Background COVID-19 vaccine is a vital strategy to prevent and control this pandemic. This will depend principally on people's acceptance of COVID-19 vaccine. We aimed to determine the willingness to accept COVID vaccine among adult household members of Dire Dawa city administration. Methods A community-based cross-sectional study was conducted among randomly selected 634 adult household members in the Dire Dawa city administration during January 16–31/2022. Data were collected using face-to-face interview. Extent of willingness was estimated using participants' self-report. Bivariate and multivariate logistic regression models were fitted, and statistical significance was set at p- value <0.05. Results The estimated willingness to accept COVID-19 vaccine was 28.4% (95% CI 25.1, 31.5) in the study setting. The odds of willingness to accept COVID-19 vaccine was higher for household members living without at least one chronic disease (AOR 1.7, 95% CI 1.10, 2.70), who had good knowledge score (AOR 2.3, 95% CI 1.31, 2.18) and positive attitude score (AOR 5.5, 95% CI 2.1, 14.5) compared to their counterparts, respectively. The estimated willingness to accept COVID-19 vaccine among household members with good knowledge score was 47.4 (95% CI 42.1, 52.7) and 15.5 (95% CI 8.7, 22.2) among those with poor knowledge. Nearly, 90% of the study participants had limited knowledge about COVID 19 vaccine. Conclusion The estimated willingness to accept COVID-19 vaccine in the study setting is very low and far from the set target to be reached by the end of 2022. Being free from chronic disease, and having good knowledge and positive attitude about COVID-19 vaccine were the main drivers for willingness. Public awareness directed to increase knowledge about COVID-19 vaccine and attitude change strategies should be scaled up to increase the COVID-19 vaccine uptake. Moreover, those individuals with chronic diseases need special attention.

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