How did Moroccan immigrants in the Netherlands decide with regard to their COVID-19 vaccine uptake? An exploratory qualitative study.

Background: In the Netherlands, a low COVID-19 vaccination uptake was reported among Moroccan immigrants. This population also faced a higher risk of contracting COVID-19, as well as severe morbidity and mortality, compared to native Dutch. We aimed to explore the COVID-19 vaccination decision-making process and the process from vaccination intention to uptake among Moroccan immigrants in the Netherlands.

Methods: Between April and June 2022, an exploratory qualitative study was performed among Moroccan immigrants in the Netherlands (n = 29). Participants were recruited through community centres, mosques, and social media. Interviews were transcribed verbatim and thematically analysed.

Results: Seven themes were generated: (1) Attitudes shifted over time and the vaccination decision was postponed, (2) A personal multi-faceted risk-benefit assessment, rather than feelings of social responsibility, resulted in a decision to vaccinate or not, (3) Feelings of decisional or anticipated regret that accompanied the personal risk-benefit assessment influenced the vaccination decision, (4) Used information sources, (5) A perceived lack of trustworthiness of the information disclosed by the government and media had a direct or indirect negative influence on the decision-making process, (6) The social environment and its norms as support or burden in the decision-making process, and (7) Religious beliefs and values holding back and encouraging in the decision-making process.

Conclusions: Many participants described the COVID-19 vaccination decision as a personal risk-benefit assessment, rather than a social responsibility. Many participants experienced lack of transparency of information from the government and the media, inhibiting them from making a good decision. We recommend providing clear and transparent information that explains possible contradictions and acknowledges uncertainties and potential adverse effects. Religious beliefs and values, and the strong influence of children and parents in making the vaccination decision should also be carefully considered in communication strategies.

Clinical Trial Number: Not applicable.