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Cited by 2,128Vaccine Coverage and HesitancySARS-CoV-2 and COVID-19 ResearchCOVID-19 and Mental Health

COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates

Open access
Sallam, Malik·2021·Vaccines
DOI 10.3390/vaccines9020160PMC PMC7920465

Published version of a preprint

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Abstract

Utility of vaccine campaigns to control coronavirus 2019 disease (COVID-19) is not merely dependent on vaccine efficacy and safety. Vaccine acceptance among the general public and healthcare workers appears to have a decisive role in the successful control of the pandemic. The aim of this review was to provide an up-to-date assessment of COVID-19 vaccination acceptance rates worldwide. A systematic search of the peer-reviewed English survey literature indexed in PubMed was done on 25 December 2020. Results from 31 peer-reviewed published studies met the inclusion criteria and formed the basis for the final COVID-19 vaccine acceptance estimates. Survey studies on COVID-19 vaccine acceptance rates were found from 33 different countries. Among adults representing the general public, the highest COVID-19 vaccine acceptance rates were found in Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%) and China (91.3%). However, the lowest COVID-19 vaccine acceptance rates were found in Kuwait (23.6%), Jordan (28.4%), Italy (53.7), Russia (54.9%), Poland (56.3%), US (56.9%), and France (58.9%). Only eight surveys among healthcare workers (doctors and nurses) were found, with vaccine acceptance rates ranging from 27.7% in the Democratic Republic of the Congo to 78.1% in Israel. In the majority of survey studies among the general public stratified per country (29/47, 62%), the acceptance of COVID-19 vaccination showed a level of ≥70%. Low rates of COVID-19 vaccine acceptance were reported in the Middle East, Russia, Africa and several European countries. This could represent a major problem in the global efforts to control the current COVID-19 pandemic. More studies are recommended to address the scope of COVID-19 vaccine hesitancy. Such studies are particularly needed in the Middle East and North Africa, Sub-Saharan Africa, Eastern Europe, Central Asia, Middle and South America. Addressing the scope of COVID-19 vaccine hesitancy in various countries is recommended as an initial step for building trust in COVID-19 vaccination efforts.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review of 31 peer-reviewed survey studies from 33 countries found wide global variation in COVID-19 vaccine acceptance, with high rates in Ecuador, Malaysia, Indonesia, and China and low rates in Kuwait, Jordan, and several European countries. It concludes that vaccine hesitancy could be a major hindrance to pandemic control and recommends more studies in under-covered regions.

Key findings

  • Among the general public, the highest COVID-19 vaccine acceptance rates were in Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%), and China (91.3%); the lowest were in Kuwait (23.6%), Jordan (28.4%), Italy (53.7%), Russia (54.9%), Poland (56.3%), the US (56.9%), and France (58.9%).
  • Among eight healthcare-worker surveys, acceptance ranged from 27.7% in the Democratic Republic of the Congo to 78.1% in Israel; three surveys reported rates below 60%.
  • Stratified per country, 29/47 (62%) general-public surveys reported acceptance ≥70%; the review analyzed 60 surveys total: 47 among the general public, 8 among healthcare workers, 3 among parents/guardians, and 2 among university students.
  • Male sex was associated with significantly higher COVID-19 vaccine acceptance in 15 countries/studies, while age was a significant factor in 11 studies/countries.

Methods

  • PRISMA-guided systematic search of PubMed/Medline as of 25 December 2020 for English peer-reviewed survey studies evaluating COVID-19 vaccine acceptance/hesitancy; 178 records were identified, 30 articles were included, and one additional Jordan/Kuwait article was added, yielding 31 studies from 33 countries.
  • Data extracted included survey date, country/countries, target population, total respondents, and COVID-19 vaccine acceptance rate, defined as respondents answering agree/somewhat/completely agree/leaning towards yes/definitely yes.
  • Findings were synthesized descriptively, with acceptance rates stratified by country and target population.

Limitations

  • The paper states that reliance on PubMed alone may have missed relevant studies, citing the example of Head et al.; included studies were cross-sectional with different sampling strategies, so results are snapshots and cannot predict future changes in acceptance.
  • The paper states that studies used different approaches to express willingness to accept COVID-19 vaccines (e.g., binary yes/no vs. Likert-type scales), which should be considered when comparing acceptance rates.
  • Evident from the text: the review added one recently published Jordan/Kuwait article outside the systematic search, and it reports a descriptive synthesis rather than a formal meta-analysis or quality appraisal.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/vaccines9020160

Cites

107 of 107 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 18 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In the majority of survey studies among the general public stratified per country (29/47, 62%), the acceptance of COVID-19 vaccination showed a level of ≥70%.

    “In the majority of survey studies among the general public stratified per country (29/47, 62%), the acceptance of COVID-19 vaccination showed a level of ≥70%.”
    Quote in the paperSubstantial claim
  • Findingown data

    Survey studies on COVID-19 vaccine acceptance were found from 33 different countries.

    “Survey studies on COVID-19 vaccine acceptance rates were found from 33 different countries.”
    • Also stated in: § 3.1. Characteristics of the Papers Included in This Review · plain
      “These studies comprised surveys on COVID-19 vaccine acceptance from a total of 33 different countries.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Low rates of COVID-19 vaccine acceptance were reported in the Middle East, Russia, Africa and several European countries.

    “Low rates of COVID-19 vaccine acceptance were reported in the Middle East, Russia, Africa and several European countries.”
    • Also stated in: § 5. Conclusions · plain
      “Low COVID-19 vaccine acceptance rates were more pronounced in the Middle East, Eastern Europe and Russia.”
    Quote in the paperSubstantial claim
  • Findingown data

    A total of 31 studies (30 published papers plus one additional article on Jordan and Kuwait) met inclusion criteria and formed the basis for the final COVID-19 vaccine acceptance estimates.

    “Results from 31 peer-reviewed published studies met the inclusion criteria and formed the basis for the final COVID-19 vaccine acceptance estimates.”
    • Also stated in: § 3.1. Characteristics of the Papers Included in This Review · plain
      “A total of 30 published papers were analysed in this review, with an additional recently published article that focused on COVID-19 vaccine acceptance in Jordan and Kuwait to yield a total of 31 studies.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [45] Sallam, M., Dababseh, D., Eid, H., Al-Mahzoum, K., Al-Haidar, A., Taim, D., Yaseen, A., Ababneh, N.A., Bakri, F.G., and Mahafzah, A. (2021). High rates of COVID-19 vaccine hesitancy and its association with conspiracy beliefs: A study in Jordan and Kuwait among other Arab countries. Vaccines, 9. source

      Not checked in the free run.

  • Findingown data

    Among adults representing the general public, the highest COVID-19 vaccine acceptance rates were found in Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%), and China (91.3%).

    “Among adults representing the general public, the highest COVID-19 vaccine acceptance rates were found in Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%) and China (91.3%).”
    • Also stated in: § 3.2. Rates of COVID-19 Vaccine Acceptance · plain
      “Classified per study, the highest vaccine acceptance rates (>90%) among the general public were found in four studies from Ecuador (97.0%), Malaysia (94.3%), Indonesia (93.3%) and China (91.3%).”
    Quote in the paperSubstantial claim
  • May combine two claims. 11
  • Classified as probably not a substantial claim. 4

  • May combine two claims.

    Findingown data

    Among healthcare workers, only eight surveys were found, with vaccine acceptance rates ranging from 27.7% in the Democratic Republic of the Congo to 78.1% in Israel.

    “Only eight surveys among healthcare workers (doctors and nurses) were found, with vaccine acceptance rates ranging from 27.7% in the Democratic Republic of the Congo to 78.1% in Israel.”
    • Also stated in: § 3.2. Rates of COVID-19 Vaccine Acceptance · plain
      “For the eight studies conducted on healthcare workers, three surveys reported vaccine acceptance rates below 60%, with the highest rate being among doctors in Israel (78.1%) and the lowest vaccine acceptance rate (27.7%) reported among healthcare workers in the Democratic Republic of the Congo (DRC).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among the general public, the lowest COVID-19 vaccine acceptance rates were found in Kuwait (23.6%), Jordan (28.4%), Italy (53.7%), Russia (54.9%), Poland (56.3%), US (56.9%), and France (58.9%).

    “However, the lowest COVID-19 vaccine acceptance rates were found in Kuwait (23.6%), Jordan (28.4%), Italy (53.7), Russia (54.9%), Poland (56.3%), US (56.9%), and France (58.9%).”
    • Also stated in: § 3.2. Rates of COVID-19 Vaccine Acceptance · plain
      “On the contrary, the lowest vaccine acceptance rates (<60%) among the general public were found in seven studies to be from Kuwait (23.6%), Jordan (28.4%), Italy (53.7), Russia (54.9%), Poland (56.3%), US (56.9%), and France (58.9%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In Israel, the highest COVID-19 vaccine acceptance rate was 75.0%, but this rate was much lower among nurses surveyed in the same study (61.1%).

    “However, the highest vaccine acceptance rate was reported in Israel (75.0%); however, this rate was much lower among nurses surveyed in the same study (61.1%) [53].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Dror, 2020, Vaccine hesitancy: The next challenge in the fight against COVID-19, Eur. J. Epidemiol. source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    In France, COVID-19 vaccine acceptance rate ranged from 62.0% to 77.1% in March/April and was 58.9% in June.

    “In France, the vaccine acceptance rate ranged from 62.0% to 77.1% in March/April and was 58.9% in June.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    In the UK, COVID-19 vaccine acceptance rates over time were 79.0% in April, 83.0% in May, 71.5% in June, 64.0% in July, and 71.7% in September/October.

    “In the UK, the vaccine acceptance rate was 79.0% in April, 83.0% in May, 71.5% in June, 64.0% in July and 71.7% in September/October.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In the Middle East, the acceptance rate was lowest in Kuwait (23.6%), followed by Jordan (28.4%), Saudi Arabia (64.7%), and Turkey (66.0%).

    “The acceptance rate was the lowest in Kuwait (23.6%), followed by Jordan (28.4%), Saudi Arabia (64.7%) and Turkey (66.0%) [45,62,75].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [45] Sallam, M., Dababseh, D., Eid, H., Al-Mahzoum, K., Al-Haidar, A., Taim, D., Yaseen, A., Ababneh, N.A., Bakri, F.G., and Mahafzah, A. (2021). High rates of COVID-19 vaccine hesitancy and its association with conspiracy beliefs: A study in Jordan and Kuwait among other Arab countries. Vaccines, 9. source

      Not checked in the free run.

    • cites [62] Salali, G.D., and Uysal, M.S. (2020). COVID-19 vaccine hesitancy is associated with beliefs on the origin of the novel coronavirus in the UK and Turkey. Psychol. Med., 1–3. source

      Not checked in the free run.

    • cites [75] Padhi, 2020, Determinants of COVID-19 Vaccine Acceptance in Saudi Arabia: A Web-Based National Survey, J. Multidiscip. Healthc. source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    In the US, COVID-19 vaccine acceptance rate was 56.9% in April, ranged from 67.0% to 75.0% in May, and reached 75.4% in June.

    “For the vaccine acceptance rates in the US, it was 56.9% in April, and ranged from 67.0% to 75.0% in May, and reached 75.4% in June.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    In Italy, COVID-19 vaccine acceptance rate was 77.3% in April, 70.8% in June, and 53.7% in September.

    “In Italy, the vaccine acceptance rate was 77.3% in April, 70.8% in June and it reached 53.7% in September.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    This review was conducted following the PRISMA guidelines.

    “This review was conducted following the PRISMA guidelines [44].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., and Group, P. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med., 6. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The review included only peer-reviewed published articles indexed in PubMed, survey studies among general population, healthcare workers, students, or parents/guardians, whose major aim was to evaluate COVID-19 vaccine acceptance/hesitancy, and published in English.

    “The inclusion criteria were: (1) peer-reviewed published articles indexed in PubMed; (2) survey studies among the general population, health-care workers, students, or parents/guardians); (3) the major aim of the study was to evaluate COVID-19 vaccine acceptance/hesitancy; and (4) publication language was English.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    High COVID-19 vaccine acceptance rates in East and South East Asia would help to achieve proper control of the pandemic.

    “High acceptance rates in East and South East Asia would help to achieve proper control of the pandemic.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    A sizable number of studies reported COVID-19 acceptance rates below 60%, which would pose a serious problem for efforts to control the current COVID-19 pandemic.

    “A sizable number of studies reported COVID-19 acceptance rates below 60%, which would pose a serious problem for efforts to control the current COVID-19 pandemic.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The included studies were cross-sectional, representing snapshots of vaccine hesitancy status in each country/region, with different sampling strategies, which may partly explain differences in vaccine acceptance rates reported in various studies from a single country.

    “In addition, the research studies included in this review represented cross-sectional studies, which can be seen as snapshots of vaccine hesitancy status in each country/region, with different sampling strategies, which may partly explain the differences in vaccine acceptance rates reported in various studies from a single country.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The relatively high rates of COVID-19 vaccine acceptance might be related to stronger confidence in vaccine safety and effectiveness, as reported previously in Asia.

    “The relatively high rates of COVID-19 vaccine acceptance might be related to stronger confidence in vaccine safety and effectiveness, as reported previously in Asia [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Larson, 2016, The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey, EBioMedicine source

      Not checked in the free run.

14 of 14

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Current US acceptance rates of 56-75% may be insufficient to reach at least 80-90% coverage, the threshold thought necessary for herd immunity against SARS-CoV-2.

    “current acceptance rates of 56–75%245 may be insufficient to reach at least 80–90% coverage246, the threshold thought to be necessary for herd immunity against SARS-CoV-2.”

    From mRNA vaccines for infectious diseases: principles, delivery and clinical translation (2021) · cites this paper as [245]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting vaccine acceptance rates for Maltese university students

    Major

    The Results section reports 57.3% acceptance among Maltese university students, excluding staff, while the Discussion reports 44.2% among students in Malta. The text does not explain the different figures.

1 of 1

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Related

Authors
Sallam, M.
Affiliations
University of Jordan (JO)
Corresponding author
Sallam, Malik
ORCID
Sallam, Malik
Venue
Vaccines
Publisher
MDPI AG
Published
2021-02-16
Volume
9
Issue
2
Pages
160
ISSN
2076-393X (ISSN-L)
DOI
10.3390/vaccines9020160
PMC
PMC7920465
OpenAlex
W3132264034
Semantic Scholar
5fdd594a2c5c5e845a8a3dfaca7f554d2d4ec788
Cited by
2,128
References
101
Citations by year
2026: 82 · 2025: 146 · 2024: 270 · 2023: 505 · 2022: 710 · 2021: 410 · 2020: 2
FWCI
51.35
Type
journal article
Language
en
Open access
Licence
Locations
  • Vaccines (publishedVersion, cc-by)
  • medRxiv (acceptedVersion, cc-by-nc-nd)
  • Preprints.org (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • SUNScholar (Stellenbosch University) (submittedVersion)
Topics
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Keywords
COVID-19 vaccine hesitancy, COVID-19 vaccination, healthcare workers, public trust in vaccination, cross-national comparison

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