommended, by nationality (Kuwaiti, non-Kuwaiti), during the Ministry of Health’s “Return to Normality” stages, Kuwait, May–Aug 2020.

Notes: Acceptance measured using a Likert scale ranging from 1 to 7, with 1 indicating strongly disagree and 7 strongly agree; ***indicates a significant (p<0.001) trend observed in the mean acceptance level overtime time (stages).

Figure 3 The proportion of agreement and disagreement towards taking the COVID-19 vaccine across the Ministry’s “Return to normality” stages, by nationality (Kuwaiti, non-Kuwaiti), Kuwait, May–Aug 2020.

Notes: Acceptance was measured using a Likert scale ranging from 1 to 7; 1–4 indicated disagreement or less likely to agree (Disagree), while 5–7 indicated agreement or more likely to take the vaccine (Agree). Vaccine acceptance (disagree/agree) was statistically significantly associated across stages, in Kuwaitis and non-Kuwaitis (P_trend<0.001); P-values for statistical association between vaccine acceptance and nationality (Kuwaiti/non-Kuwaiti) obtained by Chi-squared test, *p-value <0.05, **p-value<0.01, ***P-value<0.001

Table 3 Multivariable analysis: Factors Related to Increased Agreement Towards Taking the COVID Vaccine, by Nationality (Kuwaiti/Non-Kuwaiti), Kuwait, May–September, 2020

Characteristic	Agree to Take the COVID Vaccine
	Kuwaiti (n=5651)			Non-Kuwaiti (n=1590)
	OR	(95% CI)	p-value	OR	(95% CI)	p-value
Stage
Complete lockdown	[reference]
Stage 1	0.80	(0.67-0.95)	0.010*
Stage 2	0.80	(0.67-0.96)	0.017*
Stage 3	0.50	(0.40-0.61)	0.000**
Stage 4	0.35	(0.28-0.43)	<0.001***
Age (years)
18–29	[reference]			[reference]
30–44	0.62	(0.52-0.74)	<0.001***	0.79	(0.59-1.06)	0.120
45–59	0.52	(0.42-0.64)	<0.001***	0.61	(0.44-0.87)	0.005**
60–74	0.37	(0.28-0.49)	<0.001***	0.50	(0.26-0.95)	0.034*
Gender
Male	[reference]			[reference]
Female	0.62	(0.53-0.72)	<0.001***	0.56	(0.43-0.73)	<0.001***
Marital
Single	[reference]
Married	0.77	(0.65-0.92)	0.004**
Divorced/widowed	0.77	(0.60-0.99)	0.043*
Real knowledge ¥
	1.12	(1.05-1.20)	0.001**
Follow recommendations from authorities in my country ¥
	1.08	(1.01-1.16)	0.029 *
Preparedness towards COVID-19
Not at all				[reference]
Somewhat				1.11	(0.50-2.47)	0.807
Very much so				1.78	(0.90-3.53)	0.099
Correctly identifying protective measures ¥
	1.26	(1.09-1.47)	0.002**
Frequency of informing oneself about the coronavirus
Never/rarely	[reference]			[reference]
Sometimes	0.99	(0.83-1.18)	0.925	1.11	(0.73-1.68)	0.637***
Often/very often	1.34	(1.16-1.55)	<0.001	1.83	(1.32-2.55)	<0.001
Trust in media ¥
Very low/low confidence				[reference]
Partial confidence	0.87	(0.73-1.04)	0.123
High/very high confidence	1.32	(1.12-1.56)	0.001**
Trust in doctors ¥
Very low/low confidence	[reference]			[reference]
Partial confidence	1.20	(0.91-1.59)	0.192	1.76	(0.93-3.34)	0.085*
High/very high confidence	1.79	(1.41-2.27)	0.000**	2.11	(1.17-3.80)	0.013
Trust in hospitals ¥
Very low/low confidence				[reference]
Partial confidence				1.58	(0.97-2.58)	0.066*
High/very high confidence				1.76	(1.13-2.72)	0.012
Think measures currently taken greatly exaggerated ¥
	0.95	(0.92-0.98)	0.001	0.91	(0.86-0.97)	0.003**
Think the decisions are fair ¥
				1.08	(1.01-1.16)	0.032*
Would convince others that the decisions are right ¥
	1.09	(1.06-1.13)	<0.001***
Discriminatory policies ¥
	1.09	(1.04-1.14)	<0.001***
Containment policies ¥
	1.11	(1.05-1.17)	<0.001***	1.27	(1.15-1.41)	<0.001***
Panic buying ¥
				1.09	(1.03-1.16)	0.003**
Panic Behaviours ¥
	0.94	(0.90-1.00)	0.004**			**
Fears and worries ¥
	1.05	(1.00-1.10)	0.039*	1.12	(1.01-1.24)	0.034*
Probability of getting infected with influenza
Extremely unlikely	[reference]			[reference]
Partly likely	1.09	(0.91-1.29)	0.343	1.03	(0.75-1.43)	0.839
Extremely likely	1.33	(1.15-1.55)	<0.001***	1.38	(1.03-1.84)	0.032*
Taken the Influenza vaccine in 2019
Yes	[reference]			[reference]
No	0.61	(0.51 0.72)	<0.001***	0.61	(0.43-0.87)	0.006**

Notes: *p-value<0.05, **p-value<0.01, ***p-value<0.001; values in bold are statistically significant.