An Online Survey on COVID-19 Vaccine Hesitancy among Facebook Users in Mogadishu, Federal Republic of Somalia

Abstract

Introduction: During the height of the COVID-19 pandemic, Somalia faced challenges with mass vaccination such as limited vaccine supplies and vaccine hesitancy. Identifying reasons for vaccine hesitancy will inform the development of evidence-based interventions to address the challenge. Objectives: The objective of this study was to assess the level of COVID-19 vaccine hesitancy among Facebook users in Mogadishu, Somalia; and to identify the reasons for vaccine hesitancy. Methods: A cross-sectional study design using an online survey was applied. Data was collected from internet-connected adult Mogadishu residents. Recruitment of participants was done online through social media. Data on the demographics of the participants, willingness to be vaccinated, and views on determinants of vaccine hesitancy was collected using a structured questionnaire. Nine preselected determinants were considered; they included low confidence in the vaccine, side effects, efficacy, mistrust of government, perception of vaccine information as inconsistent and contradictory, perception of health status as not susceptible to severe disease, a belief that the COVID-19 and its vaccine are created to benefit pharmaceutical businessmen, and a belief that COVID-19 vaccines are made with non-halal compounds. Data was analyzed to obtain proportions of participants with vaccine hesitancy and other characteristics. Bivariable logistic regression analysis and multivariable logistic regression analysis assess any association between vaccine uptake and hesitancy with the independent variables. Results A total of 1325 respondents met the inclusion criteria. They were mainly university students without income and residing in Hodan and Wadajir districts in Mogadishu. Nineteen percent had been vaccinated against COVID-19. The percentage of the participants with vaccine hesitancy was 65% overall and 71% among those aged 18-26 years. Factors that emerged as significantly

associated with vaccine hesitancy were age, occupation, and income. The odds of vaccine hesitancy of participants aged less than 26 years, working in healthcare, and earning less than the mean income ($278) were 4.4, 2.9, and 3.4 times the odds of vaccine hesitancy among participants aged more than 25 years, not working in healthcare, and earning more than $278, respectively. More than 70% indicated that their confidence in the COVID-19 vaccine was low because the vaccine has side effects and is not effective. Similarly, more than 70% indicated that they did not trust the government to administer a safe vaccine, their risk of getting COVID-19 would remain the same even after getting vaccinated, the information about COVID-19 vaccines is inconsistent and contradictory, and their health status can cope with SARS-CoV-2 infection without risk for severe disease. Conclusion Majority of internet-using Mogadishu residents are vaccine-hesitant. Multiple factors contribute to the COVID-19 vaccine hesitancy. All the nine determinants of vaccine hesitancy included in the model are important. Interventions to increase vaccine acceptance in Mogadishu should target the factors and determinants highlighted in this survey. Future surveys should use larger sample sizes for precision of predictions and apply systematic sampling to enhance representativeness and generalizability of findings.