Understanding COVID19 vaccine hesitancy in older Muslim populations in Northeast India

Vaccine hesitancy continues to pose a significant challenge among older adults, particularly in marginalized religious groups. This study investigates psychological, religious, and structural determinants of COVID-19 vaccine uptake among older Muslim adults in North-East India. A cross-sectional survey was conducted among 384 Muslim adults aged 60 years and above across Assam, Tripura, and Manipur. Fifteen vaccine-related barriers were assessed using Likert scales. Principal Component Analysis (PCA) extracted three latent constructs—Psychological Fear, Religious Concerns, and Structural Barriers—which, along with socio-demographic factors, were entered into a multivariate logistic regression model predicting vaccine uptake. Adults aged 70 years and above had higher odds of remaining unvaccinated (AOR = 1.78, p = 0.015). Those with no formal schooling (AOR = 2.05, p = 0.001) or earning below ₹5,000 monthly (AOR = 2.22, p = 0.002) were significantly more hesitant. Participants without pensions (AOR = 1.67, p = 0.041) and those living beyond 5 km from health centres (AOR = 2.08, p = 0.003) showed lower uptake. Religious perceptions were key: perceiving vaccines as incompatible with Islam (AOR = 3.12, p < 0.001) or strong influence from religious leaders (AOR = 2.35, p = 0.001) reduced uptake. Infrequent family contact (AOR = 2.21, p = 0.005) further hindered vaccination. Among the latent constructs, Religious Concerns and Structural Barriers remained significant. Vaccine hesitancy among older Muslim adults in North-East India is shaped by religious beliefs, economic hardship, and access barriers. Tailored, faith-sensitive public health interventions are critical to achieving equitable vaccine coverage among older Muslim adults.