Development of Prediction Models of COVID-19 Vaccine Uptake among Lebanese and Syrians in a district of Beirut, Lebanon: a population-based study

Importance: Vaccines are essential to prevent infection and reduce morbidity of infectious diseases, and vulnerable populations may lack access to vaccination campaigns. Previous evidence has shown that migrants and refugees are particularly vulnerable to exclusion, stigma and discrimination, and low COVID-19 vaccine intention and uptake were observed among refugees globally. Objective: To develop and internally validate prediction models of COVID-19 vaccine uptake by nationality. Design: This is a nested prognostic population-based cross-sectional analysis. Setting: Data was collected between June and October 2022 in Sin-El-Fil, a district of Beirut, Lebanon. Participants: All Syrian adults and a random sample of other adults from low-socioeconomic status neighborhoods were invited to participate in the study (n=3,138). A telephone survey with consenting participants (n=2,045) was conducted. Exposures: Candidate predictors of COVID-19 vaccine uptake identified from the literature were collected. Main Outcome and Measures: The main outcome was uptake of COVID-19 vaccine. Predictors of COVID-19 vaccine uptake were assessed using LASSO regression for Lebanese and Syrian nationalities, respectively. The models discrimination capabilities are presented using the AUC, and their calibration are presented using the calibration slopes. Results: Of 2,045 participants, 79% were Lebanese, 18% Syrians and 3% of other nationalities. COVID-19 vaccination uptake was higher among Lebanese (85% (95%CI:82-86) compared to Syrians (47% (95% CI:43-51)) (P<0.001); adjusted odds ratio (aOR) 6.8 (95%CI:5.5-8.4). Predictors of uptake of one or more vaccine dose for Lebanese were older age, presence of an older adult in the household, higher education, greater asset-based wealth index, private healthcare coverage, feeling susceptible to COVID-19, belief in the safety and efficacy of vaccines and previous receipt of flu vaccine. For Syrians they were older age, male, completing school or higher education, receipt of cash assistance, presence of comorbidities, belief in the safety and efficacy of vaccines, previous receipt of flu vaccine, and legal residency status in Lebanon. Conclusions and Relevance: These findings indicate barriers for vaccine uptake in Syrian migrants and refugees, including legal residency status. They call for urgent action to enable equitable access to vaccines by raising awareness about the importance of vaccination and the targeting of migrant and refugee populations through vaccination campaigns. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was funded by the International Development Research Centre (IDRC), Canada ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol was reviewed and approved by the American University of Beirut Social and Behavioral Sciences Institutional Review Board (reference: SBS-2021-0268). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The anonymized data can be obtained upon reasonable request from the Center for Research on Population and Health at the American University of Beirut (crph@aub.edu.lb).