Cost and Safety Perceptions as Determinants of COVID-19 Vaccination Intention in Saudi Arabia

Background: Public acceptance of vaccines during emerging infectious disease outbreaks is influenced by perceptions of safety, accessibility, and cost. Understanding these determinants during the early phase of a pandemic is important for informing vaccination policy and communication strategies. This study examined the role of vaccine cost and safety perceptions in shaping COVID-19 vaccination intention among adults in Saudi Arabia prior to national vaccine rollout. Methods: A cross-sectional electronic survey was conducted among adults residing in Saudi Arabia between August and September 2020. Participants were recruited through online distribution using social media and electronic communication channels. The questionnaire assessed socio-demographic characteristics, knowledge and perceptions regarding COVID-19, and intention to receive COVID-19 vaccination under five hypothetical scenarios reflecting vaccine cost and the availability of scientific safety and efficacy evidence. Multivariable logistic regression analyses were performed to identify factors associated with vaccination intention. Results: A total of 1293 respondents completed the survey. When vaccination was offered free of charge, 57.5% of participants reported that they would likely receive the vaccine. Vaccination intention declined as the hypothetical vaccine price increased, reaching 38.7% when the cost exceeded 100 SAR. Intention was lowest when vaccination was presented under conditions in which safety and efficacy evidence had not yet been confirmed. Age, gender, educational attainment, and prior seasonal influenza vaccination were associated with COVID-19 vaccination intention across several scenarios. Conclusions: Perceived vaccine affordability and confidence in scientific safety and efficacy evidence were important factors associated with COVID-19 vaccination intention during the early phase of the pandemic in Saudi Arabia. Providing vaccination without direct cost to recipients and communicating safety and efficacy evidence transparently may support public confidence and vaccine acceptance during future large-scale immunization campaigns. These findings should be interpreted as an early-pandemic baseline and should not be extrapolated to current post-rollout attitudes.