Changing vulnerabilities and COVID-19 adherence: Older refugees in Lebanon

What did the study set out to achieve?

Lebanon has one the largest concentrations of refugees in the world living in extreme humanitarian conditions. The country is also at the intersection of political, economic, and social crises, compounded by the pandemic. This study investigated the experiences of a doubly vulnerable population – Syrian refugees and older adults – who are at increased risk of developing severe illness if infected by COVID-19, with a focus on vaccination. The study was conducted in a changing social and healthcare situation of a pandemic with a complex humanitarian context.

What were the findings?

This study found that 85% and above of older refugee respondents adhered to COVID-19 preventive measures. Refusal and hesitancy were leading causes for not registering for vaccination; though a decrease is noted in wave 5 as compared to other waves. With that, nearly half of the older refugees in the study received the vaccine. Among these, almost two-thirds took two doses.

85% of participants adhered to COVID-19 preventive measures, and more than 95% agreed that COVID-19 is a serious infection that is spreading around the world. Over two-thirds also agreed that they are intended to receive COVID-19 vaccine if it is safe and effective.

However, a high proportion of respondents did not register on the national platform for vaccination: although this dropped from 92% to 42% unregistered over time. Only 42% of respondents took their first vaccine dose, and two-thirds of this group had a second dose. The main reported reason for no vaccination, is not wanting the vaccine or being afraid of side effects.

When data was collected between January and March 2022, a significant proportion of respondents had not received their second or third shot as they are still waiting for the Ministry of Public Health (MoPH) to confirm the appointment they booked on the national ‘Impact’ platform.

Other factors affecting vaccine acceptance: older age, higher education, living outside informal tented settlements, female gender, not perceiving COVID-19 as a serious infection, using social media as a source of information on COVID-19, and perceiving vaccines as unsafe.

What does this mean for practitioners and policy makers?

Recommendations from the COVID-19 vaccination roll -out:

• Humanitarian actors can use these findings to address barriers and improve access to services for elderly refugees. Vaccination programs that are culturally sensitive, meeting the needs of older Syrian refugees are required, taking into consideration the following different factors: level of education, gender and residence type.
• Additionally, enhancing COVID-19 national surveillance systems, including vaccine registration and uptake, is key to develop targeted interventions and control the COVID-19 pandemic.
• Diffusion of timely, correct, culturally sensitive information related to Covid-19, vaccine safety and effectiveness through diverse channels is also needed for refugees.
• Community-based interventions, through engagement of local and religious leaders, play a major role in building trust, and spreading accurate messages about COVID-19 and vaccination.
• Further studies are needed to better understand the factors related to vaccine refusal. This will guide resource allocation and better readiness in case of future pandemics.

Outputs

Using the results from the first wave of data collection, the study found that misinformation about COVID-19 was prevalent in the community. The following videos were produced to tackle specific areas of misinformation and have been disseminated through the UNHCR communication trees and to all NRC beneficiaries in Lebanon.