New Challenges of COVID-19 Vaccine Booster Dose Hesitancy in Iran

Dear Editor,

Vaccination is one of the most successful and cost-effective interventions, which has primarily contributed to eliminating or controlling several infectious diseases in the 20th century (1, 2). Previous experiences have confirmed that community acceptance and high vaccination coverage are essential elements in the success of immunization programs (1, 2).

Since the middle of March 2023, the eighth wave of COVID-19 has started in Iran. By the end of April 2023, more than 7.6 million were infected in Iran alone, and nearly 146 thousand people died due to COVID-19 (3). A total of 155,194,752 vaccine doses have been administered as of April 15, 2023 (3). Considering the maximum efficiency, full-dose vaccination coverage of approximately 75% of the population is needed to control the corona epidemic (2). Some studies have been conducted to estimate the acceptance rate of the COVID-19 vaccine and indicated that about 70% had accepted the vaccine at the country level (4). In addition, a global study reported that the opposition to receiving in Iran is roughly 28% (2). Several reasons for COVID-19 vaccine hesitancy have been reported in Iran (4). Moreover, studies on accepting COVID-19 vaccine booster doses in Iran are scarce. The acceptance of booster doses differed significantly between countries of the East Mediterranean Region (EMR), with Iran having the lowest acceptance rate at 17% (1). Iran’s COVID-19 vaccine hesitancy rate can be considered high (2).

COVID-19 vaccine booster acceptance in the Iranian population needs special attention. Lack of paying enough attention to this challenge can create high economic, political, and social threats for the country at the regional and global levels. The protection of some vaccines used in Iran has not been very high, and the infection rate after vaccination for COVID-19 has been relatively high (5). Therefore, more efficient and effective vaccines into the national vaccination program for COVID-19 can be considered by health policymakers (5). Media and social networks' context should be strengthened to increase trust and resolve some of the concerns. For example, a media program should be prepared where people who have already been infected with the novel coronavirus and those who have lost a loved one due to this disease can attend and share their experiences with others in a tangible way.

Although COVID-19 vaccines are available in Iran, hesitancy to accept booster doses persists. COVID-19 booster vaccine hesitance can negatively affect the efforts to control the pandemic. Increasing vaccine booster coverage across the country is essential. There are other vaccines with better efficacy than COVID-19, but the general public should have higher levels of trust. COVID-19 vaccination should be presented as a social duty. Doing social responsibility by promoting the belief of protecting others by vaccinating yourself can be a critical motivational strategy. Lack of attention to the discussed items can increase the duration of the pandemic and has a high cost for the health system and society. Iran's health policymakers should take measures to ensure that rejecting the COVID-19 vaccine booster dose is not considered civil disobedience in the current social situation. In other words, there is concern that hesitation to take the COVID-19 vaccine booster dose may be considered an act of civil disobedience.