COVID-19 has caused a pandemic that has compelled the global health and economy, a vaccine remains the best option for restoring normal life and global economies,6 vaccinations could be an effective strategy for slowing the spread of the current coronavirus disease 2019 (COVID-19) pandemic. Up to 13 may 2021 here are now several vaccines that are in use and at least 13 different vaccines (across 4 platforms) have been administered.7 one of these vaccines is AstraZeneca vaccine. Covishield (ChAdOx1_nCoV-19) is the vaccine used in Yemen through COVAX initiative since 35 April 2021. the COVISHIELD™ Vaccine has been shown to prevent COVID-19 disease following 2 doses given between 4 and 12 weeks apart. The duration of protection against COVID-19 disease is currently unknown.8
The Serum Institute of India Pvt Ltd is the manufacturer of COVISHIELD™ vaccine, they recommended that The COVISHIELD vaccination course consists of two separate doses of 0.5 ml each. and should be given as an intramuscular (IM) injection only, preferably in the deltoid muscle. The fact sheet about the vaccine issued by the serum institute of India explained the mild side effects but it reported that serious and unexpected side effects may occur.8
In Yemen where the epidemiology of COVID-19 is uncertain due to weak health system, war and lack of governance over all governmental activities make people untrusted on any governmental recommendations. Social media play a negative role on COVID19 vaccination uptake through their news about side effects of the vaccine which are very rare complications. This situation makes people and health workers more hesitated toward the vaccine and some of them decide not to take the vaccine. Vaccine acceptance among the general public and healthcare workers appears to have a decisive role in the successful control of the pandemic.9 Vaccine hesitancy could pose a serious problem for COVID-19 prevention, due to the spread of misinformation surrounding the ongoing pandemic.10 Sallam M (2021) in his systematic review about global acceptance of COVId19 reported that the highest vaccine acceptance rates (>90%) among the general public were found in four studies from Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%) and China (91.3%). On the contrary, the lowest vaccine acceptance rates (<60%) among the general public were found in seven studies to be from Kuwait (23.6%), Jordan (28.4%), Italy (53.7), Russia (54.9%), Poland (56.3%), US (56.9%), and France (58.9%).9 This could represent a major problem in the global efforts to control the current COVID-19 pandemic. More studies are recommended to address the scope of COVID-19 vaccine hesitancy.9
Previous studies have shown that vaccine hesitancy is a common phenomenon globally, with variability in the cited reasons behind refusal of vaccine acceptance. 11,12, 13 The most common reasons included: perceived risks vs. benefits, certain religious beliefs and lack of knowledge and awareness. 14,15,16
Several studies in developing countries reported low acceptance toward COVID-19 vaccine; in one study in Uganda revealed low levels of acceptance towards the COVID-19 vaccine among medical students as the majority of the participants (62.7%) were not willing to be vaccinated against COVID-19, low self-perceived risks of COVID-19, and many had relied on social media that provided them with negative information.17 In Jordan, 37.4% of the public were acceptable, 36.3% were not acceptable and 26.3% were neutral to receive COVID-19 vaccines.18
even in developed countries concern raising about vaccine hesitancy; in Italy Overall, 31.1% of the sample reported hesitancy. significant predictors of hesitancy were: ages between 35 and 54 years, female gender, low educational level, low income, and absence of comorbidities. The most common concerns about the COVID-19 vaccine involved safety (54%) and efficacy (27%).19
it is clear from the previous studies that COVID hesitancy is a global problem and not limited to least developed countries like Yemen; but in Yemen there is a high non-acceptance rates (75%) especially among health workers. Lack of information and or prevalence of misinformation from media is a crucial role in this hesitancy. Even gender analysis did not show difference. In this study the main reasons of non-acceptance the vaccine is: the vaccine was arrived to Yemen of bad quality (69%), while 48% of hesitated participants said theta the vaccine is unsafe, other reasons for unacceptance the vaccine is: regional believes (38%), other countries stop the vaccine (37%) while 16% of refused participants said that the reason is that the virus is subject to mutation so no need to vaccinate. All the above mentioned reasons are subject to misinformation fed to the mind of people and health workers. A lack of effective communication from ministry of health before start the vaccination campaign lead this this high hesitancy rates. Ministry of health in Yemen reported during the first week of COVID-19 vaccination campaign (25 -30 April 2021) very low coverage (19% among health workers and 4% among elder person over 60 years of age).20 In Late May 2021 Saudi Arabia decided that every traveler form Yemen to Saudi Arabia must be vaccinated against COVID-19 to permit them to travel to Saudi, many Yemeni people travel every day to Saudi, this decision make a lot of people run to vaccinate but this is not due their acceptance but due to travel regulations. Could the law and regulation give positive impact than health education?
Studying the main determinants of vaccine hesitancy can help with targeting vaccination strategies, in order to gain widespread acceptance—a key path to ensure a rapid way out of the current pandemic emergency. In the Covid-19 pandemic context, it is important to mitigate the impact of misinformation on the decision of not getting vaccinated.21 but still the governmental health regulation is very important to increase vaccine uptake.