Investigating the Determinants of COVID-19 Vaccine Uptake and Attitudes in Iraq: A Study Unveiling the Negative Impact of Misinformation and Vaccine Conspiracy

Vaccine hesitancy is a major barrier challenging the control of infectious diseases. Previous studies demonstrated high rates of COVID-19 vaccine hesitancy in the Middle East. The current study aimed to investigate the attitudes towards COVID-19 vaccination and COVID-19 vaccine uptake among the adult population in Iraq. This cross-sectional self-administered survey-based study was conducted in August-September 2022. Recruitment of possible participants was done using chain-referral sampling. The survey instrument assessed participants demographics, attitudes toward COVID-19 vaccination, beliefs in COVID-19 misinformation, vaccine conspiracy beliefs, and sources of information regarding the vaccine. The study sample comprised a total of 2544 individuals, with the majority reporting the uptake of at least one dose of COVID-19 vaccination (n=2226, 87.5%). Positive attitudes towards COVID-19 vaccination were expressed by the majority of participants (n=1966, 77.3%), while neutral attitudes were expressed by 345 participants (13.6%), and negative attitudes were expressed by 233 participants (9.2%). Strong, moderate, slight, and absence of COVID-19 misinformation were expressed by 12.4%, 22.6%, 36.2%, and 28.7% participants, respectively. The majority of participants showed a neutral attitude towards COVID-19 vaccine conspiracies (n=1464, 57.5%), while 607 participants embraced these conspiracies (23.9%), and 473 disagreed with such beliefs (18.6%). In the multivariate analysis, factors associated with positive attitudes towards COVID-19 vaccination included disbelief in COVID-19 misinformation and disagreement with vaccine conspiracies. Higher COVID-19 vaccine uptake was significantly associated with history of COVID-19 infection, higher income, residence outside the capital, disbelief in COVID-19 misinformation, disagreement with vaccine conspiracies, and reliance on reputable information sources. COVID-19 vaccine coverage prevailed among the participants, with a majority having positive attitudes towards COVID-19 vaccination. Disbelief in COVID- 19 misinformation and disagreement with vaccine conspiracies were correlated with positive vaccine attitudes and higher vaccine uptake. These insights can inform targeted interventions to enhance vaccination campaigns.