COVID‑19 Vaccination Acceptance in Iran, a Nationwide Survey on Factors Associated with the Willingness toward Getting Vaccinated

Mehrdad Askarian, Linda Y. Fu, Mohammad Hossein Taghrir, Roham Borazjani, Zahra Shayan, Ehsan Taherifard, Erfan Taherifard, Hossein Akbarialiabad, Yves Longtin, Ardalan Askarian, Shahin Kavousi


Background: In the name of extensive vaccine uptake, understanding the public’s attitude, perception, and intent toward COVID‑19 vaccination is a significant challenge for public health officials.

Methods: A cross‑sectional survey via an online questionnaire rooted in the Health Belief Model and Integrated Behavioral Model was conducted to evaluate COVID‑19 vaccination intent and its associated factors. Factor analysis and multivariate logistic regression were operated to be satisfactory.

Results: Among the 4,933 respondents, 24.7% were health care workers, and 64.2% intended to accept COVID‑19 vaccination. The adjusted odds (aOR) of COVID‑19 vaccination intent was higher for individuals with greater exposure to social norms supportive of COVID‑19 vaccination (aOR = 3.07, 95% Confidence Interval (CI) = 2.71, 3.47) and higher perceived benefits of COVID‑19 vaccination (aOR = 2.9, 95% CI = 2.49, 3.38). The adjusted odds of vaccination intent were lower for individuals with greater COVID‑19 vaccine safety concerns (aOR = 0.28, 95%CI = 0.25, 0.31). Lower vaccination intent was also associated with increasing age ((aOR = 0.99, 95% CI = 0.98, 0.999), female sex (aOR = 0.76, 95% CI = 0.65, 0.88), and working in the health care field (aOR = 0.75, 95% CI = 0.63, 0.9).

Conclusions: The odds of COVID‑19 vaccination intent were higher three or more times among those with a greater belief in vaccine effectiveness, lower concerns about vaccine safety, and greater exposure to cues to vaccinate, including from doctors. This last finding is concerning as vaccine acceptance was surprisingly lower among health care workers compared to others. The remarkable results of factor analysis and reliability of the questionnaire may encourage local health authorities to apply it to their regional population.


Attitudes and beliefs; COVID‑19 vaccine; knowledge; social norms; vaccination

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WHO. DRAFT landscape of COVID-19 candidate vaccines

[updated 2020 Jul 24]. Available from: https://www.who.


Freed GL, Clark SJ, Butchart AT, Singer DC, Davis MM.

Parental vaccine safety concerns in 2009. Pediatrics


Tozzi AE, Gesualdo F, Romano M, Caione DJ. Parental attitude

toward influenza A (H1N1) v vaccination in Italy. Vaccine


Chor JS, Ngai KL, Goggins WB, Wong MC, Wong SY, Lee N,

et al. Willingness of Hong Kong healthcare workers to accept

pre‑pandemic influenza vaccination at different WHO alert

levels: Two questionnaire surveys. BMJ 2009;339:b3391.

Piccirillo B, Gaeta TJ, Epidemiology H. Survey on use of

and attitudes toward influenza vaccination among emergency

department staff in a New York metropolitan hospital. Infect

Control Hosp Epidemiol 2006;27:618‑22.

Vasilevska M, Ku J, Fisman DN. Factors associated with

healthcare worker acceptance of vaccination: A systematic

review and meta‑analysis. Infect Control Hosp Epidemiol


Heininger U, Bächler M, Schaad UB. Attitudes of pediatricians

regarding influenza self‑immunization: A survey in a Swiss

university children’s hospital. Pediatr Infect Dis J 2003;22:391‑4.

del Carmen Aguilar‑Díaz F, Jiménez‑Corona ME,

Ponce‑de‑León‑Rosales S. Influenza vaccine and healthcare

workers. Arch Med Res 2011;42:652‑7.

Takahashi O, Noguchi Y, Rahman M, Shimbo T, Goto M,

Matsui K, et al. Influence of family on acceptance of influenza

vaccination among Japanese patients. Fam Pract 2003;20:162‑6.

Fiebach NH, Viscoli CM. Patient acceptance of influenza

vaccination. Am J Med 1991;91:393‑400.

Painter JE, Sales JM, Pazol K, Wingood GM, Windle M,

Orenstein WA, et al. Psychosocial correlates of intention to

receive an influenza vaccination among rural adolescents. Health

Educ Res 2010;25:853‑64.

Sanche S, Lin YT, Xu C, Romero-Severson E, Hengartner N,

Ke R. High contagiousness and rapid spread of severe acute

respiratory syndrome coronavirus 2. Emerging infectious

diseases, 2020;26:1470.

Aliyari R, Imani S, Rezaiy T, Shariati M, Hanifehzad Masooleh P,

Mirrezaie SM. Seasonal influenza vaccination uptake and its

socioeconomic determinants in patients and staff of hospitals in

Shahroud, Northeast of Iran. Shiraz E‑Med J2019;20:e82898.

Pfizer and BioNTech announce vaccine candidate against

COVID‑19 achieved success in first interim analysis from Phase

study [press release]. November 9, 2020 2020.

Moderna’s COVID‑19 vaccine candidate meets its primary

efficacy endpoint in the first interim analysis of the phase 3

COVE study [press release]. November 16, 2020 2020.

AZC1222 vaccine met primary efficacy endpoint in preventing

COVID‑19 [press release]. November 23, 2020 2020.

Darden PM, Jacobson RM. Impact of a physician

recommendation. Hum Vaccin Immunother 2014;10:2632‑5.

Gargano LM, Herbert NL, Painter JE, Sales JM, Morfaw C,

Rask K, et al. Impact of a physician recommendation and

parental immunization attitudes on receipt or intention to receive

adolescent vaccines. Hum Vaccin Immunother 2013;9:2627‑33.

Fu LY, Zimet GD, Latkin CA, Joseph JG. Associations of trust

and healthcare provider advice with HPV vaccine acceptance

among African American parents. Vaccine 2017;35:802‑7.

Fu LY, Haimowitz R, Thompson D. Community members trusted

by African American parents for vaccine advice. Hum Vaccin

Immunother 2019;15:1715‑22.

Brunson EK. How parents make decisions about their children’s

vaccinations. Vaccine 2013;31:5466‑70.

Kahan DM, Braman D, Cohen GL, Gastil J, Slovic P. Who

fears the HPV vaccine, who doesn’t, and why? An experimental

study of the mechanisms of cultural cognition. Law and Human

Behavior 2010;34:501‑16.

Hopfer S. Effects of a narrative HPV vaccination intervention

aimed at reaching college women: A randomized controlled trial.

Prev Sci 2012;13:173‑82.

Bode L, Vraga EK. In related news, that was wrong: The

correction of misinformation through related stories functionality

in social media. J Commun 2015;65:619‑38.

Bode L, Vraga EK. See something, say something: Correction of

global health misinformation on social media. Health Commun


Wong LP, Alias H, Wong P‑F, Lee HY, AbuBakar S. The use of

the health belief model to assess predictors of intent to receive

the COVID‑19 vaccine and willingness to pay. Hum Vaccin

Immunother 2020;16:2204‑14.

Detoc M, Bruel S, Frappe P, Botelho‑Nevers E,

Gagneux‑Brunon A. Intention to participate in a COVID‑19

vaccine clinical trial and to get vaccinated against COVID‑19

in France during the pandemic. medRxiv 2020. doi:


Olagoke A, Olagoke O, Hughes A. Intention to vaccinate against

the Novel 2019 Coronavirus disease: The role of health locus of

control and religiosity. Research Square 2020. doi: 10.21203/rs.


Malik AA, McFadden SM, Elharake J, Omer SB. Determinants

of COVID‑19 vaccine acceptance in the US. EClinicalMedicine


Fu C, Wei Z, Pei S, Li S, Sun X, Liu P. Acceptance and preference

for COVID‑19 vaccination in health‑care workers (HCWs).

medRxiv 2020. doi: 10.1101/2020.04.09.20060103.

Dubé E, Gagnon D, Nickels E, Jeram S, Schuster M. Mapping

vaccine hesitancy—Country‑specific characteristics of a global

phenomenon. Vaccine 2014;32:6649‑54.

Wagner AL, Masters NB, Domek GJ, Mathew JL, Sun X,

Asturias EJ, et al. Comparisons of vaccine hesitancy across five

low‑and middle‑income countries. Vaccines 2019;7:155.

Bocquier A, Fressard L, Cortaredona S, Zaytseva A, Ward J,

Gautier A, et al. Social differentiation of vaccine hesitancy

among French parents and the mediating role of trust and

commitment to health: A nationwide cross‑sectional study.

Vaccine 2018;36:7666‑73.

Yang YT, Delamater PL, Leslie TF, Mello MM.

Sociodemographic predictors of vaccination exemptions on

the basis of personal belief in California. Am J Public Health


Atwell JE, Van Otterloo J, Zipprich J, Winter K, Harriman K,

Salmon DA, et al. Nonmedical vaccine exemptions and pertussis

in California, 2010. Pediatrics 2013;132:624‑30.

Fonzo M, Bertoncello C, Cocchio S, Zanovello S, Bennici S,

Baldovin T, et al. Health professionals as parents are not immune

to vaccine hesitancy–An Italian national survey. Eur J Public

Health 2019;29(Suppl 4). doi: 10.1093/eurpub/ckz186.526.

Pew Research Center. Internet/Broadband Fact Sheet 2018.

Available from:‑sheet


Wilson G, Bryan J, Cranston K, Kitzes J, Nederbragt L, Teal TK.

Good enough practices in scientific computing. PLoS Comput


Ebert JF, Huibers L, Christensen B, Christensen MB. Or

web‑based questionnaire invitations as a method for data

collection: Cross‑sectional comparative study of differences in

response rate, completeness of data, and financial cost. J Med

Internet Res 2018;20:e24.

Al‑Sadi AM, Al‑Oweisi FA, Edwards SG, Al‑Nadabi H,

Al‑Fahdi AM. Genetic analysis reveals diversity and genetic

relationship among Trichoderma isolates from potting

media, cultivated soil and uncultivated soil. BMC Microbiol