HISTORICAL DEVELOPMENT OF VACCINES AND PUBLIC RESISTANCE: THE IMPACT OF COVID-19 PANDEMIC ON VACCINE HESITANCY AMONG ARABS IN ISRAEL
Abstract
Background: Vaccine hesitancy continues to be a pressing public health challenge worldwide. Changes in public trust in vaccines have intensified since the COVID-19 pandemic, most acutely in the case of ethnic minorities, which stresses the need for elucidating the socio-cultural, institutional and cognitive drivers of vaccine behavior. Methods: This study was developed using an explanatory sequential mixed-methods design to examine vaccine hesitancy among Arabs in Israel. In the quantitative component of this research (200 participants), the study examined the influence of the Health Belief Model (HBM) constructs, the Theory of Planned Behavior (TPB) components, trust in science, and religious fatalism and social support, using multiple linear regression analysis. In the qualitative component, semi-structured interviews with 20 purposively selected participants were performed and analyzed using thematic analysis. Both methods' results were integrated via the explanatory sequential approach.
Results: The regression model explained 65.3% of the variance in vaccine hesitancy (R² = 0.653). Attitude toward vaccination emerged as the strongest negative predictor (β = −0.376, p < 0.001), followed by trust in science (β = −0.278, p < 0.001), while perceived barriers (β = 0.300, p < 0.001) and religious fatalism (β = 0.162, p < 0.001) significantly increased vaccine hesitancy. Social support demonstrated a modest protective effect (β = −0.120, p = 0.014). Qualitative findings revealed that vaccine hesitancy reflected a process of critical evaluation rather than outright rejection, characterized by concerns regarding rapid vaccine development, institutional transparency, misinformation, and cultural influences. Participants expressed greater trust in healthcare professionals than in governmental institutions and emphasized the importance of culturally sensitive communication. Conclusions: Vaccine hesitancy among Arabs in Israel should not be understood as a simple distinction between acceptance and refusal. Rather, it reflects a dynamic decision-making process shaped by perceived barriers, attitudes toward vaccination, trust in science, religious interpretation, social support, and broader sociocultural and institutional contexts. Public health strategies should therefore move beyond standard educational messages and prioritize transparent risk communication, culturally tailored interventions, partnerships with trusted healthcare professionals and community leaders, and sustained efforts to strengthen institutional trust.
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DOI: http://dx.doi.org/10.46827/ejphs.v9i2.264
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