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Abstract

Introduction: Vaccine hesitancy represents a critical public health challenge threatening immunization program success globally. In Saudi Arabia, despite achieving high official vaccination coverage rates, community-based studies reveal significant hesitancy ranging from 3.1% to 72.2% across populations and vaccine types.

Objective: To synthesize evidence on vaccine hesitancy prevalence, determinants, and effective intervention strategies in the Saudi Arabian context, with specific focus on COVID-19, childhood, HPV, and influenza vaccines.

Methodology: A comprehensive narrative review of peer-reviewed literature published between January 2015 and December 2024 was conducted using systematic search strategies across multiple databases. PubMed, Scopus, Web of Science, and Saudi Digital Library were searched using combinations of keywords related to vaccine hesitancy, Saudi Arabia, and specific vaccine types. Studies conducted in Saudi Arabian populations examining vaccine hesitancy rates, associated factors, and intervention effectiveness were included.

Results: COVID-19 vaccine acceptance ranged from 44.7% to 90.4% depending on population and timing. Childhood vaccine hesitancy among parents was 20-24%, with actual immunization completion rates (73%) substantially below official reports (86%). Safety concerns emerged as the primary barrier across all vaccine types, cited by 93.8% of hesitant parents. Belief that vaccines are ineffective was associated with substantially increased hesitancy (OR=28.0, 95% CI: 7.9-102.3) in one study, though effect estimates varied considerably across populations and study designs. Social media use as primary information source was associated with 40% hesitancy prevalence versus 3.8% among those consulting healthcare providers—a 10-fold difference. Brief educational video interventions significantly reduced high concern levels from 5.5% to 0.4% (p<0.001) and mistrust from 14.5% to 2.8% (p<0.001).

Conclusion: Vaccine hesitancy in Saudi Arabia is multifactorial, driven primarily by safety concerns and misinformation propagated through social media platforms. Healthcare providers emerge as most trusted messengers (61-76% of population), yet 17-68% of healthcare workers themselves demonstrate hesitancy, indicating urgent need for professional education. Digital health infrastructure serving 68.5% of the population and evidence-based educational interventions provide actionable pathways for addressing this challenge through targeted, culturally appropriate strategies tailored to high-risk groups including first-time parents, women, and social media users.

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