A mixed-methods study to assess COVID-19 vaccination acceptability among university students in the United Arab Emirates.

To effectively achieve herd immunity against COVID-19, a substantial proportion of a population would need to be vaccinated. However, vaccine hesitancy and refusal are significant issues globally. This mixed-methods study aimed to investigate university students' attitudes in the United Arab Emirates (UAE) toward the COVID-19 vaccination, determine the factors associated with vaccine hesitancy, and understand the underlying reasons. We conducted an online survey between 16th-24th February 2021 in 669 students from the University of Sharjah (UAE) and semi-structured qualitative interviews with a subsample of 11 participants. Data on COVID-19 vaccine intention and uptake, risk perception, beliefs and attitudes toward the disease and the vaccine were collected. Multinomial logistic regression was applied and thematic content analysis was conducted with qualitative data. Overall, 31.8% of students demonstrated vaccine hesitancy; 24.4% of students reported a high intention to get the vaccine, and 43.8% were already vaccinated. Vaccine hesitancy was associated with less positive beliefs and attitudes toward the COVID-19 vaccine (AdjOR = 0.557;95%CI 0.468-0.662), high perceived adverse effects (AdjOR = 1.736;95%CI 1.501-2.007), and not perceiving easy access to a vaccination center (AdjOR = 0.820;95%CI 0.739-0.909). The main reasons underlying vaccine hesitancy were related to uncertainty about the effectiveness of the vaccine, knowledge about negative experiences from vaccination among family and/or community, overvaluing the risks of the vaccine in relation to the potential benefits, and not perceiving immunization as a social norm. To increase COVID-19 vaccination uptake, interventions to reduce hesitancy could focus on reducing fears about adverse effects and highlighting individual and societal benefits of the vaccination.