Psychological antecedents toward COVID-19 vaccination explain the high rates of vaccine rejection among the Libyan population 2 years after starting vaccination campaigns

Background Libya has one of the lowest rates of coverage of the coronavirus diseases 2019 (COVID-19) vaccination in the Eastern Mediterranean Region. This study aims to explore the attitudes of the Libyan population toward COVID-19 vaccines and identify the psychological factors that influence their decision-making process regarding vaccination. Methods An anonymous online survey was distributed among the Libyan population, utilizing the validated English and Arabic versions of the 5C scale. The survey was distributed through various social media platforms. The snowball and convenience sampling methods were used to collect data from participants, who were categorized as either vaccine acceptors or vaccine rejectors. Results Of the 1838 participants, 39.2% fell within the age range of 25 to 34 years and 68.2% were female. Only 26% of the respondents had either received the COVID-19 vaccination or had a plan to do so. Four-fifths (80.0%) of the participants expressed confidence in COVID-19 vaccines, 91.1% felt complacent about vaccination, 78.4% faced constraints, 93.9% made calculations to receive the COVID-19 vaccine, and 93.6% felt collective responsibility toward getting vaccinated. Significant statistical differences were identified in the various 5C domains between vaccine acceptors and rejectors. Specifically, there were notable disparities in confidence (95.65% vs. 68.64%, p < 0.001), constraints (51.39% vs. 80.29%, p < 0.001), calculation (92.86% vs. 72.83%, p < 0.001), and collective responsibility (95.73% vs. 72.57%, p < 0.001) between the two groups. Multivariate analysis showed that older age [35–49 years or 50–65 years], being male, having confidence, and having collective responsibility positively affected COVID-19 vaccination [odds ratio (OR) = 0.61, 95% confidence interval (CI), 0.41–0.89, OR = 0.31 (95% CI, 0.15–0.62), OR = 0.54 (95%CI, 0.42–0.70), OR = 0.14, (95%CI, 0.08–0.23), OR = 0.19 (95%CI, 0.06 – 0.48)], respectively], while working in crafts and related trade work and constraints negatively affected COVID-19 vaccination [OR = 1.86 (95%CI, 1.10–3.22), OR = 4.98 (95%CI, 3.77–6.60.27), respectively]. Conclusions Vaccine rejection can be influenced by various non-modifiable factors such as age and sex. However, psychological factors, including confidence, constraints, and collective responsibility, play a significant role and can be targeted and modified to reduce vaccine rejection among Libyans.