Measurement of COVID-19 vaccination acceptance and associated factors among Afghan refugees in Iran: insights from a cross-sectional study

Afghan refugees in Iran, estimated at over 5 million, represent a large vulnerable population whose attitudes towards COVID-19 vaccination are crucial to understand. This cross-sectional study was conducted in Shiraz, Iran, in 2023. Adult Afghan refugees with children aged 5–17 were recruited using a snowball sampling method. A previously validated survey tool was adapted for the Afghan population in this study to assess underlying sociodemographic and psychosocial factors influencing the COVID-19 vaccine acceptance. Among 400 participants, 79% had received at least one dose, 57% were fully vaccinated, and 12% had received booster doses. Female gender (aOR: 2.070, 95% CI: 1.118–3.831), a history of COVID-19 in family or friends (aOR: 2.541, 95% CI: 1.393–4.636), adherence to routine childhood vaccinations for their children (aOR: 3.287, 95% CI: 1.738–6.215), trust in healthcare providers and media (aOR: 1.929, 95% CI: 1.287–2.889), and confidence in vaccine safety (aOR: 3.058, 95% CI: 2.155–4.329) were significantly associated with increased vaccine acceptance. Additionally, 59.8% of the participants vaccinated their children against COVID-19. A history of chronic diseases in participants (aOR: 2.470, 95% CI: 1.290–4.731), their own acceptance of the COVID-19 vaccine (aOR: 18.055, 95% CI: 8.206–39.724), a history of routine childhood vaccinations in children (aOR: 2.050, 95% CI: 1.103–3.810), and confidence in vaccine safety (aOR: 1.457, 95% CI: 1.04–2.032) were significantly associated with children vaccination. Trust in healthcare providers/media and confidence in vaccine safety, were associated with higher vaccine uptake among Afghan refugees. Targeted communication and trust-building strategies are vital to address vaccine hesitancy, especially among vulnerable populations.