Adult Vaccination and Healthy Aging in the UAE: Uptake, Determinants, and Policy Perspectives

Highlights

Public health relevance—How does this work relate to a public health issue?

• Adult vaccination uptake is important as there is a growing burden of vaccine-preventable diseases among adults and older populations across the globe.
• Understanding determinants, barriers, and enablers of vaccination can support strategies to improve healthy aging and reduce healthcare burden.

Public health significance—Why is this work of significance to public health?

• This study provides evidence on factors influencing adult vaccine utilization in the UAE, contributing to limited regional data on adult immunization.
• The findings can guide targeted awareness campaigns, healthcare interventions, and national vaccination policies for adults.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?

• Strengthening public awareness, physician recommendation, and accessibility of vaccines may improve adult vaccination coverage in the UAE.
• Policymakers and researchers should prioritize adult immunization programs and further studies to support evidence-based healthy aging initiatives.

Abstract

Adult vaccination is a critical component of preventive healthcare, reducing morbidity and mortality from vaccine-preventable diseases. Despite established recommendations, adult immunisation coverage remains suboptimal, particularly for vaccines beyond influenza and COVID-19. In the United Arab Emirates (UAE), limited evidence exists regarding adult vaccine uptake and determinants influencing immunisation behaviour within its diverse population. Understanding vaccine-specific coverage and associated sociodemographic, healthcare, and workplace factors is essential to guide targeted strategies that strengthen adult immunisation. A cross-sectional study was conducted among 1330 adults aged ≥ 18 years residing in the UAE. Data were collected using a structured self- or interviewer-administered questionnaire assessing uptake of recommended adult vaccines, including COVID-19, influenza, pneumococcal, herpes zoster, Tdap, and HPV. Sociodemographic characteristics, healthcare access, insurance status, workplace factors, and perceived barriers were also assessed. Descriptive statistics summarised vaccination coverage, and associations between uptake and key determinants were examined using SPSS version 30. Statistical significance was defined as p < 0.05. Overall, 71.0% reported receiving at least one adult vaccine. Uptake was highest for COVID-19 (64.9%) and influenza (57.8%), while pneumococcal, herpes zoster, and Tdap coverage remained low (12–13%). HPV uptake was 22.6% among females and 18.9% among males. Higher uptake was observed among females and adults. Social encouragement, insurance coverage, and healthcare access were associated with vaccination, whereas lack of awareness and logistical barriers hindered uptake. Although overall uptake was moderate, significant gaps persist. Integrating vaccination into routine healthcare services and addressing structural and communication barriers are necessary to improve adult vaccination coverage.

1. Introduction

Vaccination is one of the most effective public health interventions for preventing infectious diseases, reducing morbidity and mortality, and strengthening global health security. While childhood immunization programs have achieved substantial success worldwide, adult vaccination remains underutilized despite the growing burden of vaccine-preventable diseases among adults and aging populations. The World Health Organization promotes life-course immunization to ensure protection across all age groups; however, adult vaccine uptake is limited by vaccine hesitancy, complex schedules, low awareness, and inadequate health system support [1]. These challenges are particularly evident in the Middle East, where disparities in access, healthcare infrastructure, and socio-cultural factors influence immunization behaviors, even in high-income countries such as the United Arab Emirates [2].

Despite adult immunization guidelines, coverage remains suboptimal globally. In the Eastern Mediterranean, uptake of seasonal influenza, pneumococcal, and herpes zoster vaccines is low. In Saudi Arabia, the UAE, and Turkey, influenza coverage among older adults and high-risk groups is below 50%, pneumococcal uptake is under 15%, and herpes zoster coverage is below 5% [3]. Similar trends exist worldwide, even in high-income countries, reflecting differences in policy, funding, and healthcare delivery [4]. In Europe, adult coverage remains below targets despite established programs, with heterogeneity across Germany, France, the UK, Italy, Spain, Sweden, and Romania [5]. These findings highlight adult vaccination as a persistent global public health challenge.

The Middle East and North Africa (MENA) region struggles with vaccination beyond childhood. Uptake of vaccines such as HPV, pneumococcal, and rotavirus is uneven. Financial constraints, international funding, conflict-related disruptions, and weak surveillance have delayed vaccine introduction in several middle-income countries [6]. Vaccine hesitancy, driven by safety concerns, misinformation, cultural or religious considerations, low awareness, and insufficient healthcare provider engagement, further limits uptake [7]. Adults in MENA continue to experience a substantial burden of vaccine-preventable diseases, particularly invasive bacterial infections, emphasizing the need for region-specific strategies [8].

Adult vaccine uptake is shaped by complex, context-specific factors. Barriers include concerns about side effects, time constraints, and fear of needles, while enablers include perceived protection, reminders, and social support [9]. In the UAE, trust in vaccines, healthcare systems, and national policies supports uptake, but hesitancy persists over potential long-term effects [10]. Globally, adult vaccination is challenged by limited funding, fragmented registries, and weak incentives, with inconsistent policies across Europe compounding these barriers [11].

Studies in the UAE reveal a gap between availability and acceptance. Despite influenza vaccine access, many remain unvaccinated due to misconceptions and low perceived risk. Lack of time is cited by 16% [12], while over half of hesitant individuals report side effect concerns [13]. Limited awareness of vaccines such as HPV highlights knowledge gaps [14]. With advanced healthcare and a diverse population, the UAE offers a strong setting to study adult vaccination, enablers, and barriers to guide targeted interventions and strengthen public health resilience. Hence, this study was conducted to assess adult vaccination coverage in the UAE and identify the sociodemographic, healthcare, economic, and workplace factors associated with vaccine uptake, in order to inform public health strategies to improve adult immunization across the adult population.

2. Materials and Methods

2.1. Study Design, Study Population, Sample Size, and Sampling

A cross-sectional study was conducted among 1330 adults, which focuses on determining adult vaccine uptake and its factors. Inclusion criteria were adults aged ≥18 years residing in the UAE who provided informed consent. Individuals younger than 18 years or unwilling to participate were excluded. Both male and female participants, of any nationality, residing in the UAE, took part in the research. The sample size for this cross-sectional study was calculated using the standard formula: N = 4PQ/L², where P represents the estimated prevalence of the condition, Q is calculated as (1 − P), and L denotes the desired level of precision. The prevalence of the vaccine uptake was estimated at 24% (P = 0.24), yielding a corresponding Q value of 0.76. With a precision level of 2.4% (L = 0.024), the sample size was calculated as follows: N = (4 × 0.24 × 0.76)/(0.024)² = 0.7296/0.000576 = 1267. A precision level of 2.4% was selected to increase estimate accuracy while remaining feasible given available resources. The calculated minimum required sample size was 1267 participants. To improve statistical precision and account for potential non-response or incomplete questionnaires, a total of 1330 participants were recruited and included in the final analysis. The achieved sample of 1330 exceeded the minimum required sample size, increasing statistical precision. The study employed convenience sampling, a non-probability sampling method, to recruit eligible participants (see File S1).

2.2. Questionnaire and Validation

This study employed a structured questionnaire comprising both open- and closed-ended questions, developed from an extensive review of the relevant literature. The questionnaire was organized into four sections. The questionnaire was conceptually guided by Andersen’s Behavioral Model of Health Services Utilization, which classifies determinants of healthcare utilization into predisposing, enabling, and need factors. Accordingly, the questionnaire included items assessing these domains to identify factors associated with adult vaccine uptake. This framework has been widely applied in studies examining healthcare utilization and adult vaccination behaviours. The first section collected socio-demographic information, including age, gender, nationality, educational background, occupation, and marital status. The second section gathered information related to adult vaccine uptake. The third section assessed participants’ perceptions of factors that facilitate or hinder vaccine uptake. The fourth section explored behavioral, cultural, economic, medical, and medicine-related factors that may influence vaccine uptake.

Following the development of the draft questionnaire, a validation procedure was conducted. Three subject-matter experts assessed face and content validity, and their feedback was incorporated to refine and modify the questionnaire accordingly. Subsequently, a pilot study was conducted to evaluate the clarity and comprehensibility of the questions, as well as the feasibility of the questionnaire in terms of the time required for completion.

2.3. Methodology

Data collection was conducted after obtaining approval from the Institutional Review Board of the Medical University. Permission was obtained from the authorities at the study site prior to initiating the study. Eligible participants included adults aged 18 years and above residing in the UAE, irrespective of gender or nationality, who were willing to provide written informed consent. Individuals younger than 18 years or those unwilling to participate were excluded from the study. Participants were recruited through universities, community settings, healthcare facilities, and public locations using QR-code-based and interviewer-assisted questionnaires. Participants completed the questionnaire independently, while the researchers were available on-site to clarify any questions or concerns during the data collection period. Data collection was conducted between April 2025 and October 2025.

2.4. Data Analysis

The primary outcome variable was adult vaccine uptake, defined as the self-reported receipt of at least one adult vaccine from the list included in the questionnaire. For statistical analysis, the outcome was coded as a binary variable (yes/no), as illustrated in Figure 1. Statistical analyses were performed using SPSS version 29 (IBM, Chicago). Statistical analyses were performed in a stepwise manner. Descriptive statistics were first used to summarize participants’ sociodemographic characteristics and vaccination status. Vaccine-specific uptake frequencies, enabling factors, and barriers were then described. Bivariate associations between the outcome variable and independent variables were assessed using the chi-square test. Variables of interest were subsequently entered into a multivariable logistic regression model to identify independent predictors of adult vaccine uptake. Statistical significance was defined as p < 0.05. No missing data were observed for the variables included in the analyses; therefore, all 1330 participants were included in the final analysis.

2.5. Ethical Aspects

Ethical clearance for this study was granted by the Institutional Review Board of a medical university in Ajman, UAE (Reference No. IRB-COM-STD-120-Mar-2025). Informed consent was obtained from all participants after explaining the purpose of the research. Participation was completely voluntary, and measures were taken to ensure participants’ confidentiality, anonymity, and privacy throughout the study. This research followed the Declaration of Helsinki.

3. Results

The study included 1330 participants, most of whom were under 40 years old (76.9%). Females formed the majority of respondents (60.4%). Nearly half held a bachelor’s degree (46.3%), while 39.2% had a high-school education or less. A large proportion were unemployed (67.4%), and most participants were single (61.9%). Smaller percentages were over 40 years old, employed, married, or had postgraduate qualifications.

Figure 1 shows the distribution of participants based on their use of adult vaccines. Most respondents reported having received at least one adult vaccine, accounting for 944 participants (71.0%). However, 386 participants (29.0%) indicated that they had not received any adult vaccinations.

In Figure 2 uptake is defined as receiving at least one adult vaccine from the list and it shows that COVID-19 (64.9%) and influenza (57.8%) vaccines had the highest uptake. Moderate coverage was seen for hepatitis B (43.0%), hepatitis A (41.1%), chickenpox (41.5%), and Hib (39.8%). Among female participants, 22.6% reported receiving the HPV vaccine, compared with 18.9% of male participants. In contrast, several adult and travel-related vaccines, such as Tdap (12.9%), herpes zoster (12.9%), and pneumococcal vaccination (12.6–13.2%, depending on formulation) had the lowest uptake among participants. Most respondents had not received tuberculosis vaccination (71.5%).

Table 1. Distribution of participants according to predisposing and enabling factors associated with adult vaccine uptake.

Themes/Factors	Groups	Frequency	%
Predisposing factors
Friends or family recommended it	Yes	752	79.7
	No	192	20.3
Transportation available	Yes	589	62.4
	No	355	37.6
Health Conscious	Yes	716	75.8
	No	228	24.2
Enabling factors
The doctor is close (Accessibility)	Yes	637	67.5
	No	307	32.5
You can find information easily	Yes	653	69.2
	No	291	30.8
Quality of vaccination services	Yes	636	67.4
	No	308	32.6
Fast appointments	Yes	618	65.5
	No	326	34.5
Availability of vaccination services on weekends/evenings	Yes	605	64.1
	No	339	35.9
Enabling factors
Providers who speak the same language/good communication skills	Yes	558	59.1
	No	386	40.9
Enabling factors
You have health insurance	Yes	561	59.4
	No	383	40.6
Affordable Vaccination services	Yes	572	60.6
	No	372	39.4
Access to low-cost or government-sponsored vaccination services	Yes	496	65.6
	No	360	34.4
Availability of employer-supported vaccination benefits	Yes	587	62.2
	No	375	37.8
Enabling factors
Your employer helps/supports	Yes	587	62.2
	No	357	37.8
Availability of on-site medical clinics	Yes	586	62.1
	No	358	37.9
Flexibility in work hours to attend vaccination services	Yes	126	32.6
	No	260	67.4
Positive peer influence on healthcare-seeking behavior	Yes	503	58.8
	No	353	41.2

Note: Percentages are based on the number of participants who responded to each individual item. Therefore, the frequencies for some items do not sum to the total number of vaccinated participants (n = 944) due to item-level non-response.

summarizes the enabling factors associated with vaccine uptake among vaccinated participants. It shows that social encouragement strongly influenced uptake, with 79.7% guided by friends and 75.8% describing themselves as health-conscious. Practical access mattered: 67.5% had nearby doctors, 69.2% found information easy, 67.4% perceived good service quality, and 65.5% obtained quick appointments, while 64.1% could attend evenings or weekends. Financial and workplace factors mattered too: 59.4% insured, 60.6% affordable services, 62.2% employer support, 62.1% on-site clinics, but only 32.6% flexible hours.

Table 2. Distribution of participants according to key barriers to vaccine uptake.

Themes/Factors	Groups	Frequency	%
Enabling barriers
No insurance	Yes	71	20.9
	No	268	79.1
Not enough money	Yes	106	27.5
	No	280	72.5
High cost of Vaccines	Yes	81	24.3
	No	253	75.7
Predisposing barriers
Cultural beliefs or practices affecting healthcare decisions	Yes	123	31.9
	No	263	68.1
Social stigma associated with certain health conditions	Yes	84	25.1
	No	250	74.9
Lack of awareness about available vaccination services	Yes	106	27.5
	No	280	72.5
Fear of discrimination or mistreatment	Yes	63	18.9
	No	271	81.1
Lack of family support	Yes	72	21.6
	No	262	78.4
Enabling barriers
No doctors or hospitals nearby	Yes	124	32.1
	No	262	67.9
Don’t know where to find a doctor or nurse for vaccination	Yes	77	23.1
	No	257	76.9
Don’t trust doctors or nurses	Yes	95	24.6
	No	291	75.4
Scared of becoming infected at the hospital or clinic	Yes	77	23.1
	No	257	76.9
Long waiting time	Yes	126	32.6
	No	260	67.4
Inability to get appointments	Yes	77	23.1
	No	257	76.9
Challenges in finding vaccination care	Yes	61	35.3
	No	112	64.7
Enabling barriers
Lack of public transportation options	Yes	30	24.6
	No	92	75.4
Transportation costs	Yes	29	24.0
	No	92	76.0
Enabling barriers
Language barriers with healthcare providers	Yes	82	47.4
	No	91	52.6
Difficulty understanding medical terminology	Yes	31	25.6
	No	90	74.4
Enabling barriers
Afraid of getting sent back home	Yes	75	43.4
	No	98	56.6
Scared of losing a job	Yes	51	29.5
	No	122	70.5
Faced challenges in obtaining medical leave or permission	Yes	29	24.0
	No	92	76.0

Percentages are based on responses to each individual item among the 386 unvaccinated participants. Row totals may not equal 100% because of item-level non-response.

shows multiple barriers to vaccine uptake among unvaccinated participants across different domains. The most commonly reported barriers were health system–related, particularly long waiting times (32.6%) and lack of nearby healthcare facilities (32.1%), followed by cultural beliefs influencing healthcare decisions (31.9%). Economic barriers were also important, with 27.5% reporting insufficient money, 24.3% perceiving vaccines as expensive, and 20.9% lacking insurance. Moderate proportions reported issues related to awareness and trust, including lack of awareness of vaccination services (27.5%), distrust in healthcare providers (24.6%), and fear of infection at healthcare facilities (23.1%). Language-related difficulties were also notable, particularly language barriers with healthcare providers (47.4%), along with difficulty understanding medical terminology (25.6%). Workplace concerns affected a smaller but relevant proportion, including fear of being sent back home (43.4%), fear of job loss (29.5%), and difficulty obtaining medical leave (24.0%). Transportation barriers were relatively less common, affecting about 24–25% of participants.

Table 3. Association between vaccine uptake and participants’ sociodemographic characteristics and health insurance status.

Sociodemographic Characteristics	Groups	Vaccine Uptake				p-Value
		Yes		No
		No.	%	No.	%
Age (years)	<40	793	77.5	230	22.5	<0.001
	40–60	120	61.9	74	38.1
	≥60	31	27.4	82	72.6
Gender	Male	374	63.4	216	36.6	<0.001
	Female	570	77	170	23
Marital status	Single	659	80.1	164	19.9	<0.001
	Married	285	56.2	222	43.8
Education level	High school and below	419	80.3	103	19.7	<0.001
	Bachelors	407	66.1	209	33.9
	Master’s and above	118	61.5	74	38.5
Employed	Employed	307	59.3	211	40.7	<0.001
	Unemployed	636	78.4	175	21.6
Health Insurance	Yes	561	84.5	103	15.5	<0.001
	No	383	57.5	283	42.5

shows a significant association between vaccine uptake and all sociodemographic variables (p < 0.001). Vaccine uptake was highest among participants aged <40 years (77.5%), followed by those aged 40–60 years (61.9%), and lowest among those aged ≥60 years (27.4%), indicating a clear decline with increasing age. Females had higher vaccine uptake (77%) compared to males (63.4%). Single participants showed greater uptake (80.1%) than married participants (56.2%). Regarding education, uptake was highest among those with high school education and below (80.3%), followed by bachelor’s degree holders (66.1%), and lowest among those with master’s and above (61.5%). Employment status also showed a significant difference, with higher uptake among the unemployed (78.4%) compared to the employed (59.3%). Participants with health insurance also demonstrated significantly higher vaccine uptake (84.5%) compared to those without health insurance (57.5%) (p < 0.001), indicating that health insurance coverage was positively associated with vaccine uptake.

Table 4. Distribution of predictors of adult vaccine uptake.

Variables	Group	Adult Vaccine Uptake
		Crude			Adjusted
		OR	CI	p Value	OR	CI	p Value
Age group	<40	1	-	-	1	-	-
	40–60	0.47	0.34–0.65	<0.001	0.46	0.33–0.66	<0.001
	≥60	0.11	0.07–0.17	<0.001	0.10	0.06–0.15	<0.001
Gender	Male	1	-	-	-	-	-
	Female	1.94	1.52–2.42	<0.001	2.09	1.59–2.75	<0.001
Marital status	Single	1	-	-	1	-	-
	Married	0.32	0.24–0.40	<0.001	0.32	0.25–0.43	<0.001
Education level	High school and below	1	-	-	1	-	-
	Bachelors	0.48	0.36–0.63	0.001	0.46	0.34–0.63	<0.001
	Master’s and above	0.39	0.27–0.56	<0.001	0.36	0.24–0.54	<0.001
Employment status	Employed	1	-	-	1	-	-
	Unemployed	2.50	1.96–3.18	<0.001	2.21	1.69–2.90	<0.001

presents the crude and adjusted logistic regression analysis of factors associated with adult vaccine uptake. After adjustment, age, gender, marital status, education level, and employment status were all significantly associated with vaccine uptake (all p < 0.001).

Compared to participants aged below 40 years, those aged 40–60 years (AOR = 0.46, 95% CI: 0.33–0.66) and ≥60 years (AOR = 0.10, 95% CI: 0.06–0.15) had significantly lower odds of vaccine uptake. Female participants had higher odds of vaccine uptake than males (AOR = 2.09, 95% CI: 1.59–2.75). Married participants were less likely to receive adult vaccines than single participants (AOR = 0.32, 95% CI: 0.25–0.43). Participants with a bachelor’s degree (AOR = 0.46, 95% CI: 0.34–0.63) and a master’s degree or above (AOR = 0.36, 95% CI: 0.24–0.54) had lower odds of vaccine uptake compared to those with a high school education or below. Unemployed participants had higher odds of vaccine uptake than employed participants (AOR = 2.21, 95% CI: 1.69–2.90).

4. Discussion

This study provides a comprehensive assessment of adult vaccination uptake among the study population in the UAE and identifies key sociodemographic, health system, economic, and workplace-related determinants influencing vaccination behavior. Overall vaccine uptake was relatively high, with 71.0% of participants having received at least one adult vaccine, yet notable gaps persisted for several routinely recommended vaccines. These findings reflect both the strengths and ongoing challenges of adult immunization within a high-income Middle Eastern setting. The findings are interpreted within Andersen’s Behavioral Model of Health Services Utilization, which categorizes determinants of healthcare utilization into predisposing, enabling, and need-related factors. This framework provides a basis for understanding the sociodemographic, health system, and behavioural determinants of adult vaccine uptake identified in the present study.

In the present study, nearly three-fourths of participants reported receiving at least one adult vaccine, indicating moderate overall uptake. However, because overall vaccine uptake was defined as receipt of at least one adult vaccine, the relatively high coverage of COVID-19 and influenza vaccines may have inflated the overall estimate and should be considered when interpreting these findings. From the perspective of Andersen’s model, the observed uptake likely reflects the influence of enabling factors such as widespread vaccine availability, strong public health infrastructure, and extensive vaccination campaigns in the UAE. A multicountry review reported adult vaccination uptake ranging between 40–60% in most middle- and high-income countries, depending on vaccine type and target population [15,16]. Similarly, adult vaccination coverage across many European countries remains below 65%, even for recommended vaccines [16]. The relatively higher uptake observed in this study may be attributed to the UAE’s strong public health infrastructure, frequent travel of people to other countries, widespread vaccine availability, and the extensive vaccination campaigns, which likely enhanced awareness and acceptance of adult immunization. However, the finding that nearly 29% of adults remained unvaccinated highlights persistent gaps in awareness, access, and perceived necessity [17].

Vaccine-specific analysis showed that COVID-19 and influenza vaccines had the highest uptake among all assessed vaccines. In this study, 64.9% of participants reported getting a COVID-19 vaccination, while 57.8% reported getting an influenza vaccination. These findings are consistent with global evidence. A study reported COVID-19 vaccine acceptance rates between 60–80%, influenced by trust in health systems, perceived vaccine safety, and access [18]. Influenza vaccine uptake in the present study exceeded that reported in some high-income settings. For example, A population-based study from Canada reported adult influenza vaccination coverage of 41–44% before, during, and after the COVID-19 pandemic [19]. The higher uptake observed in the UAE may reflect sustained public health messaging, workplace-based vaccination initiatives, and improved access to free or subsidized vaccines following the pandemic.

In contrast, uptake of pneumococcal, herpes zoster, and Tdap vaccines was uniformly low, with each reported by only 12–13% of participants. This pattern aligns with international evidence of persistently suboptimal coverage of non-respiratory adult vaccines. In Belgium, pneumococcal vaccination uptake among people living with HIV reached 37.8%, higher than in the present study but still insufficient given the elevated disease risk [20]. Differences in uptake may reflect variations in healthcare engagement, perceived risk, and the presence of structured reminder systems.

Herpes zoster uptake in the present study (~12%) mirrors findings from Saudi Arabia, where only 12% of adults aged ≥50 years with chronic diseases were vaccinated [21]. In that study, low perceived susceptibility and limited knowledge were major barriers, while physician recommendation was the strongest predictor of uptake. Similarly, evidence from Turkey indicates a substantial pneumococcal disease burden alongside persistently low adult vaccination coverage, attributed to fragmented policies, limited public awareness, and reliance on opportunistic vaccination strategies [22]. Collectively, these findings suggest that insufficient provider recommendation, low perceived risk, and poor integration of adult vaccination into routine care contribute to low uptake.

HPV vaccine uptake in this study was 22.6% among females and 18.9% among males, indicating modest coverage. These figures are comparable to recent UAE data reporting an HPV vaccination rate of 18.9% among young adults, the highest among Gulf Cooperation Council countries, yet still reflecting overall low uptake [23]. Globally, adult HPV vaccination coverage remains considerably lower than adolescent coverage in countries without adult catch-up programs. Cultural perceptions, misconceptions regarding age appropriateness, and limited physician recommendations are frequently cited barriers [24]. Limited promotion of HPV vaccination beyond adolescence in the UAE likely contributes to these findings.

Sociodemographic differences in vaccination uptake were evident. Females were more likely to be vaccinated than males, consistent with international evidence demonstrating higher preventive healthcare utilization among females. Evidence from a systematic review suggests that women generally have higher odds of adult vaccine uptake than men, which has been attributed to greater health awareness and more frequent healthcare interactions [25]. Our findings are consistent with this evidence, as females in the present study demonstrated higher vaccine uptake than males.

Younger adults demonstrated higher vaccination uptake than older adults in this study, contrasting with population-based studies reporting higher coverage among older age groups, particularly for age-targeted vaccines [26]. A multicounty European analysis similarly found adults aged ≥60 years to be more likely to receive recommended vaccines [27]. In the UAE, younger adults may benefit from greater exposure to employer-based vaccination campaigns, while older adults may face access barriers or reduced engagement with preventive services.

Several enabling and barrier factors further contextualize these findings. Social influence emerged as a major enabler, with nearly 80% of vaccinated participants reporting encouragement from family or friends, consistent with evidence highlighting the role of social norms in collectivist societies [28]. Health system accessibility, including flexible clinic hours and service availability, was also associated with uptake. Evidence from the wider literature suggests that workplace-based vaccination programs and extended service hours can improve adult vaccination uptake. Similarly, previous studies indicate that individuals with health insurance are more likely to receive recommended vaccines because financial barriers are reduced [29]. These findings are consistent with our observation that workplace support and health insurance were associated with higher vaccine uptake.

Conversely, logistical barriers such as long waiting times and appointment difficulties were commonly reported. A meta-analysis reported that logistical barriers accounted for 30–40% of missed adult vaccination opportunities [25]. Our findings were consistent with this evidence, with long waiting times and appointment difficulties identified as important barriers to vaccine uptake. Language and communication barriers were particularly relevant in the UAE’s multicultural population and have similarly been linked to reduced preventive healthcare utilization among migrant populations [30].

Adult vaccination is essential for healthy aging, preventing infections like influenza, pneumococcal disease, and COVID-19. It reduces severe illness, hospitalizations, and complications, preserving physical health, independence, and quality of life. Integrating vaccines into routine adult care supports preventive health, enhances resilience, and promotes longevity in aging populations.

The multivariable logistic regression analysis confirmed that age, gender, marital status, education level, and employment status were independent predictors of adult vaccine uptake. Participants aged 40 years and older had significantly lower odds of vaccination, whereas females and unemployed individuals had higher odds of vaccination. Similar to a recent study by Barqawi et al. [1], females demonstrated more positive attitudes toward adult vaccination and lower vaccine hesitancy than males. However, unlike our findings, the same study reported greater vaccine hesitancy among middle-aged and highly educated individuals, suggesting that determinants of vaccine uptake may vary across different adult populations in the UAE [31].

The lower vaccine uptake observed among married, more educated, and employed participants was unexpected. One possible explanation is that the study sample was predominantly composed of younger, single students, who may have been more recently exposed to institutional vaccination campaigns. Similarly, the lower uptake among participants with higher educational attainment may reflect the demographic composition of the sample rather than a true effect of education. In addition, many participants classified as unemployed were students who may have had greater flexibility to access vaccination services, whereas employed individuals may have faced time constraints and workplace-related barriers. These findings highlight the importance of interpreting vaccine uptake within the context of the study population.

This study provides a detailed, percentage-based analysis of adult vaccination uptake and its determinants in the UAE. Despite limitations related to self-reported data and cross-sectional design, the findings offer valuable insights into immunization gaps and highlight opportunities for targeted, system-level interventions to strengthen adult vaccination coverage. A further limitation of this study is that overall adult vaccine uptake was defined as receipt of at least one adult vaccine. Consequently, the relatively high uptake of COVID-19 and influenza vaccines may have inflated the overall estimate. Because enabling factors and barriers were assessed for overall adult vaccine uptake rather than individual vaccine types, vaccine-specific analyses excluding COVID-19 and influenza vaccines could not be performed. Although the initial analyses included descriptive statistics and bivariate chi-square tests, multivariable logistic regression was subsequently performed to identify independent predictors of adult vaccine uptake while adjusting for measured confounding variables. However, because of the cross-sectional study design, causal relationships cannot be inferred, and residual confounding due to unmeasured variables cannot be excluded. Additionally, the use of convenience sampling through QR-code-based and interview-assisted recruitment may have preferentially included younger and more digitally connected individuals, contributing to the high proportion of participants aged below 40 years. This may have introduced selection bias and limited the generalizability of the findings to the broader adult population of the UAE. Because most participants were younger than 40 years, the findings should be interpreted primarily in the context of a predominantly young adult population, and conclusions regarding older adults should be made with caution.

5. Conclusions

This study evaluated adult vaccination uptake and its determinants in the UAE, revealing moderate coverage alongside persistent gaps. Overall, 71% of participants reported receiving at least one adult vaccine, with the highest uptake for COVID-19 (64.9%) and influenza (57.8%), driven by public health campaigns and workplace initiatives. Coverage for non-respiratory vaccines, including pneumococcal, herpes zoster, Tdap, and HPV, remained low. Vaccination behavior was influenced by sociodemographic factors, health system access, insurance, and social influence, while lack of awareness and logistical barriers hindered uptake. Strengthening physician recommendations, routine integration, workplace delivery, and culturally tailored communication could improve adult immunization in the UAE.