Comparisons of Vaccine Hesitancy across Five Low- and Middle-Income Countries
Open accessAbstract
Vaccine hesitancy is a continuum of behaviors ranging from delay in receipt to vaccination refusal. Prior studies have typically focused on high-income countries, where vaccine hesitancy is particularly prevalent in more affluent groups, but the relationship between socioeconomic status and vaccine hesitancy in Low- and Middle-Income Countries (LMICs) is less clear. The aim of this study was to describe vaccine hesitancy in five LMICs. Mothers of children in Sirajganj, Bangladesh (n = 60), Shanghai, China (n = 788), Addis Ababa, Ethiopia (n = 341), Guatemala City and Quetzaltenango, Guatemala (n = 767), and Chandigarh, India (n = 309), completed a survey between 2016 and 2018 using the WHO’s 10-item Vaccine Hesitancy Scale. The scores of different constructs were compared across countries and by the mother’s education level using linear regression models with generalized estimating equations. Compared to mothers in China, mothers in Bangladesh perceived less vaccination benefit (β: 0.56, P = 0.0001), however, mothers in Ethiopia (β: −0.54, P < 0.0001) and Guatemala (β: −0.74, P = 0.0004) perceived greater benefit. Education level was not significantly linked with vaccine hesitancy. Local circumstances are important to consider when developing programs to promote vaccines. We did not find consistent associations between education and vaccine hesitancy. More research is needed to understand socio-cultural influences on vaccine decision-making.
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Earlier studies revealed regional variability in perceiving the safety and effectiveness of vaccination.
“Earlier studies that assessed attitudes towards vaccines revealed the existence of regional variability in perceiving the safety and effectiveness of vaccination [12,26,27].”
From COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates (2021) · cites this paper as [12]
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- Authors
- Wagner, A. L., Masters, N. B., Domek, G. J., Mathew, J. L., Sun, X., Asturias, E. J., Ren, J., Huang, Z., Contreras-Roldan, I. L., Gebremeskel, B., & Boulton, M. L.
- Affiliations
- University of Michigan (US)
- Colorado School of Public Health (US)
- Post Graduate Institute of Medical Education and Research (IN)
- Shanghai Municipal Center For Disease Control Prevention (CN)
- Universidad del Valle de Guatemala (GT)
- Corresponding author
- Wagner, Abram L.
- ORCID
- Venue
- Vaccines
- Publisher
- MDPI AG
- Published
- 2019-10-18
- Volume
- 7
- Issue
- 4
- Pages
- 155
- ISSN
- 2076-393X (ISSN-L)
- PMC
- PMC6963484
- OpenAlex
- W2981225989
- Cited by
- 180
- References
- 38
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 31 · 2023: 30 · 2022: 46 · 2021: 42 · 2020: 11 · 2019: 1
- FWCI
- 24.38
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Vaccines (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute of Allergy and Infectious Diseases (K01AI137123)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (1R21HD084115-01)
- Office of Global Public Health, School of Public Health, University of Michigan (N/A)
- Pharmaceutical Research and Manufacturers of America Foundation (N/A)
- MCubed, University of Michigan (N/A)
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Emergency Medicine › Intramuscular injections and effects
- Keywords
- vaccine hesitancy, low- and middle-income countries, maternal education, socioeconomic status, perceived benefits of vaccination, vaccine refusal, cross-national comparison, vaccine decision-making, childhood immunization
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