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BACKGROUND: Public acceptance, trust, and actual uptake of COVID-19 vaccines are crucial to stem the pandemic. Although roll out of vaccines was high in KSA, the public response was not sufficiently studied. We aimed to investigate knowledge level, acceptance, and trust in COVID-19 vaccination and related predictors among adults in Makkah, KSA. METHODS: A web-based cross-sectional survey using a snowballing sample was carried on 507 adult Saudi population living in Makkah city. The survey was developed based on literature search. In the logistic analysis, the dependent variables included acceptance rate and trust in effectiveness and safety of COVID-19 vaccines, while the independent variables (predictors) were sociodemographics and level of knowledge. RESULTS: The survey included 507 participants, aged 18-78 years, 55.8% were females, and 36.7% had (or one of their family members) previously been exposed to COVID-19 infection. Their knowledge about COVID-19 vaccination was satisfactory (86.2%) with 71.2% intended to receive COVID-19 vaccination, and 56.4% was confident of the vaccine effectiveness. Vaccine efficacy, duration of protection, schedule of vaccination, and recommendation by authorities may favor their decision to accept or decline COVID-19 vaccines. Good knowledge about vaccines (OR = 2.07; CI: 1.24-3.48 for acceptance and OR = 2.67; CI: 1.58-4.51 for trust), higher educational level (OR = 1.80; CI: 1.07-3.40 for acceptance and OR = 3.59; CI: 2.08-6.21 for trust), previous seasonal flu vaccination (OR = 1.66; CI: 1.09-2.53 for acceptance and OR = 1.91; CI: 1.31-2.79 for trust), female sex (OR = 1.62; CI: 1.1-2.39 for acceptance and OR = 4.15; CI: 2.86-6.04 for trust), and history of COVID-19 infection (OR = 1.57; CI: 1.04-2.37 for acceptance and OR = 1.69; CI: 1.17-2.46 for trust) were among significant predictors for both vaccine acceptance and trust in vaccine effectiveness. CONCLUSIONS: Adult Saudi population in Makkah city showed satisfactory knowledge about COVID-19 vaccination with moderate rate of vaccine acceptance and a relatively low rate of confidence in vaccine effectiveness. Better understanding of public acceptance and trust in COVID-19 vaccines and addressing barriers to vaccination are recommended to improve vaccine coverage and to reinforce some communication characteristics of the current vaccination campaign.
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