P111 COVID-19 Vaccination Hesitancy among Syrian Refugees in a Suburb of Beirut, Lebanon: A Nested Cross-Sectional Study

Background Since early 2020, the global pandemic of COVID-19 has worsened inequalities amongst vulnerable populations. Refugees, in particular, are disproportionately vulnerable to exclusion, stigma and discrimination and may lack access to COVID-19 vaccination. This study examined the relationship between nationality (Syrians vs. Lebanese) and COVID-19 vaccination in a suburb of Beirut and the reasons for vaccination hesitancy. Methods This was a nested cross-sectional analysis from a longitudinal survey conducted from June to October 2022 in Sin-El-Fil, Beirut, Lebanon. The sampling frame included a listing of all households in Sin-El-Fil from which all Syrian refugees were contacted to participate, while a random sample of Lebanese adults with specific vulnerabilities to COVID-19 was selected. This included Lebanese adults aged 60 years or older, pregnant women, and/or individuals from low socio-economic areas. The survey was conducted over the phone and data on socio-demographics, COVID-19 vaccination and reasons for non-vaccination were collected. The outcome was the uptake of COVID-19 vaccination. The analysis accounted for the complex design and non-response. Logistic regression was used to assess the association between nationality and COVID-19 vaccination uptake, after accounting for confounders identified using a Directed Acyclic Graph. A sub-analysis among Syrians explored the effect of regularized residency (possession of legal documents) on vaccination by logistic regression. Analysis was performed using Stata 17.0. Results The sample included 2,283 participants, 81% were Lebanese (n=1,544), and 19% were Syrians (n=739). COVID-19 vaccination uptake in our study population was 78% (95%CI:76–79) and was higher among Lebanese (85% (95%CI:83–87)) compared to Syrians (47% (95%CI:43–50)) (P<0.001); adjusted odds ratio (OR) 6.8 (95% CI:5.5–8.4). Most common reasons reported for lack of vaccine uptake were: (1) not believing the vaccine is essential and (2) preferring to follow other precautions by both Lebanese (51% and 25%, respectively) and Syrians (43% and 26%, respectively). In addition, among Syrians, having regularized residency in Lebanon doubled the chances of being vaccinated (adjusted OR:1.9, 95%CI:1.3– 3.0). Conclusion As of late 2022, more than half the Syrian refugees living in a suburb of Beirut were still not vaccinated against COVID-19 despite the availability of vaccines free of charge to everyone in Lebanon. Although this is not representative of all Sin-El-Fil residents. This indicates a high level of vaccine hesitancy and barriers for vaccine uptake, of which some implications from regularized status, and calls for urgent action in this group at higher risk of consequences during health crisis.