Income inequality and willingness to accept COVID-19 vaccination in Islamic Republic of Iran

Background: Socioeconomic inequalities can affect vaccine acceptability and the effectiveness of vaccination programmes. Aim: To investigate income inequality in willingness to vaccinate and identify its determinants in the Islamic Republic of Iran. Method: This cross-sectional study was conducted in Hamadan City, Islamic Republic of Iran, in February and March 2021. It collected data from 864 respondents using a structured questionnaire and analysed them using Stata version 14. Logistic regression was used to assess the effects of covariates on willingness to vaccinate within income groups and a multivariate decomposition technique was applied to evaluate the factors influencing willingness to vaccinate across groups. Results: We found that 39.2% of the participants were willing to accept the COVID-19 vaccination. Fewer participants in the low-income group than those in high-income group (33.5% vs 49.1%; P < 0.001) were willing to accept the vaccination. Female sex, having elderly family members and witnessing COVID-19-related deaths among relatives were primary contributors to the willingness to accept vaccination. In contrast, being employed, previous COVID-19 infection and holding a bachelor's degree had the main contradictory effects on the inequality of willingness to vaccinate. Conclusion: The differences in income level among the participants affected their willingness to vaccinate. There is therefore a need for targeted interventions to increase COVID-19 vaccine acceptance and vaccination effectiveness among the different income groups within the study population.