Global COVID-19 vaccine acceptance rate: Systematic review and meta-analysis

COVID-19 vaccine acceptance and its association with knowledge and attitude among patients with chronic diseases in Ethiopia

COVID-19 vaccine acceptance is crucial for patients with chronic diseases, but previous studies in Ethiopia have yielded inconsistent and inconclusive findings. To fill this gap, we conducted a systematic review and meta-analysis following established guidelines. Our search included relevant articles published between 2019 and 2023 from various sources. We assessed study heterogeneity and publication bias, and performed subgroup and sensitivity analyses. Our findings indicate that the COVID-19 vaccine acceptance rate among patients with chronic diseases in Ethiopia was 55.4%. We also found that good knowledge and a favorable attitude toward the vaccine were positively associated with the acceptance rate. Based on these results, we recommend that healthcare professionals, policymakers, and healthcare guide developers should work more to address the relatively low acceptance rate. Improving the knowledge and attitude further about the COVID-19 vaccines is crucial. Future research should include community-based and qualitative studies to enhance our understanding of vaccines acceptance.

COVID-19 vaccination intention among internally displaced persons in complex humanitarian emergency context, Northeast Nigeria

Internally displaced persons (IDPs) are at high risk for COVID-19 transmission because of congested and unsanitary living conditions. COVID-19 vaccination is essential to build population immunity and prevent severe disease among this population. We determined the prevalence and factors associated with intention to accept COVID-19 vaccine among IDPs in Northeast Nigeria. This cross-sectional study, conducted during July-December 2022, included 1,537 unvaccinated IDPs from 18 IDPs camps. We performed a complex sample survey analysis and described participants' characteristics and vaccination intention with weighted descriptive statistics. We fitted weighted logistic regression models and computed adjusted odds ratios with 95% confidence intervals to identify factors associated with intention to accept COVID-19 vaccine. Of 1,537 IDPs, 55.4% were 18-39 years old, 82.6% were females, and 88.6% had no formal education. Among them, 63.5% (95% CI: 59.0-68.1) expressed intention to accept COVID-19 vaccine. Among the IDPs who intended to reject vaccine, 42.8% provided no reason, 35.3% had COVID-19 misconceptions, 9.5% reported vaccine safety concerns, and 7.4% felt no need. IDPs who perceived COVID-19 as severe (Adjusted Odds Ratio (AOR) = 2.31, [95% CI: 1.35-3.96]), perceived COVID-19 vaccine as effective (AOR = 4.28, [95% CI: 2.46-7.44]) and resided in official camps (AOR = 3.29, [95% CI: 1.94-5.56]) were more likely to accept COVID-19 vaccine. However, IDPs who resided 2 kilometers or farther from the nearest health facility (AOR = 0.34, [95% CI: 0.20-0.58]) were less likely to accept vaccine. Intention to accept COVID-19 vaccine among the IDPs was suboptimal. To improve vaccination acceptance among this population, health education and risk communication should be intensified to counter misinformation, strengthen vaccine confidence, and shape perception of COVID-19 severity, focusing on IDPs in unofficial camps. Appropriate interventions to deliver vaccines to remote households should be ramped up.

COVID-19 Vaccine Hesitancy: Umbrella Review of Systematic Reviews and Meta-Analysis

BACKGROUND

The unprecedented emergence of the COVID-19 pandemic necessitated the development and global distribution of vaccines, making the understanding of global vaccine acceptance and hesitancy crucial to overcoming barriers to vaccination and achieving widespread immunization.

OBJECTIVE

This umbrella review synthesizes findings from systematic reviews and meta-analyses to provide insights into global perceptions on COVID-19 vaccine acceptance and hesitancy across diverse populations and regions.

METHODS

We conducted a literature search across major databases to identify systematic reviews and meta-analysis that reported COVID-19 vaccine acceptance and hesitancy. The AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) criteria were used to assess the methodological quality of included systematic reviews. Meta-analysis was performed using STATA 17 with a random effect model. The data synthesis is presented in a table format and via a narrative.

RESULTS

Our inclusion criteria were met by 78 meta-analyses published between 2021 and 2023. Our analysis revealed a moderate vaccine acceptance rate of 63% (95% CI 0.60%-0.67%) in the general population, with significant heterogeneity (I2 = 97.59%). Higher acceptance rates were observed among health care workers and individuals with chronic diseases, at 64% (95% CI 0.57%-0.71%) and 69% (95% CI 0.61%-0.76%), respectively. However, lower acceptance was noted among pregnant women, at 48% (95% CI 0.42%-0.53%), and parents consenting for their children, at 61.29% (95% CI 0.56%-0.67%). The pooled vaccine hesitancy rate was 32% (95% CI 0.25%-0.39%) in the general population. The quality assessment revealed 19 high-quality, 38 moderate-quality, 15 low-quality, and 6 critically low-quality meta-analyses.

CONCLUSIONS

This review revealed the presence of vaccine hesitancy globally, emphasizing the necessity for population-specific, culturally sensitive interventions and clear, credible information dissemination to foster vaccine acceptance. The observed disparities accentuate the need for continuous research to understand evolving vaccine perceptions and to address the unique concerns and needs of diverse populations, thereby aiding in the formulation of effective and inclusive vaccination strategies.

TRIAL REGISTRATION

PROSPERO CRD42023468363; https://tinyurl.com/2p9kv9cr.

Uptake of COVID-19 vaccine among high-risk urban populations in Southern Thailand using the COM-B model

BACKGROUND

The COVID-19 pandemic has imposed unprecedented suffering on social and individual levels worldwide. Vaccines against COVID-19 have been prioritized as a crucial strategy for ending the pandemic as well as minimizing its consequences.

OBJECTIVES

This study aimed to determine the uptake of COVID-19 vaccine among high-risk urban populations in Southern Thailand using the Capability, Opportunity, Motivation, and Behavior (COM-B) model.

METHODS

We conducted a web-based cross-sectional study in the Hat Yai district, Songkhla province in Southern Thailand, in September and October 2021. The questionnaire was composed of sections on sociodemographic characteristics, COVID-19 vaccination status, and COM-B constructs. We employed a multivariable logistic regression analysis to determine factors associated with the uptake of the COVID-19 vaccine. We set statistical significance at p < 0.05.

RESULTS

In this study, females constituted 54.7% of the total participants (n = 358), and nearly half of the participants (45.8%) were in the younger age group (18-29). Of all the participants, 59.5% (95%CI: 54.2%-64.6%) received at least one dose of the COVID-19 vaccine. Factors associated with the uptake of COVID-19 vaccine and their adjusted OR (95% CI) were being married: 3.59 (2.06-6.24), having a graduate degree: 2.34 (1.38-3.96), gainfully employed: 3.30 (1.91-5.67), having a high level of opportunity: 2.90 (1.48-5.66), and having a high level of motivation: 2.87 (1.17-17.08).

CONCLUSION

The uptake of COVID-19 vaccines was moderate in this population. Moreover, the results showed that the COM-B model is useful in predicting COVID-19 vaccine uptake. The findings of this study could be used to aid future public health interventions in any event of outbreaks similar to COVID-19 disease in Thailand and beyond.

Global COVID-19 vaccine acceptance level and its determinants: an umbrella review

BACKGROUND

The COVID-19 vaccination is essential for reducing disease burden on a worldwide scale. The success of this strategy will largely depend on how well vaccines are received. Previous reviews had produced contradictory results, and there had been no umbrella review. Therefore, the objective of this umbrella review was to combine the contradictory data regarding the COVID-19 vaccination's global acceptance rate and its contributing factors.

METHODS

Using PRISMA guideline, PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus and Google Scholar which reported COVID-19 vaccine acceptance and/or its determinants were searched. The quality of the included studies was assessed using Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias and sensitivity analysis were also assessed.

RESULT

Twenty-two SRM with 10,433,306 study participants were included. The pooled COVID-19 vaccine acceptance rate globally is found to be 60.23 (95% CI: 58.27, 62.18). In low-income countries, the pooled level of COVID-19 vaccine acceptance was found to be 54.07(50.31, 57.83) while this magnitude is 64.32 (62.24,66.40) among studies across the globe. Higher level of education (AOR =1.96; 95% CI:1.20, 2.73), good level of knowledge (2.20; 95% CI:1.36, 3.03), favourable attitude (AOR =4.50; 95% CI:2.89, 6.12), previous history of COVID-19 infection (AOR =3.41; 95% CI:1.77, 5.06), male sex (AOR =1.62; 95% CI:1.47, 1.77), and chronic disease (AOR =1.54; 95% CI:1.18, 1.90) were predictors of COVID-19 vaccine acceptance.

CONCLUSION

The pooled level of COVID-19 vaccine acceptance highly varied and found to be unacceptably low particularly in low-income countries. Higher level of education, good level of knowledge, favourable attitude, previous history of COVID-19, male sex, and chronic disease were factors of COVID-19 vaccine acceptance rate. A collaborative effort of stakeholders such as policymakers, and vaccine campaign program planners is needed to improve the acceptance rate of COVID-19 vaccine.

Sex differences in the relationship between post-vaccination adverse reactions, decision regret, and WTP for the booster dose of COVID-19 vaccine in Taizhou, China

This study investigated sex differences in the relationship between post-vaccination adverse reactions, decision regret, and willingness to pay (WTP) for the booster dose of COVID-19 vaccines. This research carried out an online cross-sectional investigation among healthcare workers (HCWs) in Taizhou, China. In total, 1,054 respondents (165 males and 889 females) have received two-dose COVID-19 vaccination. We performed descriptive analysis, chi-square test, and mediation analysis on the exported data. In this study, 67 (40.6%) males and 429 (48.3%) females had WTP for the booster dose. Our study presented that decision regret mediated the effect of adverse reactions after vaccination on WTP for the booster dose in both male and female groups. In males, decision regret played a completely mediating role, while in females, it acted as a partial mediator. Sex differences in the relationship between post-vaccination side effects, decision regret, and WTP for the third dose were demonstrated in a sample of healthcare workers.

A Case of Intractable Hypophosphatemia in a Patient with Guillain-Barré Syndrome and Encephalitis after SARS-CoV-2 Infection

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection attacks the respiratory and nervous systems. Among patients with SARS-CoV-2 infection, cases with simultaneous central and peripheral nervous system damage are rare, and those with intractable hypophosphatemia and hypokalemia complicating the former have not been reported yet.

CASE PRESENTATION

A 59-year-old woman presented to the emergency department with incoherent speech evolving for 3 days. She had tested positive for the SARS-CoV-2 RT-PCR assay 8 days earlier. Her physical examination showed progressive limb weakness with diminished tendon reflexes and normal sensory examination. Cranial MRI revealed multiple abnormal signals in the brain. Cerebrospinal fluid (CSF) analysis and electromyography revealed acute motor axonal neuropathy (AMAN), further diagnosed as encephalitis combined with Guillain.Barré syndrome (GBS). The patient received glucocorticoid therapy, intravenous immune globulin (IVIG), and rehabilitation therapy. The patient experienced an intractable hypophosphatemia and hypokalemia during the treatment period, which was not effectively corrected several times. The symptoms improved after 1 month of treatment.

CONCLUSION

Early diagnosis is important for the management of Guillain-Barré syndrome associated with SARS-CoV-2 infection. Moreover, in order to prevent life-threatening long-term persistent electrolyte disturbances in non-seriously ill patients, clinicians should pay particular attention to their electrolyte status.

Quantitative Synthesis of Factors Associated with COVID-19 Vaccine Acceptance and Vaccine Hesitancy in 185 Countries

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.

COVID-19 vaccine hesitancy in Turkey: A systematic review and meta-analysis

This systematic review and meta-analysis aims to estimate the prevalence of coronavirus disease 2019 (COVID-19) vaccine hesitancy in Turkey, which can aid future health policies and strategies. A comprehensive search was conducted on various databases using keywords related to COVID-19 vaccine hesitancy in Turkey. Quality assessment was performed using Joanna Briggs Institute (JBI) checklist for prevalence studies. Data extraction was conducted. The random effect model (DerSimonian and Laird method) was used in pooled prevalence data analysis (95% confidence interval [CI]). A total of 1,072 articles were identified. After removing duplicates and excluding articles, 61 articles remained for bias assessment. Among these, 19 articles with low risk of bias were included in the review and meta-analysis. Total population included in the analysis was 15,164, vaccine hesitancy was 30.5% (95% Cl: 24.3-36.8%). Prevalence of the vaccine hesitancy was found to be 39.8% (95% Cl: 31.4-48.2%) in studies conducted before the initiation of vaccination, while in studies conducted after the commencement of vaccination, hesitancy was 20.4% (95% Cl: 12.9-28%). We suggest conducting high-quality studies in different populations to understand the level of vaccine hesitancy, as many of the previous studies have mainly focused on healthcare workers and students, and rest were community-based studies, which have generally shown high bias. Also, we suggest that early vaccination can reduce vaccine hesitancy.

Assessment of attitudes and practices towards COVID-19 pandemic: a survey on a cohort of educated Syrian population

BACKGROUND

Coronavirus disease (COVID-19) caused the death of millions of people and affected the lives of hundreds of millions worldwide. The WHO recommendations aimed mainly to reduce transmission, minimize infection, and get people vaccinated. Nevertheless, opinions and attitudes about the disease varied. In this study, we evaluated personal attitudes and practices of a cohort of an educated Syrian population, after several waves of infection with COVID-19 and the release of different types of vaccines.

METHODS

A cross-sectional internet-based survey was launched in January 2022.The survey queried the participants' personal experience, attitudes, practices towards COVID-19, and vaccination.

RESULTS

The study included 408 individuals. The respondents were mainly females (72.6%), 20-29 years old (39.2%), and college graduates (59.3%). A large proportion (89.7%) reported having been infected at least once during the pandemic; a significant association was found with age (p = 0.001). Nearly half of the respondents got vaccinated; the majority were > 40 years old. Opinions differed regarding the effectiveness and safety of the vaccines; only a small percentage of the participants (17.4%) thought all vaccines were effective and safe. Remarkably, the level of education did not significantly dominate the participants' attitudes or practices towards the COVID-19 pandemic. Approximately half of the respondents (44.9%) stated their lives were affected by the pandemic and over the third were worried (38%). A significant association was detected with gender in favour of females. Most of the participants have taken at least one precautionary measure to limit the infection.

CONCLUSION

The level of education did not significantly dominate the participants' attitudes or practices towards the COVID-19 pandemic. Female respondents were more cautious, concerned and committed to taking precautionary measures regardless of their education level. However, their unwillingness to receive the vaccine raises significant concerns. Efforts should be made to emphasize the importance of immunization, the safety and effectiveness of vaccines, and encourage vaccination among individuals.

The pervasive association between political ideology and COVID-19 vaccine uptake in Brazil: an ecologic study

BACKGROUND

Despite the unequivocal benefits of vaccination, vaccine coverage has been falling in several countries in the past few years. Studies suggest that vaccine hesitancy is an increasingly significant phenomenon affecting adherence to vaccines. More recently, during the COVID-19 pandemic, political views have emerged as an additional influencing factor for vaccine hesitancy.

METHODS

In this ecologic study, we used information from publicly available databases to investigate the association between political ideology, depicted by the percentage of votes for the right-wing candidate Jair Bolsonaro in the presidential elections of 2018 and 2022, and COVID-19 vaccination in Brazilian municipalities. The primary endpoint was the COVID-19 vaccination index, calculated as the number of COVID-19 vaccine doses administered up to September 2022 divided by the number of inhabitants in each municipality. The analysis was conducted using Pearson correlation coefficients and linear regression models adjusted for HDI, the percentage of male voters, the percentage of voters who were older than 50 years old, and the percentage of voters with a middle school education or less. In addition, we explored whether the effect of the percentage of Bolsonaro voters on the COVID-19 vaccination index was modified in different quartiles of HDI using an interaction term.

RESULTS

Five thousand five hundred sixty-three Brazilian municipalities were included in the analysis. For both the 2018 and 2022 elections, the percentage of votes for Jair Bolsonaro was significantly and inversely associated with COVID-19 vaccine uptake after adjustment for the sociodemographic characteristics of the voters (change in mean vaccination index in 2018 for each 1% increase in Bolsonaro voters -0.11, 95% confidence interval [CI] -0.13 to -0.08, p < 0.001; change in mean vaccination index in 2022 for each 1% increase in Bolsonaro voters -0.09, 95% CI -0.11 to -0.07, p < 0.001). We also found a statistically significant interaction between the primary predictor of interest and HDI scores, with a more significantly detrimental effect of the right-wing political stance in municipalities in the lower HDI quartiles (interaction p < 0.001 for the first HDI quartile; p = 0.001 for the second HDI quartile).

CONCLUSION

Our findings suggest that political ideologies have influenced COVID-19 vaccine hesitancy in Brazilian municipalities, affecting communities inequitably. The politicization of vaccines is a new challenge for vaccine programs. Strategies to face these challenges should include joint efforts from governments and civil society for a common public health goal.

COVID-19 vaccine acceptance among people living with HIV: A systematic review and meta-analysis

OBJECTIVE

To assess coronavirus disease 2019 (COVID-19) vaccine acceptance among people living with HIV (PLHIV) worldwide.

METHODS

We searched MEDLINE, PSYINFO, CINHAL, Scopus and EMBASE databases and other sources including free Google search and subject-specific journals from January 2020 to September 2021. The study population included adults (aged 18+ years) living with HIV and evaluated for COVID-19 vaccine acceptance. A random effect meta-analysis model was used to estimate the pooled COVID-19 vaccine acceptance rate. Subgroup analyses were performed, and factors associated with COVID-19 vaccine hesitancy underwent narrative analysis. Of 558 initial records, 14 studies were eligible for review.

RESULTS

The overall pooled COVID-19 vaccine acceptance rate among adult PLHIV was 62% (95% confidence interval [CI], 56%-69%). In subgroup analysis, the estimated pooled COVID-19 vaccine acceptance rate was higher in high-income countries: 63% (95% CI, 55%-70%) versus 62% (95% CI, 54%-71%) in low- and middle-income countries, and in studies conducted in 2022 (66% [95% CI, 58%-75%]) than in studies conducted in 2021 (57% [95% CI, 47%-68%]). Reasons for lower COVID-19 vaccine acceptance included higher monthly income, being non-homosexual, history of chronic disease, COVID-19-related medical mistrust, not knowing anyone who died of COVID-19, believing oneself to be immune to COVID-19, general vaccine refusal, negative attitude to the vaccine, concerns about efficacy, safety and side effects, distrust in common sources of vaccine-related information and using social media as a source of information on COVID-19.

CONCLUSION

Among PLHIV, acceptance of COVID-19 vaccine is generally low. A greater emphasis on collaborative efforts between all concerned bodies is needed to boost vaccine acceptance in this population.

Exploring Determinants of COVID-19 Vaccine Acceptance, Uptake, and Hesitancy in the Pediatric Population: A Study of Parents and Caregivers in Saudi Arabia during the Initial Vaccination Phase

OBJECTIVES

This study aims to assess COVID-19 vaccine acceptance, uptake, and hesitancy among parents and caregivers of children in Saudi Arabia during the initial rollout of pediatric COVID-19 vaccination.

METHODS

An electronic survey was used to collect data from participants who visited a COVID-19 vaccine center. The survey included demographic data, COVID-19 vaccine status among participants and their children, and reasons for vaccine acceptance or rejection. The Vaccine Hesitancy Scale (VHS) tool was also employed to assess vaccine hesitancy and attitudes toward the COVID-19 vaccine and routine childhood vaccination. Multivariate binary regression analysis was used to identify predictors of actual COVID-19 vaccine uptake among children.

RESULTS

Of the 873 respondents included in the analysis, 61.5% were parents and 38.5% were other caregivers. Of the participants, 96.9% had received the COVID-19 vaccine. Six hundred and ninety-four participants accepted the vaccine for their children, with the main reasons being an endorsement by the Saudi Ministry of Health (60%) and the importance of going back to school (55%). One hundred and seventy-nine participants would not vaccinate their children, with the most common reasons being fear of adverse effects (49%) and inadequate data about vaccine safety (48%). Factors such as age, COVID-19 vaccination status, self-rated family commitment level, attitudes toward routine children's vaccines, and participants' generalized anxiety disorder (GAD7) score did not significantly correlate with children's COVID-19 vaccination status. Parents were less likely to vaccinate their children compared to other caregivers, and participants with a higher socioeconomic status were more likely to vaccinate their children.

CONCLUSION

Vaccine acceptance and uptake were high during the initial pediatric COVID-19 vaccination rollout in Saudi Arabia. Still, the ongoing endorsement of the Ministry of Health and healthcare authorities should continue to advocate for better vaccine uptake in children.