Influenza Vaccine Hesitancy and its Associated Factors among Healthcare Workers in Saudi Arabia: A Cross-Sectional Study, 2026

Background: Seasonal influenza causes substantial morbidity and mortality, and healthcare workers (HCWs) are at increased risk of infection and may facilitate healthcare-associated transmission. Although influenza vaccination is freely available and widely promoted in Saudi Arabia, uptake remains suboptimal. This study assessed influenza vaccine hesitancy and its associated factors among HCWs in Saudi Arabia. Methods: An analytical cross-sectional study was conducted using a self-administered online questionnaire distributed to HCWs across Saudi Arabia. The survey assessed sociodemographic and professional characteristics, vaccination history and intentions, workplace facilitators, perceived barriers, and hesitancy using an adapted 8-item WHO SAGE Vaccine Hesitancy Scale (Cronbach’s alpha=0.91). Hesitancy scores were summarized using the median and interquartile range (IQR). Group differences were examined using Mann–Whitney U and Kruskal–Wallis tests, and a multivariable generalized linear model was used to identify independently associated factors. Results: A total of 395 HCWs participated. Influenza vaccine uptake during the most recent season was 51.4%, and 54.9% intended to vaccinate in the upcoming season. Workplace accessibility and encouragement were reported by 90.1% and 89.9%, respectively. The most common barriers were fear of side effects (33.7%), perceiving influenza as a mild illness (32.2%), and lack of time (28.1%). The median hesitancy score was 32 (IQR 26–37). Profession was associated with hesitancy in the unadjusted analysis (p=0.042). In the multivariable model, recent vaccination was the only independently associated factor; vaccinated participants had scores 5.21 points higher than unvaccinated participants (95% CI 3.82–6.59, p<0.001). Conclusion: Vaccine hesitancy remains prevalent despite strong workplace support. Vaccination uptake and hesitancy may coexist, highlighting the need to strengthen confidence and address misconceptions.