Majer Jennifer, Elhissi Jehad H, Mousa Nabil, Kostandova Natalya
International Programs Department, International Medical Corps, Los Angeles, CA, USA.
Department of Medicine, Al-Azhar University, Gaza City, Palestine.
Confl Health. 2022 Sep 9;16(1):48. doi: 10.1186/s13031-022-00477-7.
The Gaza Strip, like other settings of complex humanitarian emergencies, faces immense challenges in vaccinating its population against COVID-19. This study was conducted in October 2021 among Gaza's adult population and healthcare workers (HCWs). The primary aim was to estimate two indicators, coverage of COVID-19 vaccination and the prevalence of vaccine hesitancy. The secondary aim was to evaluate the two indicators' associations with globally identified risk factors.
A cross-sectional study was conducted using a population-based survey of adults and a purposive survey of HCWs in Gaza. A multi-stage sampling design was used for the population survey component. For the HCW component, five health facilities were purposively selected as entry points; HCWs in the facilities holding clinical or other specialized positions were approached to participate in the survey. Data were summarized as univariable descriptive statistics with unweighted and weighted point estimates. Logistic regression was used to evaluate associations of risk factors with vaccination status and vaccine hesitancy.
A total of 1075 individuals were surveyed, of whom 906 were community members and 169 were HCWs. Population-weighted vaccine coverage was estimated to be 49.08% (95% CI 43.10-55.08). 89.35% of HCWs were vaccinated. Population-weighted vaccine hesitancy was estimated to be 34.08% (95% CI 28.14-40.56) in the overall population and 67.24% (95% CI 49.04-81.41) among the unvaccinated sub-group. In logistic regression vaccination was independently associated with male sex (aOR 1.88, p = 0.006, 95% CI 1.20-2.95), older age (40+ vs. 18-39 age group) (aOR 1.92, p < 0.001, 95% CI 1.73-2.13), higher education (aOR 2.19, p < 0.001, 95% CI 1.51-3.17), and confidence in the safety of the vaccine (aOR 13.8, p < 0.001, 95% CI 10.1-18.8). Risk factors for hesitancy were similar to those identified for vaccination status, however hesitant individuals were somewhat more likely to obtain vaccine information from family members (aOR 1.29, p = 0.051, 95% CI 1.00-1.67) and less likely to trust healthcare providers (aOR 0.58, p < 0.001, 95% CI 0.49-0.68).
The continued emergence of SARS-CoV-2 variants reinforces the importance of achieving high levels of vaccination coverage globally-a difficult undertaking in Gaza. This study estimated half of Gaza's adult population received at least one dose of any COVID-19 vaccine by October 2021, and the majority of unvaccinated individuals were hesitant. Disparities in vaccination across the territory's demographic groups underscore the need for targeted outreach to these populations and messaging through community-based channels to permeate social networks of the unvaccinated.
加沙地带与其他复杂人道主义紧急情况地区一样，在为其民众接种新冠疫苗方面面临巨大挑战。本研究于2021年10月在加沙的成年人口和医护人员中开展。主要目的是估算两个指标，即新冠疫苗接种覆盖率和疫苗犹豫率。次要目的是评估这两个指标与全球确定的风险因素之间的关联。
采用横断面研究，对加沙的成年人进行基于人群的调查，并对医护人员进行有目的的调查。人群调查部分采用多阶段抽样设计。对于医护人员部分，有目的地选择了五个卫生机构作为切入点；邀请在这些机构中担任临床或其他专业职位的医护人员参与调查。数据汇总为单变量描述性统计，包括未加权和加权点估计。采用逻辑回归评估风险因素与疫苗接种状况及疫苗犹豫之间的关联。
共调查了1075人，其中906人为社区成员，169人为医护人员。人群加权疫苗接种覆盖率估计为49.08%（95%置信区间43.10 - 55.08）。89.35%的医护人员接种了疫苗。总体人群中人群加权疫苗犹豫率估计为34.08%（95%置信区间28.14 - 40.56），未接种亚组中的疫苗犹豫率为67.24%（95%置信区间49.04 - 81.41）。在逻辑回归中，疫苗接种与男性（调整后比值比1.88，p = 0.006，95%置信区间1.20 - 2.95）、年龄较大（40岁及以上与18 - 39岁年龄组相比）（调整后比值比1.92，p < 0.001，95%置信区间1.73 - 2.13）、高等教育程度（调整后比值比2.19，p < 0.001，95%置信区间1.51 - 3.17）以及对疫苗安全性的信心（调整后比值比13.8，p < 0.001，95%置信区间10.1 - 18.8）独立相关。犹豫的风险因素与疫苗接种状况的类似，但犹豫的个体从家庭成员处获取疫苗信息的可能性略高（调整后比值比1.29，p = 0.051，95%置信区间1.00 - 1.67），而信任医护人员的可能性较低（调整后比值比0.58，p < 0.001，95%置信区间0.49 - 0.68）。
新冠病毒变异株的持续出现凸显了在全球实现高疫苗接种覆盖率的重要性——这在加沙是一项艰巨的任务。本研究估计，到2021年10月，加沙一半的成年人口至少接种了一剂新冠疫苗，且大多数未接种者存在犹豫。该地区不同人口群体在疫苗接种方面的差异凸显了有针对性地向这些人群开展宣传以及通过社区渠道传递信息以渗透到未接种者社交网络的必要性。
