COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries.
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ABSTRACT:
SUBMITTER: Solis Arce JS
PROVIDER: S-EPMC8363502 | biostudies-literature | 2021 Aug
REPOSITORIES: biostudies-literature
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COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries.
Solís Arce Julio S JS Warren Shana S SS Meriggi Niccolò F NF Scacco Alexandra A McMurry Nina N Voors Maarten M Syunyaev Georgiy G Malik Amyn Abdul AA Aboutajdine Samya S Adeojo Opeyemi O Anigo Deborah D Armand Alex A Asad Saher S Atyera Martin M Augsburg Britta B Awasthi Manisha M Ayesiga Gloria Eden GE Bancalari Antonella A Björkman Nyqvist Martina M Borisova Ekaterina E Bosancianu Constantin Manuel CM Cabra García Magarita Rosa MR Cheema Ali A Collins Elliott E Cuccaro Filippo F Farooqi Ahsan Zia AZ Fatima Tatheer T Fracchia Mattia M Galindo Soria Mery Len ML Guariso Andrea A Hasanain Ali A Jaramillo Sofía S Kallon Sellu S Kamwesigye Anthony A Kharel Arjun A Kreps Sarah S Levine Madison M Littman Rebecca R Malik Mohammad M Manirabaruta Gisele G Mfura Jean Léodomir Habarimana JLH Momoh Fatoma F Mucauque Alberto A Mussa Imamo I Nsabimana Jean Aime JA Obara Isaac I Otálora María Juliana MJ Ouédraogo Béchir Wendemi BW Pare Touba Bakary TB Platas Melina R MR Polanco Laura L Qureshi Javaeria Ashraf JA Raheem Mariam M Ramakrishna Vasudha V Rendrá Ismail I Shah Taimur T Shaked Sarene Eyla SE Shapiro Jacob N JN Svensson Jakob J Tariq Ahsan A Tchibozo Achille Mignondo AM Tiwana Hamid Ali HA Trivedi Bhartendu B Vernot Corey C Vicente Pedro C PC Weissinger Laurin B LB Zafar Basit B Zhang Baobao B Karlan Dean D Callen Michael M Teachout Matthieu M Humphreys Macartan M Mobarak Ahmed Mushfiq AM Omer Saad B SB
Nature medicine 20210716 8
Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a tot ...[more]
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Project description:BackgroundVaccination is the most effective method to prevent the spread of infectious diseases. Nevertheless, vaccine hesitancy has been an issue. Parental hesitancy toward vaccines is a major part of the problem. COVID-19 vaccine acceptance is no different, it poses another challenge in facing the pandemic. In Low- and Middle-Income Countries (L&MICs) several studies measured parents' acceptance to vaccinate their children against COVID-19 and resulted in different acceptance proportions.AimsThe paper aims at obtaining a precise estimate of the overall proportion of L&MICs' parents accepting to vaccinate their children against COVID-19 and identifying the main determinant of their decisions.MethodsThis meta-analysis follows the PRISMA 2020 statement on updated guidelines and the checklist for reporting systematic reviews. Studies published between December till February 2022 were assessed for inclusion. The final effect size (i.e., the proportion of parents in L&MICs accepting to vaccinate their children against COVID-19) was measured using the Arcsine proportions method. Analysis was done using R program.ResultsThe proportion of parents in L&MICs accepting to vaccinate their children against COVID-19 is 49%. The major reason for their acceptance is their belief that COVID-19 vaccine is fundamental to the fight against the pandemic while the most common factor for parents' hesitancy to vaccinate their children against COVID-19 is their concerns about vaccine efficacy, safety, and possible side effects.ConclusionThe proportion of parents in L&MICs accepting to vaccinate their children against COVID-19 is lower than the global level. To increase parental acceptance, responsible authorities should concentrate on increasing their population's trust in the government and in vaccine manufacturers. As well as concentrating on increasing acceptance of the vaccine idea in general.
| S-EPMC10010145 | biostudies-literature
Project description:ObjectivesThis study aims to estimate the levels of COVID-19 vaccine hesitancy in 53 low-income and middle-income countries, differences across population groups in hesitancy, and self-reported reasons for being hesitant to take the COVID-19 vaccine.MethodsThis paper presents new evidence on levels and trends of vaccine hesitancy in low-income and middle-income countries based on harmonised high-frequency phone surveys from more than 120 000 respondents in 53 low-income and middle-income countries collected between October 2020 and August 2021. These countries represent a combined 53% of the population of low-income and middle-income countries excluding India and China.ResultsOn average across countries, one in five adults reported being hesitant to take the COVID-19 vaccine, with the most cited reasons for hesitancy being concerns about the safety of the vaccine, followed by concerns about its efficacy. Between late 2020 and the first half of 2021, there tended to be little change in hesitancy rates in 11 of the 14 countries with available data, while hesitancy increased in Iraq, Malawi and Uzbekistan. COVID-19 vaccine hesitancy was higher among female, younger adults and less educated respondents, after controlling for selected observable characteristics.ConclusionsCountry estimates of vaccine hesitancy from the high-frequency phone surveys are correlated with but lower than those from earlier studies, which often relied on less representative survey samples. The results suggest that vaccine hesitancy in low-income and middle-income countries, while less prevalent than previously thought, will be an important and enduring obstacle to recovery from the pandemic.
| S-EPMC10632876 | biostudies-literature
Project description:Widespread vaccination against COVID-19 is critical for controlling the pandemic. Despite the development of safe and efficacious vaccinations, low-and lower-middle income countries (LMICs) continue to encounter barriers to care owing to inequitable access and vaccine apprehension. This study aimed to summarize the available data on COVID-19 vaccine acceptance rates and factors associated with acceptance in LMICs. A comprehensive search was performed in PubMed, Scopus, and Web of Science from inception through August 2021. Quality assessments of the included studies were carried out using the eight-item Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies. We performed a meta-analysis to estimate pooled acceptance rates with 95% confidence intervals (CI). A total of 36 studies met the inclusion criteria and were included in the review. A total of 83,867 respondents from 33 countries were studied. Most of the studies were conducted in India (n = 9), Egypt (n = 6), Bangladesh (n = 4), or Nigeria (n = 4). The pooled-effect size of the COVID-19 vaccine acceptance rate was 58.5% (95% CI: 46.9, 69.7, I2 = 100%, 33 studies) and the pooled vaccine hesitancy rate was 38.2% (95% CI: 27.2-49.7, I2 = 100%, 32 studies). In country-specific sub-group analyses, India showed the highest rates of vaccine acceptancy (76.7%, 95% CI: 65.8-84.9%, I2= 98%), while Egypt showed the lowest rates of vaccine acceptancy (42.6%, 95% CI: 16.6-73.5%, I2= 98%). Being male and perceiving risk of COVID-19 infection were predictors for willingness to accept the vaccine. Increasing vaccine acceptance rates in the global south should be prioritized to advance global vaccination coverage.
| S-EPMC8950670 | biostudies-literature
Project description:BackgroundVaccine hesitancy remains a critical barrier in mitigating the effects of the ongoing COVID-19 pandemic. The willingness of health care workers (HCWs) to be vaccinated, and, in turn, recommend the COVID-19 vaccine for their patient population is an important strategy. This study aims to understand the uptake of COVID-19 vaccines and the reasoning for vaccine hesitancy among facility-based health care workers (HCWs) in LMICs.MethodsWe conducted nationally representative phone-based rapid-cycle surveys across facilities in six LMICs to better understand COVID-19 vaccine hesitancy. We gathered data on vaccine uptake among facility managers, their perceptions of vaccine uptake and hesitancy among the HCWs operating in their facilities, and their perception of vaccine hesitancy among the patient population served by the facility.Results1,148 unique public health facilities participated in the study, with vaccines being almost universally offered to facility-based respondents across five out of six countries. Among facility respondents who have been offered the vaccine, more than 9 in 10 survey respondents had already been vaccinated at the time of data collection. Vaccine uptake among other HCWs at the facility was similarly high. Over 90% of facilities in Bangladesh, Liberia, Malawi, and Nigeria reported that all or most staff had already received the COVID-19 vaccine when the survey was conducted. Concerns about side effects predominantly drive vaccine hesitancy in both HCWs and the patient population.ConclusionOur findings indicate that the opportunity to get vaccinated in participating public facilities is almost universal. We find vaccine hesitancy among facility-based HCWs, as reported by respondents, to be very low. This suggests that a potentially effective effort to increase vaccine uptake equitably would be to channel promotional activities through health facilities and HCWs.However, reasons for hesitancy, even if limited, are far from uniform across countries, highlighting the need for audience-specific messaging.
| S-EPMC10328245 | biostudies-literature
Project description:Delayed acceptance or refusal of COVID-19 vaccines may increase and prolong the threat to global public health and the economy. Identifying behavioural determinants is considered a critical step in explaining and addressing the barriers of vaccine refusal. This study aimed to identify the behavioural determinants of COVID-19-vaccine acceptance and provide recommendations to design actionable interventions to increase uptake of the COVID-19 vaccine in six lower- and middle-income countries. Taking into consideration the health belief model and the theory of reasoned action, a barrier analysis approach was employed to examine twelve potential behavioural determinants of vaccine acceptance in Bangladesh, India, Myanmar, Kenya, the Democratic Republic of the Congo (DRC), and Tanzania. In all six countries, at least 45 interviews with those who intended to get the vaccine ("Acceptors") and another 45 or more interviews with those who did not ("Non-acceptors") were conducted, totalling 542 interviews. Data analysis was performed to find statistically significant (p < 0.05) differences between Acceptors and Non-acceptors of COVID-19 vaccines and to identify which beliefs were most highly associated with acceptance and non-acceptance of vaccination based on the estimated relative risk. The analysis showed that perceived social norms, perceived positive and negative consequences, perceived risk, perceived severity, trust, perceived safety, and expected access to COVID-19 vaccines had the highest associations with COVID-19-vaccine acceptance in Bangladesh, Kenya, Tanzania, and the DRC. Additional behavioural determinants found to be significant in Myanmar and India were perceived self-efficacy, trust in COVID-19 information provided by leaders, perceived divine will, and perceived action efficacy of the COVID-19 vaccines. Many of the determinants were found to be significant, and their level of significance varied from country to country. National and local plans should include messages and activities that address the behavioural determinants found in this study to significantly increase the uptake of COVID-19 vaccines across these countries.
| S-EPMC8875839 | biostudies-literature
Project description:BackgroundVaccine acceptance and hesitancy among the general population and health care workers play an important role in successfully controlling the Coronavirus Disease (COVID)-19 pandemic. While there is evidence for vaccine hesitancy across the globe, wide variation in factors influencing vaccine acceptance has been reported, mainly from High-Income Countries (HIC). However, the evidence from Low- and Middle-Income Countries (LMICs) remains unclear. The objective of this review was to describe the determinants of vaccine acceptance and strategies to address those in an LMIC context.MethodsThe World Health Organization's (WHO) Measuring Behavioral and Social Drivers of Vaccination (BeSD) Increasing Vaccination Model was employed to identify factors that influenced vaccine acceptance. All evidence related to supply-side and demand-side determinants and social and health system processes were examined. A comprehensive search for published literature was conducted in three databases and grey literature in relevant websites of government, multinational agencies, and COVID-19 resource aggregators, followed by a narrative synthesis.ResultsOverall, the results showed that the vaccine acceptance rates differed across LMICs, with a wide variety of reasons cited for vaccine hesitancy. Vaccine acceptance was reportedly greater among males, those with higher education, elevated socio-economic status, the unmarried, those employed as health care workers. Evidence suggested that exposure to misinformation about COVID-19 vaccines and public concerns over the safety of vaccines may contribute to lower acceptance rates. Strategies to increase vaccine acceptance rates included direct engagement with communities through influencers, including community leaders and health experts; clear and transparent communication about COVID-19 vaccines, financial and non-financial incentives; and strong endorsement from health care workers. Trust in government was identified as a significant enabler of vaccine acceptance.ConclusionsThere is a need for measures to address public acceptability, trust and concern over the safety and benefit of approved vaccines. Local context is essential to consider while developing programs to promote vaccine uptake. The governments worldwide also need to strategize to develop plans to address the anxiety and vaccine related concerns of community regarding vaccine hesitancy. There is a need for further research to evaluate strategies to address vaccine hesitancy in LMIC.
| S-EPMC8645216 | biostudies-literature
Project description:Purpose The delay in acceptance or refusal to get vaccinated despite the availability of services is called vaccine hesitancy. The Global Polio Eradication Initiative in Pakistan faced consistent barriers preventing the eradication of the disease in the country. Similarly with the advent of the coronavirus disease 2019 (COVID-19) pandemic mass vaccination drives were initiated to a vaccine hesitant population. The aim of this study is to explore the prevalence and reasons for COVID-19 vaccine hesitancy in the Pakistani population. Materials and Methods Cross-sectional study conducted during July to September 2021 using a snowball sampling technique targeting the adult population of Pakistan. The modified version of the vaccine hesitancy questionnaire related to the Strategic Advisory Group of Experts on Immunization Vaccine Hesitancy matrix was distributed online. Results Out of 973 participants, 52.4% were immediately willing to take the vaccine and constituted the acceptance group whereas the remaining 47.6% who were still not sure formed the hesitant group. Support from leaders was found to be statistically significant for the difference between the hesitant and acceptance groups (p-value=0.027). Hesitant people were concerned about the effectiveness of the vaccine (60.9%) and potential side effects (57.9%) as it was not sufficiently tested prior to launch (44.7%). Age and education were significant factors affecting the acceptance of vaccination. The most trusted source of information regarding vaccination was health care workers (43.8%). Conclusion A moderately high prevalence of vaccine hesitancy was reported in Pakistan. To overcome it, policymakers need to address the reasons for it. Leaders, celebrities, and healthcare workers can play an instrumental role in dispelling conspiracy theories regarding vaccines and making the vaccination drive a success.
| S-EPMC10435776 | biostudies-literature
Project description:Mass vaccination against COVID-19 is the best method to ensure herd immunity in order to curb the effect of the pandemic on the global economy. It is therefore important to assess the determinants of COVID-19 vaccine acceptance and hesitancy on a global scale. Factors were recorded from cross-sectional studies analyzed with t-Test, ANOVA, correlation, and meta-regression analyses and synthesized to identify global trends in order to inform policy. We registered the protocol (ID: CRD42022350418) and used standard Cochrane methods and PRISMA guidelines to collect and synthesize cross-sectional articles published between January 2020 and August 2023. A total of 67 articles with 576 studies from 185 countries involving 3081,766 participants were included in this synthesis. Global COVID-19 vaccine acceptance was 65.27% (95% CI; 62.72-67.84%), while global vaccine hesitancy stood at 32.1% (95% CI; 29.05-35.17%). One-Way ANOVA showed that there was no significant difference in the percentage Gross Domestic Product spent on vaccine procurement across the World Bank income levels (p < 0.187). There was a significant difference of vaccine acceptance (p < 0.001) and vaccine hesitancy (p < 0.005) across the different World Bank Income levels. World Bank income level had a strong influence on COVID-19 vaccine acceptance (p < 0.0004) and hesitancy (p < 0.003) but percentage Gross Domestic Product spent on vaccine procurement did not. There was no correlation between percentage Gross Domestic Product spent on vaccine procurement and COVID-19 vaccine acceptance (r = -0.11, p < 0.164) or vaccine hesitancy (r = -0.09, p < 0.234). Meta-regression analysis showed that living in an urban setting (OR = 4.83, 95% CI; 0.67-212.8), rural setting (OR = 2.53, 95% CI; 0.29-119.33), older (OR = 1.98, 95% CI; 0.99-4.07), higher education (OR = 1.76, 95% CI; 0.85-3.81), and being a low income earner (OR = 2.85, 95% CI; 0.45-30.63) increased the odds of high COVID-19 vaccine acceptance. Factors that increased the odds of high COVID-19 vaccine hesitancy were no influenza vaccine (OR = 33.06, 95% CI; 5.03-1395.01), mistrust for vaccines (OR = 3.91, 95% CI; 1.92-8.24), complacency (OR = 2.86, 95% CI; 1.02-8.83), pregnancy (OR = 2.3, 95% CI; 0.12-141.76), taking traditional herbs (OR = 2.15, 95% CI; 0.52-10.42), being female (OR = 1.53, 95% CI; 0.78-3.01), and safety concerns (OR = 1.29, 95% CI; 0.67-2.51). We proposed a number of recommendations to increase vaccine acceptance and ensure global herd immunity against COVID-19.
| S-EPMC10818751 | biostudies-literature
Project description:Vaccine hesitancy forms a critical barrier to the uptake of COVID-19 vaccine in high-income countries or regions. This review aims to summarize rates of COVID-19 hesitancy and its determinants in high-income countries or regions. A scoping review was conducted in Medline®, Embase®, CINAHL®, and Scopus® and was reported in accordance with the PRISMA-SCr checklist. The search was current as of March 2021. Studies which evaluated COVID-19 vaccine hesitancy and its determinants in high-income countries (US$12,536 or more GNI per capita in 2019) were included. Studies conducted in low, lower-middle, and upper-middle income countries or regions were excluded. Factors associated with vaccine hesitancy were grouped into four themes (vaccine specific, individual, group, or contextual related factors). Of 2237 articles retrieved, 97 articles were included in this review. Most studies were conducted in U.S. (n = 39) and Italy (n = 9). The rates of vaccine hesitancy across high-income countries or regions ranged from 7-77.9%. 46 studies (47.4%) had rates of 30% and more. Younger age, females, not being of white ethnicity and lower education were common contextual factors associated with increased vaccine hesitancy. Lack of recent history of influenza vaccination, lower self-perceived risk of contracting COVID-19, lesser fear of COVID-19, believing that COVID-19 is not severe and not having chronic medical conditions were most frequently studied individual/group factors associated with increased vaccine hesitancy. Common vaccine-specific factors associated with increased vaccine hesitancy included beliefs that vaccine are not safe/effective and increased concerns about rapid development of COVID-19 vaccines. Given the heterogeneity in vaccine hesitancy definitions used across studies, there is a need for standardization in its assessment. This review has summarized COVID-19 vaccine hesitancy determinants that national policymakers can use when formulating health policies related to COVID-19 vaccination.
| S-EPMC8402587 | biostudies-literature
Project description:BackgroundThe COVID-19 pandemic has disrupted immunization services critical to the prevention of vaccine-preventable diseases in many low- and middle- income countries around the world. These services will need to be modified in order to minimize COVID-19 transmission and ensure the safety of health workers and the community. Additional budget will be required to implement these modifications that ensure safe delivery.MethodsUsing a simple modeling analysis, we estimated the additional resource requirements associated with modifications to supplementary immunization activities (campaigns) and routine immunization services via fixed sites and outreach in 2020 US dollars. We considered the following four categories of costs: (1) personal protective equipment (PPE) & infection prevention and control (IPC) measures for immunization sessions; (2) physical distancing and screening during immunization sessions; (3) delivery strategy changes, such as changes in session sizes and frequency; and (4) other operational cost increases, including additional social mobilization, training, and hazard pay to compensate health workers.ResultsWe found that implementing a range of measures to protect health workers and communities from COVID-19 transmission could result in a per-facility start-up cost of $466-799 for routine fixed-site delivery and $12-220 for routine outreach delivery, and $12-108 per immunization campaign site. A recurrent monthly cost of $137-1,024 for fixed-site delivery and $152-848 for outreach delivery per facility could be incurred, and a $0.32-0.85 increase in the cost per dose during campaigns.ConclusionsBy illustrating potential cost implications of providing immunization services through a range of strategies in a safe manner, these estimates can provide a benchmark for program managers and policy makers on the additional budget required. These findings can help country practitioners and global development partners planning the continuation of immunization services in the context of COVID-19.
| S-EPMC8238647 | biostudies-literature