Barriers of vaccination for PWUD in this study can be classified into 5 main categories: Vaccine hesitancy, low health literacy and knowledge, low social capital, limited access to vaccine and finally, fear and worry caused by previous experiences.
Stereotyped beliefs
Table of Contents
Stereotyped beliefs were identified as one of the barriers to COVID-19 vaccination among the participants in this study.
These beliefs consist of stereotypes—oversimplified and often inaccurate ideas that lack scientific basis and increase people’s risk of infection. A stereotype is a simplified, uncritical, and sometimes incorrect judgment about a particular subject. Below, the subcategories of stereotypical beliefs are explained:
Believing that PWUD will not become infected with COVID-19
Most participants in this study believed that they were immune to COVID-19 infection because of the resistance created in their bodies built up by their use of drugs.
Participant 9 in this regard stated: “Addicts do not get infected with coronavirus…who said addicts get sick?”
Participant 7 also stated: “PWUD don’t get any disease because of the substances in their blood.”
Ineffectiveness of COVID-19 vaccine
Some participants believed that COVID-19 vaccine is not effective, and the use of face masks is more effective than vaccination in preventing COVID-19. Some people viewed the free COVID-19 vaccination with suspicion, arguing that it seemed strange to offer vaccines for free while there was a severe shortage of alcohol and face masks, and everything else had to be paid for.
Participant 21 in this regard stated: “They say that even if you get vaccinated, you still need to wear a mask, which means that a mask can prevent this infection, but a vaccine cannot.”
Participant 3 added: “In Iran, you have to pay for everything. In this tough economic condition, is it possible to vaccinate everyone only for altruism purposes?”
Negative effect of vaccine on underlying diseases
One of the stereotypes beliefs about the vaccination was related to its negative effect on underlying diseases, which believed by the participants to increase the mortality rate. Considering the fact that most PWUDs have various underlying diseases, participants in this study, were less willing to get vaccinated.
Participant 3 stated: “We (the addicts) have hundreds of diseases, some of which we don’t even know about. I think that if I get vaccinated, it will have a bad effect on my health and my condition gets worse. If I’m going to die, let me die a little later.”
Lack of trust in the healthcare system and the type of vaccine
A number of participants had a problem with the type of vaccine and stated that they would be willing to get vaccinated if they receive European or American vaccines.
Participant 2 stated: “They put us in the priority list for vaccination and think we are laboratory rats. They receive Pfizer vaccine, but when it is our turn, they suggest Sinopharm or Barekat vaccines for us.”
Low health literacy and knowledge
High health knowledge makes people to prioritize their health. It also helps them to distinguish between important facts and issues and false news and information. This category includes the following subcategories:
Neglecting health and underestimating the disease
Some drug users refused to receive vaccination because they did not prioritize health and underestimated the risks of diseases. These people may not pay enough attention to side effects and consequences of the disease because of their addiction and think that diseases are not a serious threat to them. This attitude can increase their risk of diseases and other health problems. Also, based on the results of this study, some of the drug users, contrary to the observations, believed that they have not been sick in the past few years despite their living conditions and substance use.
Participant 19 stated: “I’m healthy and I don’t get sick. Even if I get sick, COVID-19 is nothing compared to diseases I have had in the past. If we get sick, we’ll get rid of it quickly by taking some more substances.”
Participant 5 also stated: “As far as I can remember, influenza has always existed. It is a seasonal disease and will end when the weather gets hotter.”
Participant 17 added: “We (the addicts), who sleep, eat and use substances together, and do not follow the protocol, nor the physical distance. We never got infected. It’s all propaganda.”
Not prioritizing the health
A number of drug users, especially psychedelic drug users and homeless people, referred to their high substance consumption and behaviors such as gambling and theft as the reasons for not getting vaccinated.
Participant 7 in this regard stated: “We are all either looking for money or taking substance. Who has a time to go for vaccination?”
Participant 6 also stated: “Do you think I should give up gambling and business, and not take substances for two hours just to go for vaccination?”
Low health literacy
Although there were people with high education among the drug users, lack of health literacy seemed to be one of the barriers of vaccination among them.
Participant 12 in this regard stated: “People say that the vaccine causes infertility. I don’t want that to happen to me. Maybe one day I withdraw substance use, and want to have a child.”
Participant 16 added: “We need to know who has made these vaccines, how they have been made, and whether the manufacturer is valid or not.”
Believing in self-treatment and traditional medicine
Some drug users believed in self-medication through traditional and herbal medicines.
Participant 18 stated: “Whenever I feel sick, I drink tea with candy.”
Participant 9 also stated: “We put harmful substances and chemicals into our bodies every day. So why would we want to get vaccinated? It feels like solving one problem but creating a hundred more.”
Available rumors
The increase of rumors without scientific basis among drug users, especially those with a lower level of literacy, was found to be another barrier of vaccination. Rumors can spread quickly among people’s network, and when their frequency increases, people began to believe them.
Participant 18 in this regard said: “It’s true, we don’t want to be alive, but why should we die because of a vaccine? You know why—because they say everyone who gets the vaccine will die within two years, and if they don’t, they’ll end up with a whole bunch of diseases.”
Participant 16 also said, “Don’t they say that if more people get vaccinated, herd immunity will be achieved? So, go get vaccinated so we can all benefit from it. God bless you.”
Social capital gives meaning to life and makes life simpler and more enjoyable. Considering the issue of CIVID-19, the role of social capital was important for the participants. This category has several subcategories as follow:
The peer social network of PWUD and their negative impact on each other was one of the reasons for encouraging and persuading drug users not to get vaccinated. The noteworthy point in this regard was the lack of correct information provision to homeless people by radio and local trustees. So, in the absence of such information provision, drug users were trusting their peers more than the media.
Participant 20 in this regard said: “Anyone who watches the video clip will immediately know how much of a lie it is.”
Participant 21 added: “Those who received the vaccine, their body become magnet and got covered by blistered”.
Most of the participants did not feel an obligation towards the society, and did not feel the need to comply with the preventive measures and collective safety. Responsibility is one of the main components of social capital.
Participant 10 stated: “I have no moral sense and I don’t think it is necessary for me and people like me to get vaccinated.”
Structural and experiential barriers
One of the issues raised in the interviews was discrimination in the distribution of medical services, in a way that it denies drug users a fair access to healthcare services without social stigmatization.
Lack of access to vaccine
According to the participants in this study, the distance and long queues for vaccination were the most important obstacles to COVID-19 vaccination for them. It seemed that access to vaccine in a place close to their hangout was one of the main drivers of COVID-19 vaccination for them.
Participant 15 in this regard stated: “In the beginning, when the number of centers was few and far away from us, we did not feel like going to get vaccinated.”
Participant 14 added: “The queues were so crowded and long, we couldn’t deal with it. We also didn’t have the patience to wait for our turn.”
Unpleasant past experiences in relation with the vaccination
Some drug users were not well-groomed in terms of cleanliness and appearance due to their condition, illness and lifestyle, and also, they had experienced stigma and discrimination in utilizing health services. They had encountered the unpleasant experience of not receiving health services. That was why they did not have any trust in the health system.
Participant 1 in this regard stated: “When we go to healthcare centers, they cover their noses, they stay away from us and think they will become substance addicts or get AIDS. How do they want us to go there and get vaccinated? It’s better for us to stay away from them, so that they don’t humiliate us.”
Fear and worry caused by previous experiences
The previous observations and experiences of drug users were the cause of their fear, anxiety and worry about vaccination, and prevented them from receiving the vaccination.
Death or illness of close friends/relatives who had been vaccinated
If previous experiences in relation to a particular subject are stressful and unpleasant, the desire to repeat it, is minimized. The experience of infection or death of close friends/relatives after getting vaccinated was one of the barriers of vaccination for the participants.
Participant 2 in this regard stated: “We heard about and saw many people who got sick or died after getting vaccinated.”
Participant 4 also stated: “Many of my acquaintances received the vaccine for several times, but still got infected with COVID-19.”
Fear of the vaccine
A number of participants believed that injecting the vaccine itself could be harmful and believed that the vaccine might have some side effects.
Participant 2 stated: “Many people in our family have been vaccinated, and yet two of them began to show symptoms of COVID-19, and two more got infected with COVID-19. Do you think it is wise to get vaccinated? I don’t think so.”
Participant 3 added: “I think these vaccines are doing more harm than good.”