Underlying Factors Associated with COVID-19 Vaccine Hesitancy and Refusal among the Iranian Population: A Qualitative Content Analysis

COVID-19 vaccination is one of the most successful ways to control the ongoing pandemic and prevent severe diseases, hospitalization, and death. Current evidence suggests COVID-19 vaccine hesitancy (a delay in accepting or rejecting the vaccine despite the availability of vaccination services) is a barrier to successful vaccination programs worldwide. This study aimed to explore the underlying factors associated with COVID-19 vaccine hesitancy among the Iranian population. This qualitative content analysis study was conducted using in-depth semi-structured interviews. A total of 32 Iranian participants with diverse ethnicity, language, age, and gender were selected through purposive sampling. Interviews were analyzed using Graneheim and Lundman’s qualitative content analysis method. MAXQDA software was used for data analysis. Three themes and eight subthemes emerged from the qualitative interviews. Individual underlying factors included knowledge, beliefs, and the fear of COVID-19 infection. Social factors included social media, the health system, and governance. Institutional factors included vaccine opponents and health experts that fueled COVID-19 vaccine hesitancy and refusal among the participants. Poor knowledge, misbelief, and fear were the most commonly reported causes of vaccine hesitancy and refusal among Iranians. Therefore, targeted interventions are recommended to address misinformation among the Iranian population.