Hesitancy Toward the First COVID-19 Vaccine Booster Dose: A Cross-Sectional Study in Morocco

Background: The COVID-19 pandemic has posed significant global health challenges, requiring mass vaccination to reduce severe illness and mortality. Despite strong evidence supporting booster dose safety and efficacy, uptake remains low due to widespread hesitancy. This study aims to comprehensively...

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Main Authors: Fatima Zahra Chellat, Nassiba Bahra, Zakia Marsou, Marwa El Baldi, Soumaya Benmaamar, Nabil Tachfouti, Nada Otmani, Mohamed Berraho, Karima El Rhazi
Format: Article
Language:English
Published: SAGE Publishing 2025-07-01
Series:Journal of Primary Care & Community Health
Online Access:https://doi.org/10.1177/21501319251348145
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author Fatima Zahra Chellat
Nassiba Bahra
Zakia Marsou
Marwa El Baldi
Soumaya Benmaamar
Nabil Tachfouti
Nada Otmani
Mohamed Berraho
Karima El Rhazi
author_facet Fatima Zahra Chellat
Nassiba Bahra
Zakia Marsou
Marwa El Baldi
Soumaya Benmaamar
Nabil Tachfouti
Nada Otmani
Mohamed Berraho
Karima El Rhazi
author_sort Fatima Zahra Chellat
collection DOAJ
description Background: The COVID-19 pandemic has posed significant global health challenges, requiring mass vaccination to reduce severe illness and mortality. Despite strong evidence supporting booster dose safety and efficacy, uptake remains low due to widespread hesitancy. This study aims to comprehensively explore the factors contributing to first COVID-19 booster vaccine hesitancy among the general population in Morocco. Methods: A cross-sectional study was conducted among 574 participants from primary healthcare centers in Fez, Morocco, between April 2022 and April 2023. Data were collected using a structured questionnaire based on the WHO SAGE framework, assessing socio-demographic, contextual, individual, group, and vaccine-specific determinants. Statistical analyses included chi-squared tests and multivariate logistic regression ( P  < .05). Results: Hesitancy toward the first booster dose was reported by 66.2% of participants. Vaccine-specific concerns were the strongest predictor (Adjusted Odds Ratio [AOR] = 27.6; 95% Confidence Interval [CI] = [11.1-68.3]; P  < .001), followed by contextual factors (AOR = 7.8; 95% CI = [4.0-15.4]; P  < .001) and individual/group determinants (AOR = 3.0; 95% CI = [1.6-5.6]; P  = .001). Younger age (<46 years, AOR = 3.0) and lower income (AOR = 5.9) also increased hesitancy. Conclusion: Booster dose hesitancy in Morocco is driven by vaccine-specific concerns, contextual influences, and individual beliefs. Addressing these factors through targeted communication, trust-building strategies, and inclusive public health policies is essential to increase booster uptake and strengthen national pandemic response efforts.
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spelling doaj-art-ab1d0e38c1ef43d598aeca5dbc7e62462025-08-20T02:39:50ZengSAGE PublishingJournal of Primary Care & Community Health2150-13272025-07-011610.1177/21501319251348145Hesitancy Toward the First COVID-19 Vaccine Booster Dose: A Cross-Sectional Study in MoroccoFatima Zahra Chellat0Nassiba Bahra1Zakia Marsou2Marwa El Baldi3Soumaya Benmaamar4Nabil Tachfouti5Nada Otmani6Mohamed Berraho7Karima El Rhazi8Sidi Mohamed Ben Abdallah University, Fez, MoroccoSidi Mohamed Ben Abdallah University, Fez, MoroccoSidi Mohamed Ben Abdallah University, Fez, MoroccoSidi Mohamed Ben Abdallah University, Fez, MoroccoSidi Mohamed Ben Abdallah University, Fez, MoroccoSidi Mohamed Ben Abdallah University, Fez, MoroccoSidi Mohamed Ben Abdallah University, Fez, MoroccoSidi Mohamed Ben Abdallah University, Fez, MoroccoSidi Mohamed Ben Abdallah University, Fez, MoroccoBackground: The COVID-19 pandemic has posed significant global health challenges, requiring mass vaccination to reduce severe illness and mortality. Despite strong evidence supporting booster dose safety and efficacy, uptake remains low due to widespread hesitancy. This study aims to comprehensively explore the factors contributing to first COVID-19 booster vaccine hesitancy among the general population in Morocco. Methods: A cross-sectional study was conducted among 574 participants from primary healthcare centers in Fez, Morocco, between April 2022 and April 2023. Data were collected using a structured questionnaire based on the WHO SAGE framework, assessing socio-demographic, contextual, individual, group, and vaccine-specific determinants. Statistical analyses included chi-squared tests and multivariate logistic regression ( P  < .05). Results: Hesitancy toward the first booster dose was reported by 66.2% of participants. Vaccine-specific concerns were the strongest predictor (Adjusted Odds Ratio [AOR] = 27.6; 95% Confidence Interval [CI] = [11.1-68.3]; P  < .001), followed by contextual factors (AOR = 7.8; 95% CI = [4.0-15.4]; P  < .001) and individual/group determinants (AOR = 3.0; 95% CI = [1.6-5.6]; P  = .001). Younger age (<46 years, AOR = 3.0) and lower income (AOR = 5.9) also increased hesitancy. Conclusion: Booster dose hesitancy in Morocco is driven by vaccine-specific concerns, contextual influences, and individual beliefs. Addressing these factors through targeted communication, trust-building strategies, and inclusive public health policies is essential to increase booster uptake and strengthen national pandemic response efforts.https://doi.org/10.1177/21501319251348145
spellingShingle Fatima Zahra Chellat
Nassiba Bahra
Zakia Marsou
Marwa El Baldi
Soumaya Benmaamar
Nabil Tachfouti
Nada Otmani
Mohamed Berraho
Karima El Rhazi
Hesitancy Toward the First COVID-19 Vaccine Booster Dose: A Cross-Sectional Study in Morocco
Journal of Primary Care & Community Health
title Hesitancy Toward the First COVID-19 Vaccine Booster Dose: A Cross-Sectional Study in Morocco
title_full Hesitancy Toward the First COVID-19 Vaccine Booster Dose: A Cross-Sectional Study in Morocco
title_fullStr Hesitancy Toward the First COVID-19 Vaccine Booster Dose: A Cross-Sectional Study in Morocco
title_full_unstemmed Hesitancy Toward the First COVID-19 Vaccine Booster Dose: A Cross-Sectional Study in Morocco
title_short Hesitancy Toward the First COVID-19 Vaccine Booster Dose: A Cross-Sectional Study in Morocco
title_sort hesitancy toward the first covid 19 vaccine booster dose a cross sectional study in morocco
url https://doi.org/10.1177/21501319251348145
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