Uptake of COVID-19 vaccine among female healthcare workers in Syria: results from a 2022 cross-sectional survey | Conflict and Health

Table 1 captures the basic descriptive statistics of the sub-sample used in the analysis. Most of the female healthcare workers (96.0%) are between the age of 18 and 55. Given the nature of our sample (which includes both, medically trained professionals and auxiliary staff), about a third of the sample has a university degree. Furthermore, 43.4 percent of the respondents in the sample have completed a secondary school. The majority of them (59.8%) trust all vaccines. In addition, the share of female healthcare workers who is vaccinated is extremely high at 93.7%, with another 1.3% willing to be vaccinated. Only 3.1% of them are not willing to be vaccinated. In addition, we provide a breakdown of the sample by governorates. As evidenced by the table, about a quarter of the respondents are from Homs. While there are respondents across all of the country’s governorates, the majority of respondents are concentrated in four main governorates: Homs, Hama, Lattakia and R Damascus. In the rest of this section, we further elaborate on the findings related to the four vaccination personas among female healthcare workers.

Vaccinated

This vaccination persona is characterised by a few main characteristics. First, this vaccination persona tends to be very well educated. Moreover, this vaccination persona is more informed about COVID-19. More specifically, 98.3% of female healthcare workers who reported receiving information all the time, are also vaccinated (Table 3). Third and most importantly, this vaccination persona tends to have positive attitudes and beliefs around the vaccines. Over 90% of those vaccinated are also convinced that the vaccines are safe and important to health (Table 3). In addition, this vaccination persona tends to trust their colleagues the most. More specifically, 98.6% of female healthcare workers with robust trust in healthcare workers are vaccinated. Finally, this vaccination persona tends to also trust all vaccines. 98.3% of vaccinated tend to trust all vaccines. 94.8% believe in the fairness of the distribution of vaccines and 97.3% believe in the importance of the vaccines for one’s health. Importantly, as Table 3 suggests, this vaccination persona tends to encourage others to take up the vaccine; and, more importantly, this vaccination persona is associated with people with similar beliefs. Furthermore, as Table 4 indicates, there is no statistically significant link between this persona and the most trusted source of information. A formal modelling exercise conducted on a set of socio-demographic and beliefs correlates of being vaccinated has yielded similar results (please see Table A1).

Not vaccinated but willing

As in the vaccination persona above, here as well, we find a robust link between trust in healthcare workers and willingness to vaccinate. More specifically, 89% of those willing to be vaccinated have listed healthcare workers as the most trusted source for COVID-19 related information (furthermore, as demonstrated by Table 3, 3.6% of respondents with high trust in healthcare workers are willing to be vaccinated, as opposed to none among those with little or no trust in healthcare workers). In this vaccination persona, however, the positive beliefs around COVID-19 vaccines tend to play a lesser role. Still, this persona believes in the protection that the vaccines provide to the family and the community.

This persona does not seem to be concerned about fairness in the distribution of vaccines. They may have some concerns about vaccine safety but tend to trust vaccines in general and tends to recognise vaccines as important. As in the case of vaccinated, this vaccination persona tends to spend time with people with similar belief system. Table 4 lists some of the factors associated with not trusting vaccines and it suggests that among this vaccination persona, confusing information is the predominant one (40.7%). Furthermore, Table 4 suggests self-reported factors that may increase the willingness of this persona to be vaccinated, including, receiving more information on the side effects (40.7% of respondents) as well as on the safety of the vaccines (27.8%).

Not vaccinated and undecided

Table 2 reveals that there is no clear link between education attainment and this vaccination persona. This vaccination persona tends to receive very little information about COVID-19 (4.8% of respondents who never receive news are undecided, compared to 0.3% who receive news about COVID-19 all the time). As evidenced by Table 3, this vaccination persona tends to be neutral about COVID-19 attitudes and beliefs. In other words, a higher share of female healthcare workers with neutral beliefs are undecided regarding obtaining a COVID-19 vaccine. For example, 6.9% of those with neutral beliefs around the safety of the vaccines are also undecided regarding the vaccine (similarly, 4.1% of those with neutral beliefs about how challenging is to get the vaccine are undecided). This group also tends to be neutral about whether vaccines offer protection to family and community.

Those who are undecided tend to only trust a few vaccines. While this persona trusts their colleagues, they tend to trust them less than the two personas above. As evidenced by Table 3, 10.6% of those with neutral predisposition towards their colleagues have stated that they are undecided. Furthermore, this vaccination persona hasn’t been encouraged to be vaccinated, and it does not encourage others to take the vaccine. Similar to those willing to be vaccinated, this vaccination persona lists receiving confusing information (48.8%) as the main reason for not trusting the vaccines, as further corroborated by Table 4. Finally, this vaccination persona could benefit from more information specific to their beliefs about vaccines (e.g. the side effects of the vaccine as well as the longevity of protection offered by the vaccine).

Not vaccinated and unwilling

This vaccination persona is radically different compared to the other three. First, they tend to be less reliant on COVID-19 information. 10% of respondents who never receive information about COVID-19 tend to be unwilling to be vaccinated. Furthermore, this vaccination tends to have lower trust in the vaccines and significantly more negative beliefs regarding the COVID-19 vaccines, especially side effects. 15.7% of respondents who do not believe in the safety of the vaccines are also more likely to be vaccinated. 15.8% of respondents who believe that vaccines have low importance for one’s health, are also more likely to be unwilling to vaccinate.

This group has lower levels of trust in healthcare workers than other personas, and higher concerns about safety of vaccines. 40% of respondents who do not trust healthcare workers are also unwilling to vaccinate; 26.4% of respondents who do not trust any vaccine are also unwilling to receive the COVID-19 vaccine. They are more likely to be motivated by the opportunity to travel and less likely to recognise other benefits of vaccination such as protecting family and friends.