COVID-19 vaccination intention and behavior in a large, diverse, U.S. refugee population

Jana Shaw; Kathryn B Anderson; Rachel E Fabi; Carlie A Thompson; Megan Harris; Nidaa Aljabbarin; Donna Bolourchi; Nicole Mozo; Daniel Lichtenstein; Christina D Lupone; David A Larsen; Andrea V Shaw

doi:10.1016/j.vaccine.2022.01.057

COVID-19 vaccination intention and behavior in a large, diverse, U.S. refugee population

Vaccine. 2022 Feb 23;40(9):1231-1237. doi: 10.1016/j.vaccine.2022.01.057. Epub 2022 Feb 1.

Authors

Affiliations

¹ Department of Pediatrics, SUNY Upstate Medical University Suite 5400, 750 East Adams Street, Syracuse, NY 13210, USA. Electronic address: shawja@upstate.edu.
² Department of Internal Medicine, SUNY Upstate Medical University Suite 5142, 750 East Adams Street, Syracuse, NY 13210, USA; Institute for Global Health and Translational Science, SUNY Upstate Medical University Suite 4200, 505 Irving Avenue, Syracuse, NY 13210, USA. Electronic address: AndeKath@upstate.edu.
³ Center for Bioethics and Humanities, SUNY Upstate Medical University, 618 Irving Avenue, Syracuse, NY 13210, USA. Electronic address: fabir@upstate.edu.
⁴ College of Medicine, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA. Electronic address: ThompCar@upstate.edu.
⁵ College of Medicine, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA. Electronic address: harrimeg@upstate.edu.
⁶ Institute for Global Health and Translational Science, SUNY Upstate Medical University Suite 4200, 505 Irving Avenue, Syracuse, NY 13210, USA. Electronic address: naljab78@gmail.com.
⁷ Institute for Global Health and Translational Science, SUNY Upstate Medical University Suite 4200, 505 Irving Avenue, Syracuse, NY 13210, USA.
⁸ Department of Pediatrics, SUNY Upstate Medical University Suite 5400, 750 East Adams Street, Syracuse, NY 13210, USA. Electronic address: MozoN@upstate.edu.
⁹ College of Medicine, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA. Electronic address: LichtenD@upstate.edu.
¹⁰ Institute for Global Health and Translational Science, SUNY Upstate Medical University Suite 4200, 505 Irving Avenue, Syracuse, NY 13210, USA. Electronic address: LuponeC@upstate.edu.
¹¹ Department of Public Health, 430C White Hall, Syracuse University, Syracuse, NY 13244, USA. Electronic address: dalarsen@syr.edu.
¹² Department of Pediatrics, SUNY Upstate Medical University Suite 5400, 750 East Adams Street, Syracuse, NY 13210, USA; Department of Internal Medicine, SUNY Upstate Medical University Suite 5142, 750 East Adams Street, Syracuse, NY 13210, USA; Institute for Global Health and Translational Science, SUNY Upstate Medical University Suite 4200, 505 Irving Avenue, Syracuse, NY 13210, USA. Electronic address: ShawAn@upstate.edu.

Abstract

Introduction: Refugees often face increased risk of exposure to COVID-19 due to their disproportionate representation in the essential workforce and crowded household conditions. There is a paucity of data about risk factors for under-immunization for COVID-19 among refugees.

Methods: Refugees were surveyed in two phases that corresponded to before and after wide availability of COVID-19 vaccines. Participants were asked about their attitudes, and perceptions about COVID-19, previous acceptance of vaccines, sources utilized to obtain trusted health information, and intent to get vaccinated. The overall participant vulnerability was assessed using the social vulnerability index. In-depth semi-structured interviews were completed with key stakeholders through snowball sampling.

Results: Of 247 refugees, 244 agreed to participate in the initial survey. Among those, 140 (57.4%) intended to get vaccinated, 43 (17.6%) were unsure, and 61 (25%) did not intend to get vaccinated. In the follow up survey, all 215 who were reached, agreed to provide information about their vaccination status. Among those respondents, 141 (65.6%) were either vaccinated or expressed intent to do so, and 74 (34.4%) remained hesitant. We did not observe any significant correlation between socio-demographic variables, country of origin, and vaccination status/intent. Among those who initially intended to get vaccinated, nearly 1 in 5 changed their mind and decided to forego vaccination, and among those who initially did not plan getting vaccinated, 1 in 3 changed their mind and got vaccinated. Fears related to the vaccine, concerns that the vaccine is religiously prohibited, "wait and see" how others did with the vaccine, communication and transportation barriers were commonly cited as reason not to get vaccinated.

Conclusions: Over a third of refugees in our study were hesitant to get vaccinated. Refugees desired additional education about the benefits and safety of vaccines along with easier access to vaccination clinics in their communities.

Keywords: COVID-19; Hesitancy; Refugee; Vaccine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19 Vaccines
COVID-19*
Humans
Intention
Refugees*
SARS-CoV-2
Vaccination

Substances

COVID-19 Vaccines