Barriers and facilitators of COVID-19 vaccination among drug users: a qualitative analysis for future crisis management.

introductionPeople Who Use Drugs (PWUD), are a population at the high risk of exposure to infectious disease and should be considered as a priority for vaccination against communicable diseases. However, during the COVID-19 pandemic this population showed resistance to vaccination. The aim of this study was to better understand the barriers and facilitators of COVID-19 vaccination in PWUD in Tehran, Iran. MATERIALS AND

methodsIn this qualitative study data were collected through semi-structured interviews with participants through purposeful sampling with maximum variation. The collected data were analyzed using content analysis informed by Graneheim and Lundman using MAXQDA-10 Software. Lincoln and Guba's criteria were used to ensure the accuracy and validity of the data.

findingsOur study results were presented under two main themes: barriers and facilitators to COVID-19 vaccination acceptance among PWUD. Based on the results of this study, the most important barriers to COVID-19 vaccine acceptance were; Stereotyped beliefs (The belief that drug users will not get infected with COVID-19, Ineffectiveness of COVID-19 vaccine, The negative effect of vaccine on underlying disease, Lack of trust in healthcare system and the type of vaccine), Low health literacy and knowledge (Neglecting health and underestimating the disease, Not prioritizing the health, Low health literacy, Believing in self-treatment and traditional medicine, Available rumors), low social capital(including having limited social networks, believing misinformation and perceived powerlessness), Structural and Experiential Barriers (Lack of access to vaccine, Unpleasant past experiences in related with the vaccination), and fear and worry caused by previous experiences(Death or illness of friends/people around who had been vaccinated, Fear of the vaccine). In addition, the most important facilitators of COVID-19 vaccine acceptance can also be classified into 2 categories of The role of incentives and social responsibility(Incentive payments, Social responsibility, Immune system strengthening as a motivation for vaccination) and Rebuilding Trust and Improving Public Perceptions (Compensating for past mistakes, The effect of advertisement by physicians and officials).

conclusionGiven the possibility of future pandemics the role of vaccination in the prevention and control of communicable diseases, it is imperative to reduce the most negative consequences of pandemics for the general public and high-risk groups. Barriers to vaccination can be minimized through effective engagement with different social groups the goal of which is to effectively explain the benefits of vaccination. When planned and implemented well this will maintain health and prevent deaths in future pandemics. Health care policymakers can use the results of this study to reduce the barriers to vaccination and encourage high risk social groups to receive vaccination in future pandemics.